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Seelandt JC, Schneider J, Kolbe M, Grande B. Effective debriefings in the clinical setting: a pilot study to test the impact of an evidence based debriefing app on anesthesia care providers' performance. Front Med (Lausanne) 2024; 11:1427061. [PMID: 39131087 PMCID: PMC11310000 DOI: 10.3389/fmed.2024.1427061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024] Open
Abstract
Background Debriefing enhances team learning, performance, and patient safety. Despite its benefits, it's underused. To address this, we developed an evidence-based debriefing app. Methods This pilot study, conducted at a Swiss hospital, evaluated team performance during two anesthesia inductions using the Team Performance Scale (TPS). Following the first induction, teams engaged with the Zurich Debriefing App, with debriefing sessions meticulously recorded for subsequent evaluation. To mitigate bias, raters underwent comprehensive TPS training. The debriefings were analyzed through the DE-CODE framework. We utilized paired t-tests to examine performance improvements and linear regressions to assess the impact of reflective statements on performance, moderated by psychological safety. Results Team performance significantly improved from the first to the second induction (t (9) = -2.512, p = 0.033). Senior physicians' (n = 8) reflective statements predicted post-assessment TPS scores (R 2 = 0.732, p = 0.061), while consultants (n = 7) and nurse anesthetists (n = 10) did not. Interaction analysis revealed no moderation effects, but a main effect indicated the significance of senior physicians' reflective statements. Conclusion This pilot study confirms the efficacy of the evidence-based debriefing app in enhancing anesthesia team performance. Senior physicians' reflective statements positively influenced performance; however, no moderation effects were observed. The study highlights the potential of debriefing apps to streamline and enhance team debriefing processes, with significant implications for improving clinical practice and patient safety. Further research is needed to validate these findings on a larger scale and optimize the integration of debriefing into routine clinical practice.
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Affiliation(s)
- Julia C Seelandt
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Jeannine Schneider
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
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Bochatay N, Ju M, O'Brien BC, van Schaik SM. A Scoping Review of Interprofessional Simulation-Based Team Training Programs. Simul Healthc 2024:01266021-990000000-00117. [PMID: 38526045 DOI: 10.1097/sih.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
SUMMARY STATEMENT Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.
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Affiliation(s)
- Naike Bochatay
- From the University of California San Francisco, San Francisco, CA
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Krielen P, Meeuwsen M, Tan ECTH, Schieving JH, Ruijs AJEM, Scherpbier ND. Interprofessional simulation of acute care for nursing and medical students: interprofessional competencies and transfer to the workplace. BMC MEDICAL EDUCATION 2023; 23:105. [PMID: 36774481 PMCID: PMC9921059 DOI: 10.1186/s12909-023-04053-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Teamwork and communication are essential tools for doctors, nurses and other team members in the management of critically ill patients. Early interprofessional education during study, using acute care simulation, may improve teamwork and communication between interprofessional team members on the long run. METHODS A comparative sequential quantitative-qualitative study was used to understand interprofessional learning outcomes in nursing and medical students after simulation of acute care. Students were assigned to a uni- or interprofessional training. Questionnaires were used to measure short and long term differences in interprofessional collaboration and communication between the intervention and control group for nursing and medical students respectively. Semi-structured focus groups were conducted to gain a better understanding of IPE in acute simulation. RESULTS One hundred and ninety-one students participated in this study (131 medical, 60 nursing students). No differences were found between the intervention and control group in overall ICCAS scores for both medical and nursing students (p = 0.181 and p = 0.441). There were no differences in ICS scores between the intervention and control group. Focus groups revealed growing competence in interprofessional communication and collaboration for both medical and nursing students. CONCLUSIONS Interprofessional simulation training did show measurable growth of interprofessional competencies, but so did uniprofessional training. Both medical and nursing students reported increased awareness of perspective and expertise of own and other profession. Furthermore, they reported growing competence in interprofessional communication and collaboration in transfer to their workplace.
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Affiliation(s)
- Pepijn Krielen
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Malon Meeuwsen
- Department for Research in Learning and Education Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Nijmegen, The Netherlands
| | - Edward C T H Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jolanda H Schieving
- Department of Child Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annelies J E M Ruijs
- Department for Research in Learning and Education Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Nijmegen, The Netherlands
| | - Nynke D Scherpbier
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Ren DM, Abrams A, Banigan M, Batabyal R, Chamberlain JM, Garrow A, Izem R, Nicholson L, Ottolini M, Patterson M, Sarnacki R, Walsh HA, Zaveri P. Evaluation of Communication and Safety Behaviors During Hospital-Wide Code Response Simulation. Simul Healthc 2022; 17:e45-e50. [PMID: 33787552 DOI: 10.1097/sih.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION To understand the baseline quality of team communication behaviors at our organization, we implemented institution-wide simulation training and measured the performance of safety behaviors of ad hoc teams in emergent situations. METHODS Clinicians participated in 2 interprofessional video-recorded simulation scenarios, each followed by debriefing. Using a standardized evaluation instrument, 2 reviewers independently evaluated the presence or absence of desired team safety behaviors, including escalating care, sharing a mental model, establishing leadership, thinking out loud, and identifying roles and responsibilities. We also scored the quality of sharing the mental model, closed-loop communication, and overall team performance on a 7-point scale. Discordant reviews were resolved with scoring by an additional reviewer. RESULTS A total of 1404 clinicians participated in 398 simulation scenarios, resulting in 257 usable videos. Overall, teams exhibited desired behaviors at the following frequencies: escalating care, 85%; sharing mental models, 66%; verbally establishing leadership, 6%; thinking out loud, 87%; and identifying roles and responsibilities, 27%. Across all reviews, the quality of the graded behaviors (of 7 points) was 2.8 for shared mental models, 3.3 for closed-loop communication, and 3.2 for overall team performance. CONCLUSIONS In a simulation setting with ad hoc teams, there was variable performance on completing safety behaviors and only a fair quality of graded communication behaviors. These results establish a baseline assessment of communication and teamwork behaviors and will guide future quality improvement interventions.
