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Martinho B, Ferreira L, Koch MJ, Madeira F, Santos E, Baptista S, Alexandrino H. Observational Study About the Impact of Simulation Training of Non-Technical Skills on Teamwork: Towards a Paradigm Shift in Undergraduate Medical Training. ACTA MEDICA PORT 2024; 37:83-89. [PMID: 36972551 DOI: 10.20344/amp.19021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/02/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Recently, simulation as an educational method has gained increasing importance in Medicine. However, medical education has favored the acquisition of individual knowledge and skills, while overlooking the development of teamwork skills. Since most errors in clinical practice are due to human factors, i.e., non-technical skills, the aim of this study was to assess the impact that training in a simulation environment has on teamwork in an undergraduate setting. MATERIAL AND METHODS This study took place in a simulation center, with a study population of 23 participants, fifth year undergraduate students, randomly divided into teams of four elements. Twenty simulated scenarios of teamwork in the initial assessment and resuscitation of critically ill trauma patients were recorded. Video recordings were made at three distinct learning moments (before training, end of the semester, and six months after the last training), and a blinded evaluation was performed by two independent observers, who applied the Trauma Team Performance Observation Tool (TPOT). Additionally, the Team STEPPS Teamwork Attitudes Questionnaire (T-TAQ) was applied to the study population before and after the training to assess any change in individual attitudes towards non-technical skills. A 5% (or 0.05) significance level was considered for statistical analysis. RESULTS With a moderate level of inter-observer agreement (Kappa = 0.52, p = 0.002), there was a statistically significant improvement in the team's overall approach, evidenced by the TPOT scores (median of 4.23, 4.35 and 4.50, in the three time-points assessed, respectively, p = 0.003). In the T-TAQ, there was an improvement in non-technical skills, that was statistically significant for "Mutual Support" (median from 2.50 to 3.00, p = 0.010). CONCLUSION In this study, incorporating non-technical skills education and training in undergraduate medical education was associated with sustained improvement in team performance in the approach to the simulated trauma patient. Consideration should be given to introducing non-technical skills training and teamwork in the emergency setting during undergraduate training.
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Affiliation(s)
| | - Luís Ferreira
- Faculty of Medicine. Universidade de Coimbra; Department of Surgery. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Maria João Koch
- Department of Anesthesiology. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. Portugal
| | - Filipa Madeira
- Department of Surgery. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. Portugal
| | - Eva Santos
- Department of Surgery. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. Portugal
| | - Sérgio Baptista
- Department of Anesthesiology. Centro Hospitalar Médio Tejo. Tomar. Portugal. Portugal
| | - Henrique Alexandrino
- Faculty of Medicine. Universidade de Coimbra; Department of Surgery. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Nadir N, Winfield A, Bentley S, Hock SM, Backster A, Bradby C, Rotoli J, Jones N, Falk M. Simulation for diversity, equity and inclusion in emergency medicine residency training: A qualitative study. AEM EDUCATION AND TRAINING 2023; 7:S78-S87. [PMID: 37383838 PMCID: PMC10294220 DOI: 10.1002/aet2.10870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 06/30/2023]
Abstract
Background The last few years have seen an increased focus on diversity, equity, and inclusion (DEI) initiatives across organizations. Simulation has been used in varying degrees for teaching about DEI topics with emergency medicine; however, there are no established best practices or guidelines on this subject. To further examine the use of simulation for DEI teachings, the DEISIM work group was created as a collaboration between the Society of Academic Emergency Medicine (SAEM) Simulation Academy and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM). This study represents their findings. Method This qualitative study was conducted using a three-pronged approach. Initial literature search was conducted followed by a call for submission of simulation curricula. These were then followed by five focus groups. Focus groups were recorded, transcribed by a professional transcription service, and then subjected to thematic analysis. Results Data were analyzed and organized into four broad categories including Learners, Facilitators, Organizational/Leadership, and Technical Issues. Challenges within each of these were identified, as were potential solutions. Select pertinent findings included focused faculty development, a carefully planned approach that utilized DEI content experts and the use of simulation for workplace microaggressions or discriminations. Conclusions There appears to be a clear role for simulation in DEI teachings. Such curricula, however, should be undertaken with careful planning and input from appropriate and representative parties. More research is needed on optimizing and standardizing simulation-based DEI curricula.
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Affiliation(s)
- Nur‐Ain Nadir
- Department of Emergency MedicineKaiser Permanente Central ValleyModestoCaliforniaUSA
- Department of Clinical ScienceKaiser Permanente Bernard Tyson School of MedicinePasadenaCaliforniaUSA
| | | | - Suzanne Bentley
- Emergency Medicine and Medical EducationIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
- Emergency MedicineElmhurst Hospital CenterElmhurstNew YorkUSA
| | - Sara M. Hock
- Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | | | - Cassandra Bradby
- Emergency MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Jason Rotoli
- Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Nathaniel Jones
- The Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Michael Falk
- Pediatric Emergency MedicineChildren's National Medical CenterWashingtonDistrict of ColumbiaUSA
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Schouten AM, Flipse SM, van Nieuwenhuizen KE, Jansen FW, van der Eijk AC, van den Dobbelsteen JJ. Operating Room Performance Optimization Metrics: a Systematic Review. J Med Syst 2023; 47:19. [PMID: 36738376 PMCID: PMC9899172 DOI: 10.1007/s10916-023-01912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/26/2022] [Indexed: 02/05/2023]
Abstract
Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of 'optimization' has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.