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Affiliation(s)
- Dennis M Ren
- From the Division of Emergency Medicine (D.M.R., R.B., J.M.C, P.Z.), Children's National Hospital, Washington, DC; Division of Emergency Medicine (A.A.), Children's Hospital Colorado, Aurora, CO; Department of Anesthesiology and Critical Care Medicine (M.B.), Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics (R.B., J.M.C., A.G., R.I., P.Z.), George Washington University School of Medicine and Health Sciences; Simulation Program (L.N., H.A.W.), Children's National Hospital; School of Nursing & Allied Health (A.G.), Liverpool John Moores University in Liverpool, England; Division of Biostatistics and Study Methodology (R.I.), Children's Research Institute, Children's National Hospital, Washington, DC; Department of Pediatrics (M.O.), Maine Medical Center, Portland, ME; Department of Emergency Medicine (M.P.), University of Florida College of Medicine; University of Florida Center for Experiential Learning and Simulation (M.P.), University of Florida College of Medicine, Gainesville, FL; and Global Health Initiative Children's National Hospital (R.S.), Washington, DC
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Data S, Dubé MM, Bajunirwe F, Kyakwera C, Robinson T, Najjuma JN, Cherop M, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, MacIntosh H, Cheng A. Feasibility of an Interprofessional, Simulation-Based Curriculum to Improve Teamwork Skills, Clinical Skills, and Knowledge of Undergraduate Medical and Nursing Students in Uganda: A Cohort Study. Simul Healthc 2021; 16:e100-e108. [PMID: 33337727 DOI: 10.1097/sih.0000000000000531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Many deaths in Sub-Saharan Africa are preventable with provision of skilled healthcare. Unfortunately, skills decay after training. We determined the feasibility of implementing an interprofessional (IP) simulation-based educational curriculum in Uganda and evaluated the possible impact of this curriculum on teamwork, clinical skills (CSs), and knowledge among undergraduate medical and nursing students. METHODS We conducted a prospective cohort study over 10 months. Students were divided into 4 cohorts based on clinical rotations and exposed to rotation-specific simulation scenarios at baseline, 1 month, and 10 months. We measured clinical teamwork scores (CTSs) at baseline and 10 months; CSs at baseline and 10 months, and knowledge scores (KSs) at baseline, 1 month, and 10 months. We used paired t tests to compare mean CTSs and KSs, as well as Wilcoxon rank sum test to compare group CS scores. RESULTS One hundred five students (21 teams) participated in standardized simulation scenarios. We successfully implemented the IP, simulation-based curriculum. Teamwork skills improved from baseline to 10 months when participants were exposed to: (a) similar scenario to baseline {baseline mean CTS = 55.9% [standard deviation (SD) = 14.4]; 10-month mean CTS = 88.6%; SD = 8.5, P = 0.001}, and (b) a different scenario to baseline [baseline mean CTS = 55.9% (SD = 14.4); 10-month CTS = 77.8% (SD = 20.1), P = 0.01]. All scenario-specific CS scores showed no improvement at 10 months compared with baseline. Knowledge was retained in all scenarios at 10 months. CONCLUSIONS An IP, simulation-based undergraduate curriculum is feasible to implement in a low-resource setting and may contribute to gains in knowledge and teamwork skills.
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Affiliation(s)
- Santorino Data
- From the Mbarara University of Science and Technology (S.D., F.B., C.K., N.N.J., C.M., L.A., T.N., M.T.), Mbarara, Uganda; KidSIM Simulation Program (M.D., T.R., I.W., A.C.), Alberta Children's Hospital; and Department of Pediatrics (J.L.B., N.S., I.W., A.C.), and Global Health and International Partnerships (H.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Rodríguez E, Chabrera C, Farrés M, Castillo J, Virumbrales M, Raurell M. Adaptation and validation of a Spanish version of the KidSIM Team Performance Scale. J Prof Nurs 2021; 37:795-803. [PMID: 34742507 DOI: 10.1016/j.profnurs.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interprofessional education offers students from different disciplines the opportunity to share learning experiences. PURPOSE To develop and validate a Spanish version of the KidSIM Team Performance Scale, thus providing a tool for assessing the team performance of undergraduate health professionals in our cultural context. METHOD Descriptive observational study consisting of two phases: a) translation and adaptation of the original instrument, b) validation of the Spanish version. RESULTS The Spanish version comprises 11 items and is linguistically and conceptually equivalent to the original scale. Factor analysis yielded a model comprising three factors: roles and leadership capacity, communication, and use of resources. Internal consistency was good (Cronbach's alpha = 0.85), while inter-observer agreement was moderate (Cohen's kappa = 0.58). The RMSEA fit index was acceptable (0.0801 [0.0618-0.115]). CONCLUSION The Spanish version of the KidSIM Team Performance Scale is a valid and reliable tool for assessing simulated teamwork among undergraduate health professionals.
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Affiliation(s)
- Encarna Rodríguez
- Department of Nursing, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carolina Chabrera
- Department of Nursing, Tecnocampus, Universitat Pompeu Fabra, Research group in Attention to Chronicity and Innovation in Health (GRACIS), Barcelona, Spain.
| | - Mariona Farrés
- Department of Nursing, Campus Docent Sant Joan de Déu, Barcelona, Spain
| | - Jordi Castillo
- Department of Nursing, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Montse Virumbrales
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Raurell
- Department of Nursing, Universitat de Barcelona, Barcelona, Spain
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Ginsberg JS, Hoffmann RL, Lebet R, Gonzalez JZ. Behavioral Crisis Management: A Quality Improvement Pilot for Improving Teamwork in a Primary Care Pediatric Setting. J Pediatr Nurs 2021; 59:151-157. [PMID: 33892295 DOI: 10.1016/j.pedn.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Children with behavioral escalations in the primary care office may pose safety risks to themselves and others. Interprofessional teams utilizing crisis resource management (CRM) skills more successfully manage behavioral crises. The purpose of this quality improvement (QI) pilot project was to improve team performance during a behavioral crisis in pediatric primary care, as well as evaluate learner satisfaction with the curriculum. METHOD We implemented an evidence-based curriculum using simulation and didactic techniques in primary care offices within a pediatric network. Using a one group pre-post design, we evaluated roles, communication, and patient-centered care with the KidSIM Team Performance Scale. Utilizing a post intervention survey, learner feedback was elicited regarding learning environment, facilitators and barriers to learning, skill of facilitator, and usability and applicability of content. FINDINGS 101 interprofessional participants attended one of eight educational sessions. KidSIM Team Performance Scale results demonstrated statistically significant improved total team performance in a simulated behavioral crisis (Z = -2.52, p = 0.012). Post simulation evaluation demonstrated positive feedback about the program, content and facilitators. DISCUSSION This pilot QI project demonstrated that a curriculum using behavioral simulation scenarios and CRM principles can improve teamwork in an interprofessional primary care office. Additionally, participants overwhelmingly indicated satisfaction with the curriculum. APPLICATION TO PRACTICE Ensuring staff have the appropriate skills to manage behavioral health crises facilitates safer and more effective patient care, enhances patient-centered care and solidifies a positive staff approach in the pediatric ambulatory setting.
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Affiliation(s)
- Julie S Ginsberg
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA; Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | | | - Ruth Lebet
- Center for Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Weingart SN, Coakley M, Yaghi O, Shayani A, Sweeney M. Teamwork Among Medicine House Staff During Work Rounds: Development of a Direct Observation Tool. J Patient Saf 2021; 17:e313-e320. [PMID: 30920432 DOI: 10.1097/pts.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Teamwork is integral to effective health care but difficult to evaluate. Few tools have been tested outside of classroom or medical simulation settings. Accordingly, we aimed to develop and pilot test an easy-to-use direct observation instrument for measuring teamwork among medical house staff. METHODS We performed direct observations of 18 inpatient medicine house staff teams at a teaching hospital using an instrument constructed from existing teamwork tools, expert panel review, and pilot testing. We examined differences across teams using the Kruskal-Wallis statistic. We examined interrater reliability with the κ statistic, domain scales using Cronbach α, and construct validity using correlation and multivariable regression analyses of quality and utilization metrics. Observers rated team performance before and after providing feedback to 12 of the 18 team leaders and assessed changes in team performance using paired two-tailed t tests. RESULTS We found variation in team performance in the situation monitoring, mutual support, and communication domains. The instrument evidenced good interrater reliability among concurrent, independent observers (κ = 0.7, P < 0.001). It had satisfactory face validity based on expert panel review and the assessments of resident team leaders. Construct validity was supported by a positive correlation between team performance and the Hospital Consumer Assessment of Healthcare Providers and Systems physician communication score (r = 0.6, P = 0.03). Providing resident physicians with information about their teams' performance was associated with improved mean performance in follow-up observations (3.6-3.8/4.0, P = 0.001). CONCLUSIONS Direct observation of teamwork behaviors by medicine house staff on ward rounds is feasible and feedback may improve performance.
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Affiliation(s)
- Saul N Weingart
- From the Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
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Phillips EC, Smith SE, Hamilton AL, Kerins J, Clarke B, Tallentire VR. Assessing Medical Students' Nontechnical Skills Using Immersive Simulation: What Are the Essential Components? Simul Healthc 2021; 16:98-104. [PMID: 32649588 DOI: 10.1097/sih.0000000000000463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Nontechnical skills (NTS) have been acknowledged to be important for medical students and can be linked to improved clinical performance. However, existing tools to evaluate these within a simulated setting address only a limited number of NTS. The Medical Students' Nontechnical Skills (Medi-StuNTS) behavioral marker system (BMS) outlines 5 categories of NTS for medical students. This study aimed to seek evidence for completeness and content validity to refine the BMS and to ascertain which NTS are essential for medical students. METHODS We asked 128 workshop participants if they felt there were any missing or irrelevant items in Medi-StuNTS system. A subject matter expert panel (n = 10) rated how essential they considered each item in the BMS. An Item-Content Validity Index was calculated for each skill element and the Scale-Content Validity Index was calculated as a measure of content validity of the full system. RESULTS Of the workshop participants, 78.9% felt that there were no missing items and 93% felt that there were no irrelevant items. Potentially missing items highlighted were as follows: "working in a hierarchy," "leadership," "awareness of the emotional state of other team members," and "nonverbal communication." Fourteen of 16 skill elements achieved the recommended level for content validity (Item-Content Validity Index ≥ 0.78), and the Scale-Content Validity Index was higher than the acceptable level (≥0.8). CONCLUSIONS Evidence for completeness and content validity of Medi-StuNTS has been demonstrated. There is a far wider range of NTS that seem to be essential for medical students than those assessed by tools developed before Medi-StuNTS. Medi-StuNTS provides comprehensive cover of the essential NTS required by medical students, with specific reference to the skill categories "self-awareness" and "escalating care," which do not feature in other tools for assessing NTS in this group.
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Affiliation(s)
- Emma C Phillips
- From the Scottish Centre for Simulation and Clinical Human Factors (E.C.P., V.R.T.), Larbert; The University of Edinburgh (E.C.P., S.E.S., V.R.T.); and NHS Lothian (A.L.H., J.K., V.R.T.), Edinburgh, United Kingdom
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Effectiveness of a training intervention to improve communication between/awareness of team roles: A randomized clinical trial. J Prof Nurs 2020; 37:479-487. [PMID: 33867108 DOI: 10.1016/j.profnurs.2020.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Interprofessional teamwork training of nursing undergraduates is essential to improving healthcare. The absence of clear role definitions and poor interprofessional communications have been listed as the main reasons behind abandonment of the profession by recently graduated nurses. PURPOSE The aim of this parallel randomized clinical trial was to evaluate the impact of Situation-Background-Assessment-Recommendation (SBAR) role-play training on interprofessional teamwork skills (role-related and communication-related) and non-technical skills (patient assessment, patient intervention, patient safety, and critical thinking). METHOD The intervention group were taught teamwork skills, role and task assignment skills, and use of the SBAR worksheet in a 1-hour role-play training session, while the control group received conventional lecture-based training. Teamwork and non-technical skills were then assessed in high-fidelity simulation scenarios using the KidSIM Team Performance Scale (teamwork skills) and the Clinical Simulation Evaluation Tool (non-technical skills). Cohen's d (d) was used to examine effect size differences. RESULTS Compared to the control group, the intervention group improved in 4 teamwork items - 'verbalize out loud' (p < 0.001, d = 0.99), 'paraphrase' (p < 0.001, d = 0.77), 'cross-monitoring' (p < 0.001, d = 0.72), and 'role clarity' (p = 0.002, d = 0.66) - and in a single non-technical skill (patient intervention: p = 0.004, d = 0.66), while also reporting greater confidence in performing patient assessments (p = 0.02, d = 0.56). CONCLUSIONS Role-play and SBAR training for undergraduate nurses improved patient intervention, enhanced information sharing in an interprofessional team, and raised awareness of their own and other team members' roles.