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Affiliation(s)
- Anne M Schouten
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands.
| | - Steven M Flipse
- Science Education and Communication Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
| | - Kim E van Nieuwenhuizen
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Frank Willem Jansen
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Anne C van der Eijk
- Operation Room Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - John J van den Dobbelsteen
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
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Skov RAC, Lawaetz J, Konge L, Westerlin L, Aasvang EK, Meyhoff CS, Vogt K, Ohrlander T, Resch TA, Eiberg JP. Simulation-Based Education of Endovascular Scrub Nurses Reduces Stress and Improves Team Performance. J Surg Res 2022; 280:209-217. [PMID: 35994983 DOI: 10.1016/j.jss.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/08/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Endovascular procedures have become commonplace in vascular surgery. This development calls for new training strategies for future specialists. Most simulation-based education (SBE) programs have a monodisciplinary focus on physicians, although successful surgery is a multidisciplinary team effort. Mental stress impairs the learning process and surgical performance and heart rate variability (HRV) can be measured as a proxy for both mental and physical stress. This study aims to assess how SBE of endovascular scrub nurses affects team performance and HRV during endovascular aneurysm repair (EVAR). MATERIALS AND METHODS Prospective interventional study in which EVAR-inexperienced scrub nurses followed a focused SBE EVAR program. During real-life EVAR procedures, HRV was continuously recorded with a wireless electrocardiogram patch and multidisciplinary team performance was assessed with the Imperial College Error CAPture (ICECAP) tool, before and after the SBE program, allowing each scrub nurse to serve as their own control. Eight scrub nurses with experience in lower limb endovascular procedures, but not EVAR, were invited to participate. RESULTS Seven participants completed the study. In five of seven scrub nurses, HRV-derived stress levels during real-time EVAR procedures were lower after SBE compared to before SBE. Mean HRV increased from 24 msec to 35 msec (P < 0.001), indicating stress level reduction. Before SBE, the mean number of errors/hour was 7.3 (standard deviation ± 1.8) compared to 3.6 (standard deviation ± 2.7) after SBE. Most errors were categorized as technical (58 %) and communicative (23 %). CONCLUSIONS SBE of scrub nurses may improve team performance and may lower mental stress during EVAR procedures. In this small study, we suggest using mental stress, as evaluated with HRV, and multidisciplinary team performance, as evaluated with ICECAP, to assess SBE effectiveness in real-case EVAR procedures. This SBE program and live ICECAP observations and electrocardiogram patches was well-accepted by scrub nurses and the entire team.
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Affiliation(s)
- Rebecca Andrea Conradsen Skov
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark.
| | - Jonathan Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Lars Konge
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Lise Westerlin
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Eske Kvanner Aasvang
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Christian Sylvest Meyhoff
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Katja Vogt
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Tomas Ohrlander
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Timothy Andrew Resch
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jonas Peter Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
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Metersky ML, Eldridge N, Wang Y, Eckenrode S, Galusha D, Jaser L, Mathew J, Angus S, Nardino R. Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect? J Patient Saf 2022; 18:253-259. [PMID: 34387249 PMCID: PMC8831642 DOI: 10.1097/pts.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to determine whether patients in teaching hospitals are at higher risk of suffering from an adverse event during the summer trainee changeover period. METHODS We performed a retrospective analysis of data from the Medicare Patient Safety Monitoring System, a medical-record abstraction-based database in the United States. Hospital admissions from 2010 to 2017 for acute myocardial infarction, heart failure, pneumonia, or a major surgical procedure were studied. Admissions were divided into nonsurgical (acute myocardial infarction, heart failure, or pneumonia) and surgical. Adverse event rates in July/August were compared with the rest of the year. Hospitals were stratified into major teaching, minor teaching, or nonteaching. Results were adjusted for patient demographics, comorbidities, and hospital characteristics. Outcomes were the adjusted odds of having at least 1 adverse event in July/August versus the rest of the year. RESULTS We included 185,652 hospital admissions. The adjusted odds ratios (ORs) of suffering from at least one adverse event in a major teaching hospital in July/August was 0.83 (95% confidence interval [CI], 0.69-0.98) for nonsurgical patients and 1.09 (95% CI, 0.84-1.40) for surgical patients. In minor teaching hospitals, the adjusted ORs were 0.96 (95% CI, 0.88-1.04) for nonsurgical patients and 0.99 (95% CI, 0.87-1.12) for surgical patients. In nonteaching hospitals, the adjusted ORs were 0.98 (95% CI, 0.91-1.06) for nonsurgical patients and 1.10 (95% CI, 0.96-1.24) for surgical patients. CONCLUSIONS Patients admitted to teaching hospitals in July/August are not at increased risk of adverse events. These findings should reassure patients and medical educators that patients are not excessively endangered by admission to the hospital during these months.
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Affiliation(s)
| | - Noel Eldridge
- Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD
| | | | - Sheila Eckenrode
- From the Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven
| | - Deron Galusha
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven
| | | | - Jasie Mathew
- From the Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven
| | - Steven Angus
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - Robert Nardino
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
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