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Malcom DR, Pate AN, Rowe AS. Applying safety lessons from aviation to pre-licensure health professions education: A narrative critical review. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:1028-1035. [PMID: 32564990 DOI: 10.1016/j.cptl.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/22/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Significant numbers of patients continue to be harmed annually by healthcare systems in the United States (US) and around the world. Through a lens of safety, the fields of aviation and healthcare share many similarities in the non-technical skills required by team members, including situational awareness, communication, problem-solving, and leadership. Despite these links and evidence of effective interventions in the clinical setting, there is a lack of a guidance on how to incorporate non-technical skills training into pre-licensure health professions curricula. METHODS Following guidance for a narrative critical review, a comprehensive literature search was conducted looking for studies incorporating non-technical skills training including crew resource management (CRM) and human factors and ergonomics (HFE) into pre-licensure health professions curricula. RESULTS Eleven example articles were organized into three broad themes: (1) changing the teaching paradigm around errors, (2) targeted curricular interventions, and (3) interprofessional team training. Several useful tools for evaluating training effectiveness were highlighted, but consistent measures of efficacy for CRM/HFE training are lacking. Interprofessional team training may have the most tangible and broadly applicable link to pre-licensure curricula. IMPLICATIONS Additional research is needed to identify best practices for consistent incorporation of non-technical skills into pre-licensure curricula. A cultural shift to focus on error management (vs. solely error avoidance) is also needed early in training with development of a common language to discuss patient safety issues and opportunities for improvement across various healthcare settings.
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Affiliation(s)
- Daniel R Malcom
- Sullivan University College of Pharmacy and Health Sciences, 2100 Gardiner Ln, Louisville, KY 40205, United States.
| | - Adam N Pate
- University of Mississippi School of Pharmacy, Faser Hall 221, Oxford, MS 38677, United States.
| | - A Shaun Rowe
- University of Tennessee Health Science Center College of Pharmacy, 1924 Alcoa Hwy, Knoxville, TN 37920, United States.
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Oldland E, Botti M, Hutchinson AM, Redley B. A framework of nurses’ responsibilities for quality healthcare — Exploration of content validity. Collegian 2020. [DOI: 10.1016/j.colegn.2019.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wooding EL, Gale TC, Maynard V. Evaluation of teamwork assessment tools for interprofessional simulation: a systematic literature review. J Interprof Care 2019; 34:162-172. [PMID: 31552752 DOI: 10.1080/13561820.2019.1650730] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There is growing evidence supporting the use of simulation-based education to improve teamwork in the clinical environment, which results in improved patient outcomes. Interprofessional simulation improves awareness of professional roles and responsibilities, promotes teamwork and provides training in non-technical skills. Tools have been developed to assess the quality of teamwork during simulation, but the use of these tools should be supported by validity evidence in appropriate contexts. This study aims to assess the validity of teamwork tools used in simulation-based interprofessional training for healthcare workers and students, and to compare the design and reporting of these studies. Medline, EMBASE, ERIC, and CINAHL were searched using terms synonymous with simulation, crew resource management, training, assessment, interprofessional, and teamwork, from 2007-2017. Interprofessional healthcare simulation studies involving objectively rated teamwork training were included. The initial search provided 356 records for review, of which 24 were ultimately included. Three tools demonstrated good validity evidence underpinning their use. However, three studies did not explore tool psychometrics at all, and the quality of reporting amongst these studies on design and participant demographics was variable. Further research to generate reporting guidelines and validate existing tools for new populations would be beneficial.
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Affiliation(s)
- E L Wooding
- Peninsula Medical School, Plymouth University, Plymouth, UK.,Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - T C Gale
- Peninsula Medical School, Plymouth University, Plymouth, UK.,Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - V Maynard
- Peninsula Medical School, Plymouth University, Plymouth, UK
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Cheng A, Nadkarni VM, Mancini MB, Hunt EA, Sinz EH, Merchant RM, Donoghue A, Duff JP, Eppich W, Auerbach M, Bigham BL, Blewer AL, Chan PS, Bhanji F. Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e82-e122. [PMID: 29930020 DOI: 10.1161/cir.0000000000000583] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.
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Higham H, Greig PR, Rutherford J, Vincent L, Young D, Vincent C. Observer-based tools for non-technical skills assessment in simulated and real clinical environments in healthcare: a systematic review. BMJ Qual Saf 2019; 28:672-686. [DOI: 10.1136/bmjqs-2018-008565] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022]
Abstract
BackgroundOver the past three decades multiple tools have been developed for the assessment of non-technical skills (NTS) in healthcare. This study was designed primarily to analyse how they have been designed and tested but also to consider guidance on how to select them.ObjectivesTo analyse the context of use, method of development, evidence of validity (including reliability) and usability of tools for the observer-based assessment of NTS in healthcare.DesignSystematic review.Data sourcesSearch of electronic resources, including PubMed, Embase, CINAHL, ERIC, PsycNet, Scopus, Google Scholar and Web of Science. Additional records identified through searching grey literature (OpenGrey, ProQuest, AHRQ, King’s Fund, Health Foundation).Study selectionStudies of observer-based tools for NTS assessment in healthcare professionals (or undergraduates) were included if they: were available in English; published between January 1990 and March 2018; assessed two or more NTS; were designed for simulated or real clinical settings and had provided evidence of validity plus or minus usability. 11,101 articles were identified. After limits were applied, 576 were retrieved for evaluation and 118 articles included in this review.ResultsOne hundred and eighteen studies describing 76 tools for assessment of NTS in healthcare met the eligibility criteria. There was substantial variation in the method of design of the tools and the extent of validity, and usability testing. There was considerable overlap in the skills assessed, and the contexts of use of the tools.ConclusionThis study suggests a need for rationalisation and standardisation of the way we assess NTS in healthcare and greater consistency in how tools are developed and deployed.
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Bismilla Z, Boyle T, Mangold K, Van Ittersum W, White ML, Zaveri P, Mallory L. Development of a Simulation-Based Interprofessional Teamwork Assessment Tool. J Grad Med Educ 2019; 11:168-176. [PMID: 31024648 PMCID: PMC6476092 DOI: 10.4300/jgme-d-18-00729.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/22/2019] [Accepted: 02/11/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) Milestone projects required each specialty to identify essential skills and develop means of assessment with supporting validity evidence for trainees. Several specialties rate trainees on a milestone subcompetency related to working in interprofessional teams. A tool to assess trainee competence in any role on an interprofessional team in a variety of scenarios would be valuable and suitable for simulation-based assessment. OBJECTIVE We developed a tool for simulation settings that assesses interprofessional teamwork in trainees. METHODS In 2015, existing tools that assess teamwork or interprofessionalism using direct observation were systematically reviewed for appropriateness, generalizability, adaptability, ease of use, and resources required. Items from these tools were included in a Delphi method with multidisciplinary pediatrics experts using an iterative process from June 2016 to January 2017 to develop an assessment tool. RESULTS Thirty-one unique tools were identified. A 2-stage review narrowed this list to 5 tools, and 81 items were extracted. Twenty-two pediatrics experts participated in 4 rounds of Delphi surveys, with response rates ranging from 82% to 100%. Sixteen items reached consensus for inclusion in the final tool. A global 4-point rating scale from novice to proficient was developed. CONCLUSIONS A novel tool to assess interprofessional teamwork for individual trainees in a simulated setting was developed using a systematic review and Delphi methodology. This is the first step to establish the validity evidence necessary to use this tool for competency-based assessment.
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Zamjahn JB, Baroni de Carvalho R, Bronson MH, Garbee DD, Paige JT. eAssessment: development of an electronic version of the Objective Structured Assessment of Debriefing tool to streamline evaluation of video recorded debriefings. J Am Med Inform Assoc 2018; 25:1284-1291. [PMID: 30299477 PMCID: PMC7646921 DOI: 10.1093/jamia/ocy113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/21/2018] [Accepted: 07/28/2018] [Indexed: 11/13/2022] Open
Abstract
Objective The Objective Structured Assessment of Debriefing (OSAD) is an evidence-based, 8-item tool that uses a behaviorally anchored rating scale in paper-based form to evaluate the quality of debriefing in medical education. The objective of this project was twofold: 1) to create an easy-to-use electronic format of the OSAD (eOSAD) in order to streamline data entry; and 2) to pilot its use on videoed debriefings. Materials and Methods The eOSAD was developed in collaboration with the LSU Health New Orleans Epidemiology Data Center using SurveyGizmo (Widgix Software, LLC, Boulder, CO, USA) software. The eOSAD was then piloted by 2 trained evaluators who rated 37 videos of faculty teams conducting pre-briefing and debriefing after a high-fidelity trauma simulation. Inter-rater reliability was assessed, and evaluators' qualitative feedback was obtained. Results Inter-rater reliability was good [prebrief, intraclass correlation coefficient, ICC = 0.955 (95% CI, 0.912-0.977), P < .001; debrief, ICC = 0.853 (95% CI, 0.713-0.924), P < .001]. Qualitative feedback from evaluators found that the eOSAD was easy to complete, simple to read and add comments, and reliably stored data that were readily retrievable, enabling the smooth dissemination of information collected. Discussion The eOSAD features a secure login, sharable internet access link for distant evaluators, and the immediate exporting of data into a secure database for future analysis. It provided convenience for end-users, produced reliable assessments among independent evaluators, and eliminated multiple sources of possible data corruption. Conclusion The eOSAD tool format advances the post debriefing evaluation of videoed inter-professional team training in high-fidelity simulation.
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Affiliation(s)
- John B Zamjahn
- Department of Cardiopulmonary Science, LSU Health New Orleans School of Allied Health Professions, 1900 Gravier Street, New Orleans, Louisiana 70112, USA
| | | | - Megan H Bronson
- Epidemiology Data Center, LSU Health New Orleans School of Public Health, 2020 Gravier Street, New Orleans, Louisiana 70112, USA
| | - Deborah D Garbee
- LSU Health New Orleans School of Nursing, 1900 Gravier Street, New Orleans, Louisiana 70112, USA
| | - John T Paige
- Department of Surgery, LSU Health New Orleans School of Medicine, 1542 Tulane Ave, Rm 734, New Orleans, LA 70112, USA
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Weingart SN, Yaghi O, Wetherell M, Sweeney M. Measuring Medical Housestaff Teamwork Performance Using Multiple Direct Observation Instruments: Comparing Apples and Apples. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1064-1070. [PMID: 29642102 DOI: 10.1097/acm.0000000000002238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To examine the composition and concordance of existing instruments used to assess medical teams' performance. METHOD A trained observer joined 20 internal medicine housestaff teams for morning work rounds at Tufts Medical Center, a 415-bed Boston teaching hospital, from October through December 2015. The observer rated each team's performance using nine teamwork observation instruments that examined domains including team structure, leadership, situation monitoring, mutual support, and communication. Observations recorded on paper forms were stored electronically. Scores were normalized from 1 (low) to 5 (high) to account for different rating scales. Overall mean scores were calculated and graphed; weighted scores adjusted for the number of items in each teamwork domain. Teamwork scores were analyzed using t tests, pairwise correlations, and the Kruskal-Wallis statistic, and team performance was compared across instruments by domain. RESULTS The nine tools incorporated five major domains, with 5 to 35 items per instrument, for a total of 161 items per observation session. In weighted and unweighted analyses, the overall teamwork performance score for a given team on a given day varied by instrument. While all of the tools identified the same low outlier, high performers on some instruments were low performers on others. Inconsistent scores for a given team across instruments persisted in domain-level analyses. CONCLUSIONS There was substantial variation in the rating of individual teams assessed concurrently by a single observer using multiple instruments. Because existing teamwork observation tools do not yield concordant assessments, researchers should create better tools for measuring teamwork performance.
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Affiliation(s)
- Saul N Weingart
- S.N. Weingart is chief medical officer, Tufts Medical Center, and professor of medicine, public health, and community medicine, Tufts University School of Medicine, Boston, Massachusetts. O. Yaghi is a research assistant, Quality Improvement/Patient Safety Department, Tufts Medical Center, Boston, Massachusetts. M. Wetherell is a fourth-year medical student, Tufts University School of Medicine, Boston, Massachusetts. M. Sweeney is a research assistant, Quality Improvement/Patient Safety Department, Tufts Medical Center, Boston, Massachusetts
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Jakobsen RB, Gran SF, Grimsmo B, Arntzen K, Fosse E, Frich JC, Hjortdahl P. Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students. J Interprof Care 2017; 32:80-88. [DOI: 10.1080/13561820.2017.1376625] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rune Bruhn Jakobsen
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, University of Oslo, Oslo, Norway
| | - Sarah Frandsen Gran
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bergsvein Grimsmo
- Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Kari Arntzen
- Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Erik Fosse
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Jan C. Frich
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per Hjortdahl
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Paige JT, Garbee DD, Yu Q, Rusnak V. Team Training of Inter-Professional Students (TTIPS) for improving teamwork. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017; 3:127-134. [PMID: 35517834 PMCID: PMC8936634 DOI: 10.1136/bmjstel-2017-000194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/04/2022]
Abstract
Objective In surgery, dysfunctional teamwork is perpetuated by a 'silo' mentality modelled by students. Interprofessional education using high-fidelity simulation-based training (SBT) may counteract such modelling. We sought to determine whether SBT of interprofessional student teams (1) changes long-term teamwork attitudes and (2) is an effective form of team training. Design A quasiexperimental, pre/postintervention comparison design was employed at an academic health sciences institution. High-fidelity simulation-based training of 42 interprofessional teams of third year surgery clerkship medical students and senior undergraduate nursing students was undertaken using a two-scenario format with immediate after action debriefing. Pre/postintervention TeamSTEPPS Teamwork Attitudes questionnaires (5 subscales, 30 items, Likert type) were given to the medical student and undergraduate nursing student classes. Pre/postsession Readiness for Inter-Professional Learning (RIPL; 19 items, Likert type) surveys and postscenario participant-rated and observer-rated Teamwork Assessment Scales (3 subscales, 11 items, Likert type) were given during each training session. Mean TeamSTEPPS Teamwork Attitudes Questionnaire, RIPL and Teamwork Assessment Scales scores were calculated; matched pre/postscore differences and trained versus non-trained TeamSTEPPS Teamwork Attitudes Questionnaire scores were compared using paired t-test or analysis of variance. Results Both student groups had 10 significantly improved RIPL items as well as TeamSTEPPS Teamwork Attitudes Questionnaire (TTAQ) mutual support subscales. Medical students had a significantly improved TTAQ team structure subscale. Over a simulation-based training session, each observer-rated Teamwork Assessment Scales subscale and two self-rated Teamwork Assessment Scales subscales significantly improved. Trained students had significantly higher TTAQ team structure subscales than non-trained students. Conclusions Interprofessional education using high-fidelity simulation-based training of students is effective at teaching teamwork, changing interprofessional attitudes and improving long-term teamwork attitudes.
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Affiliation(s)
- John T Paige
- Surgery, Louisiana State University (LSU) Health New Orleans School of Medicine, New Orleans, Louisiana, USA
| | - Deborah D Garbee
- Office of the Dean, LSU Health New Orleans School of Nursing, New Orleans, Louisiana, USA
| | - Qingzhao Yu
- Biostatistics, LSU Health New Orleans School of Public Health, New Orleans, Louisiana, USA
| | - Vadym Rusnak
- Internal Medicine, Leonard J. Chabert Medical Center, Houma, Louisiana, USA
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Belfrage A, Grotmol KS, Lien L, Moum T, Wiese RV, Tyssen R. Medical school predictors of later perceived mastery of clinical work among Norwegian doctors: a cohort study with 10-year and 20-year follow-up. BMJ Open 2017; 7:e014462. [PMID: 28947437 PMCID: PMC5623388 DOI: 10.1136/bmjopen-2016-014462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Doctors' self-perceived mastery of clinical work might have an impact on their career and patient care, in addition to their own health and well-being. The aim of this study is to identify predictors at medical school of perceived mastery later in doctors' careers. DESIGN A cohort of medical students (n=631) was surveyed in the final year of medical school in 1993/1994 (T1), and 10 (T2) and 20 (T3) years later. SETTING Nationwide healthcare institutions. PARTICIPANTS Medical students from all universities in Norway. MAIN OUTCOME MEASURES Perceived mastery of clinical work was measured at T2 and T3. The studied predictors measured at T1 included personality traits, medical school stress, perceived medical recording skills, identification with the role of doctor, hazardous drinking and drinking to cope, in addition to age and gender. Effects were studied using multiple linear regression models. RESULTS Response rates: T1, 522/631 (83%); T2, 390/522 (75%); and T3, 303/522 (58%). Mean scores at T2 and T3 were 22.3 (SD=4.2) and 24.5 (3.0) (t=8.2, p<0.001), with no gender difference. Adjusted associations at T2 were: role identification (β=0.16; p=0.006; 95% CI 0.05 to 0.28), perceived medical recording skills (β=0.13; p=0.02; 95% CI 0.02 to 0.24) and drinking to cope (β=-2.45; p=0.001; 95% CI -3.88 to -1.03). Adjusted association at T3 was perceived medical recording skills (β=0.11; p=0.015; 95% CI 0.02 to 0.21). CONCLUSIONS Perceived medical recording skills and role identification were associated with higher perceived mastery. Medical schools should provide experiences, teaching and assessment to enhance students' physician role identification and confidence in their own skills. Drinking to cope was associated with lower perceived mastery, which indicates the importance of acquiring healthier coping strategies in medical school.
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Affiliation(s)
- Anna Belfrage
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Kjersti Støen Grotmol
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Regional Centre of Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Torbjørn Moum
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragna Veslemøy Wiese
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Reidar Tyssen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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Shrader S, Farland MZ, Danielson J, Sicat B, Umland EM. A Systematic Review of Assessment Tools Measuring Interprofessional Education Outcomes Relevant to Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2017; 81:119. [PMID: 28970620 PMCID: PMC5607729 DOI: 10.5688/ajpe816119] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/03/2016] [Indexed: 05/19/2023]
Abstract
Objective. To identify and describe the available quantitative tools that assess interprofessional education (IPE) relevant to pharmacy education. Methods. A systematic approach was used to identify quantitative IPE assessment tools relevant to pharmacy education. The search strategy included the National Center for Interprofessional Practice and Education Resource Exchange (Nexus) website, a systematic search of the literature, and a manual search of journals deemed likely to include relevant tools. Results. The search identified a total of 44 tools from the Nexus website, 158 abstracts from the systematic literature search, and 570 abstracts from the manual search. A total of 36 assessment tools met the criteria to be included in the summary, and their application to IPE relevant to pharmacy education was discussed. Conclusion. Each of the tools has advantages and disadvantages. No single comprehensive tool exists to fulfill assessment needs. However, numerous tools are available that can be mapped to IPE-related accreditation standards for pharmacy education.
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Affiliation(s)
- Sarah Shrader
- University of Kansas School of Pharmacy, Lawrence, Kansas
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Nelson S, White CF, Hodges BD, Tassone M. Interprofessional Team Training at the Prelicensure Level: A Review of the Literature. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:709-716. [PMID: 27782914 DOI: 10.1097/acm.0000000000001435] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The authors undertook a descriptive analysis review to gain a better understanding of the various approaches to and outcomes of team training initiatives in prelicensure curricula since 2000. METHOD In July and August 2014, the authors searched the MEDLINE, PsycINFO, Embase, Business Source Premier, and CINAHL databases to identify evaluative studies of team training programs' effects on the team knowledge, communication, and skills of prelicensure students published from 2000 to August 2014. The authors identified 2,568 articles, with 17 studies meeting the selection criteria for full text review. RESULTS The most common study designs were single-group, pre/posttest studies (n = 7), followed by randomized controlled or comparison trials (n = 6). The Situation, Background, Assessment, Recommendation communication tool (n = 5); crisis resource management principles (n = 6); and high-fidelity simulation (n = 4) were the most common curriculum bases used. Over half of the studies (n = 9) performed training with students from more than one health professions program. All but three used team performance assessments, with most (n = 8) using observed behavior checklists created for that specific study. The majority of studies (n = 16) found improvements in team knowledge, communication, and skills. CONCLUSIONS Team training appears effective in improving team knowledge, communication, and skills in prelicensure learners. Continued exploration of the best method of team training is necessary to determine the most effective way to move forward in prelicensure interprofessional team education.
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Affiliation(s)
- Sioban Nelson
- S. Nelson is vice provost, academic, and professor, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. C.F. White is a registered nurse, University Health Network, Toronto, Ontario, Canada. B.D. Hodges is executive vice president, University Health Network, and professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. M. Tassone is senior director, Collaborative and Transformative Learning, University Health Network, director, Centre for Interprofessional Education, University of Toronto, and assistant professor, Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Clary-Muronda V, Pope C. Integrative Review of Instruments to Measure Team Performance During Neonatal Resuscitation Simulations in the Birthing Room. J Obstet Gynecol Neonatal Nurs 2016; 45:684-98. [DOI: 10.1016/j.jogn.2016.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 10/21/2022] Open
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Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC MEDICAL EDUCATION 2016; 16:218. [PMID: 27552977 PMCID: PMC4995823 DOI: 10.1186/s12909-016-0743-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/18/2016] [Indexed: 05/29/2023]
Abstract
BACKGROUND Teamwork training is an essential component of health professional student education. A valid and reliable teamwork self-assessment tool could assist students to identify desirable teamwork behaviours with the potential to promote learning about effective teamwork. The aim of this study was to develop and evaluate a self-assessment teamwork tool for health professional students for use in the context of emergency response to a mass casualty. METHODS The authors modified a previously published teamwork instrument designed for experienced critical care teams for use with medical and nursing students involved in mass casualty simulations. The 17-item questionnaire was administered to students immediately following the simulations. These scores were used to explore the psychometric properties of the tool, using Exploratory and Confirmatory Factor Analysis. RESULTS 202 (128 medical and 74 nursing) students completed the self-assessment teamwork tool for students. Exploratory factor analysis revealed 2 factors (5 items - Teamwork coordination and communication; 4 items - Information sharing and support) and these were justified with confirmatory factor analysis. Internal consistency was 0.823 for Teamwork coordination and communication, and 0.812 for Information sharing and support. CONCLUSIONS These data provide evidence to support the validity and reliability of the self-assessment teamwork tool for students This self-assessment tool could be of value to health professional students following team training activities to help them identify the attributes of effective teamwork.
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Affiliation(s)
| | - Christine Jorm
- Sydney Medical School, The University of Sydney, Sydney, NSW Australia
| | - Boaz Shulruf
- Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
| | - Jennifer Weller
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jane Currie
- Sydney Nursing School, The University of Sydney, Sydney, 2006 NSW Australia
| | - Renee Lim
- Northern Clinical School, The University of Sydney, Sydney, NSW Australia
| | - Adam Osomanski
- Sydney Adventist Hospital Clinical School, The University of Sydney, Sydney, NSW Australia
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Havyer RD, Nelson DR, Wingo MT, Comfere NI, Halvorsen AJ, McDonald FS, Reed DA. Addressing the Interprofessional Collaboration Competencies of the Association of American Medical Colleges: A Systematic Review of Assessment Instruments in Undergraduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:865-88. [PMID: 26703415 DOI: 10.1097/acm.0000000000001053] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To summarize characteristics and validity evidence of tools that assess teamwork in undergraduate medical education (UME), and provide recommendations for addressing the interprofessional collaboration competencies of the Association of American Medical Colleges (AAMC). METHOD The authors conducted a systematic review, searching MEDLINE, MEDLINE In-process, CINAHL, and PsycINFO from January 1, 1979, through April 1, 2014; they searched reference lists and national meeting abstracts. They included original research reports that described a quantitative tool used to assess teamwork in UME. They abstracted characteristics and validity evidence for the tools, plus study quality, according to established frameworks. Two authors independently abstracted 25% of articles and calculated agreement. Authors then applied predefined criteria to identify tools best suited to address the AAMC's teamwork competencies. RESULTS Of 13,549 citations, 70 articles describing 64 teamwork assessment tools were included. Of these 64 tools, 27 (42%) assessed teamwork in classroom, 31 (48%) in simulation, and only 7 (11%) in actual clinical settings. The majority (47; 73%) of tools assessed medical students' teamwork in interprofessional teams. On the basis of content concordance, strength of validity evidence, generalizability of scores, and level of outcomes, four published tools were recommended to assess the AAMC's teamwork competencies: the Collaborative Healthcare Interdisciplinary Relationship Planning Scale, Readiness for Interprofessional Learning Scale, Communication and Teamwork Skills assessment, and Teamwork Mini-Clinical Evaluation Exercise. CONCLUSIONS Substantial validity evidence supports the use of several UME teamwork assessments. Four tools have been appropriately designed and sufficiently studied to constitute appropriate assessments of the AAMC's teamwork competencies.
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Affiliation(s)
- Rachel D Havyer
- R.D. Havyer is assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. D.R. Nelson is assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. M.T. Wingo is assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. N.I. Comfere is associate professor of dermatology and of laboratory medicine and pathology, Mayo Clinic College of Medicine, Rochester, Minnesota. A.J. Halvorsen is assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. F.S. McDonald is professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, and vice president, Graduate Medical Education, American Board of Internal Medicine, Philadelphia, Pennsylvania. D.A. Reed is associate professor of medicine and of medical education, Mayo Clinic College of Medicine, Rochester, Minnesota
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Yu TC, Webster CS, Weller JM. Simulation in the medical undergraduate curriculum to promote interprofessional collaboration for acute care: a systematic review. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2016; 2:90-96. [DOI: 10.1136/bmjstel-2016-000103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/16/2016] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Abstract
This literature review summarises interprofessional, simulation-based interventions in the context of preparing undergraduate and prelicensure healthcare students for the management of acutely unstable patients. There was a particular focus on the impact of such interventions on medical students. The review sought to identify the range of described interprofessional education (IPE) learning outcomes, types of learners, methods used to evaluate intervention effectiveness and study conclusions. We systematically compiled this information and generated review findings through narrative summary. A total of 18 articles fulfilled the review criteria. The diversity of IPE interventions described suggests a developing field where the opportunities provided by simulation are still being explored. With significant heterogeneity among the studies, comparison between them was unfeasible, but each study provided a unique narrative on the complex interplay between intervention, curriculum, learning activities, learners and facilitators. Together, the narratives provided in these studies reflect positively on undergraduate simulation-based interventions to promote interprofessional collaboration in acute care settings, and provide the basis for recommendations for future IPE design and delivery, and areas requiring further research.
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Kaba A, Wishart I, Fraser K, Coderre S, McLaughlin K. Are we at risk of groupthink in our approach to teamwork interventions in health care? MEDICAL EDUCATION 2016; 50:400-8. [PMID: 26995480 DOI: 10.1111/medu.12943] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/02/2015] [Accepted: 09/21/2015] [Indexed: 05/22/2023]
Abstract
CONTEXT The incidence of medical error, adverse clinical events and poor quality health care is unacceptably high and there are data to suggest that poor coordination of care, or teamwork, contributes to adverse outcomes. So, can we assume that increased collaboration in multidisciplinary teams improves performance and health care outcomes for patients? METHODS In this essay, the authors discuss some reasons why we should not presume that collective decision making leads to better decisions and collaborative care results in better health care outcomes. RESULTS Despite an exponential increase in interventions designed to improve teamwork and interprofessional education (IPE), we are still lacking good quality data on whether these interventions improve important outcomes. There are reasons why some of the components of 'effective teamwork', such as shared mental models, team orientation and mutual trust, could impair delivery of health care. For example, prior studies have found that brainstorming results in fewer ideas rather than more, and hinders rather than helps productivity. There are several possible explanations for this effect, including 'social loafing' and cognitive overload. Similarly, attributes that improve cohesion within groups, such as team orientation and mutual trust, may increase the risk of 'groupthink' and group conformity bias, which may lead to poorer decisions. CONCLUSIONS In reality, teamwork and IPE are not inherently good, bad or neutral; instead, as with any intervention, their effect is modified by the persons involved, the situation and the interaction between persons and situation. Thus, rather than assume better outcomes with teamwork and IPE interventions, as clinicians and educators we must demonstrate that our interventions improve the delivery of health care.
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Affiliation(s)
- Alyshah Kaba
- Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Ian Wishart
- Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Kristin Fraser
- Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Sylvain Coderre
- Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
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Calhoun AW, Sigalet E, Burns R, Auerbach M. Simulation Along the Pediatric Healthcare Education Continuum. COMPREHENSIVE HEALTHCARE SIMULATION: PEDIATRICS 2016. [DOI: 10.1007/978-3-319-24187-6_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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The Role of Simulation in Improving Patient Safety. COMPREHENSIVE HEALTHCARE SIMULATION: PEDIATRICS 2016. [DOI: 10.1007/978-3-319-24187-6_5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Paige JT, Garbee DD, Brown KM, Rojas JD. Using Simulation in Interprofessional Education. Surg Clin North Am 2015. [DOI: 10.1016/j.suc.2015.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sigalet EL, Donnon TL, Grant V. Insight into team competence in medical, nursing and respiratory therapy students. J Interprof Care 2014; 29:62-7. [DOI: 10.3109/13561820.2014.940416] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Paige JT, Garbee DD, Kozmenko V, Yu Q, Kozmenko L, Yang T, Bonanno L, Swartz W. Getting a Head Start: High-Fidelity, Simulation-Based Operating Room Team Training of Interprofessional Students. J Am Coll Surg 2014; 218:140-9. [DOI: 10.1016/j.jamcollsurg.2013.09.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/22/2013] [Accepted: 09/16/2013] [Indexed: 02/01/2023]
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