1
|
Clifford E, Stourton F, Willers J, Colucci G. Development of a Low-Cost, High-Fidelity, Reusable Model to Simulate Clamshell Thoracotomy. Surg Innov 2023; 30:739-744. [PMID: 37876028 PMCID: PMC10656785 DOI: 10.1177/15533506231208572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Clamshell thoracotomy (CST) is an emergency procedure performed during traumatic cardiac arrest. Emergency physicians and surgeons are expected to perform this procedure in the Emergency Department. However, the procedure has a low occurrence rate, therefore physicians are often poorly prepared. Current teaching methods include expensive simulators and anatomically inaccurate animal models. The goal of this study was to design, produce and test, a low-cost, high-fidelity model for the teaching of CST. DESIGN, SETTING AND PARTICIPANTS The model was produced from inexpensive, commercially available materials as well as ADAMgel; a custom, recyclable, inexpensive tissue analogue. The model was tested across 19 physicians, mostly consultants and senior registrars in emergency medicine, anaesthesia and surgery. Participants completed comparative questionnaires before and after testing the model. The questionnaires were adapted from previous anaesthetic-based simulation studies and used a modified Likert scale to assess prior knowledge, anatomical realism and the teaching benefits of the model. RESULTS Participants had varied prior knowledge and experience before testing the model. Results showed that 89.47% (n = 17) of trainees felt the model was a reasonable substitute for practice and 100% (n = 19) agreed that the model was a good training aid for inexperienced trainees and would recommend it to others. CONCLUSIONS The model proved a successful teaching tool, improving physicians' knowledge and confidence with performing CST. This high fidelity, low cost model demonstrated that a high standard simulation teaching tool can be made which improves teaching of CST.
Collapse
Affiliation(s)
| | - Frederick Stourton
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
| | - Johann Willers
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
| | - Gianluca Colucci
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
| |
Collapse
|
2
|
Pappada S, Owais MH, Aouthmany S, Rega P, Schneiderman J, Toy S, Schiavi A, Miller C, Guris RD, Papadimos T. Personalizing simulation-based medical education: the case for novel learning management systems. Simul Healthc 2022. [DOI: 10.54531/mngy8113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Simulation-based medical education (SBME) is often delivered as one-size-fits-all, with no clear guidelines for personalization to achieve optimal performance. This essay is intended to introduce a novel approach, facilitated by a home-grown learning management system (LMS), designed to streamline simulation program evaluation and curricular improvement by aligning learning objectives, scenarios, assessment metrics and data collection, as well as integrate standardized sets of multimodal data (self-report, observational and neurophysiological). Results from a pilot feasibility study are presented. Standardization is important to future LMS applications and could promote development of machine learning-based approaches to predict knowledge and skill acquisition, maintenance and decay, for personalizing SBME across healthcare professionals.
Collapse
Affiliation(s)
- Scott Pappada
- 1Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Mohammad Hamza Owais
- 3Department of Electrical Engineering and Computer Science, College of Engineering, University of Toledo, Toledo, OH, USA
| | - Shaza Aouthmany
- 4Department of Emergency Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Paul Rega
- 4Department of Emergency Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Jeffrey Schneiderman
- 6College of Medicine and Life Sciences, EMS Education, University of Toledo, Toledo, OH, USA
| | - Serkan Toy
- 7Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Adam Schiavi
- 8Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christina Miller
- 8Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rodrigo Daly Guris
- 9Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas Papadimos
- 1Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| |
Collapse
|
3
|
Toohey S, Wray A, Hunter J, Waldrop I, Saadat S, Boysen-Osborn M, Sudario G, Smart J, Wiechmann W, Pressman SD. Comparing the Psychological Effects of Manikin-Based and Augmented Reality-Based Simulation Training: Within-Subjects Crossover Study. JMIR MEDICAL EDUCATION 2022; 8:e36447. [PMID: 35916706 PMCID: PMC9379786 DOI: 10.2196/36447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/27/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patient simulators are an increasingly important part of medical training. They have been shown to be effective in teaching procedural skills, medical knowledge, and clinical decision-making. Recently, virtual and augmented reality simulators are being produced, but there is no research on whether these more realistic experiences cause problematic and greater stress responses as compared to standard manikin simulators. OBJECTIVE The purpose of this research is to examine the psychological and physiological effects of augmented reality (AR) in medical simulation training as compared to traditional manikin simulations. METHODS A within-subjects experimental design was used to assess the responses of medical students (N=89) as they completed simulated (using either manikin or AR) pediatric resuscitations. Baseline measures of psychological well-being, salivary cortisol, and galvanic skin response (GSR) were taken before the simulations began. Continuous GSR assessments throughout and after the simulations were captured along with follow-up measures of emotion and cortisol. Participants also wrote freely about their experience with each simulation, and narratives were coded for emotional word use. RESULTS Of the total 86 medical students who participated, 37 (43%) were male and 49 (57%) were female, with a mean age of 25.2 (SD 2.09, range 22-30) years and 24.7 (SD 2.08, range 23-36) years, respectively. GSR was higher in the manikin group adjusted for day, sex, and medications taken by the participants (AR-manikin: -0.11, 95% CI -0.18 to -0.03; P=.009). The difference in negative affect between simulation types was not statistically significant (AR-manikin: 0.41, 95% CI -0.72 to 1.53; P=.48). There was no statistically significant difference between simulation types in self-reported stress (AR-manikin: 0.53, 95% CI -2.35 to 3.42; P=.71) or simulation stress (AR-manikin: -2.17, 95% CI -6.94 to 2.59; P=.37). The difference in percentage of positive emotion words used to describe the experience was not statistically significant between simulation types, which were adjusted for day of experiment, sex of the participants, and total number of words used (AR-manikin: -4.0, 95% CI -0.91 to 0.10; P=.12). There was no statistically significant difference between simulation types in terms of the percentage of negative emotion words used to describe the experience (AR-manikin: -0.33, 95% CI -1.12 to 0.46; P=.41), simulation sickness (AR-manikin: 0.17, 95% CI -0.29 to 0.62; P=.47), or salivary cortisol (AR-manikin: 0.04, 95% CI -0.05 to 0.13; P=.41). Finally, preexisting levels of posttraumatic stress disorder, perceived stress, and reported depression were not tied to physiological responses to AR. CONCLUSIONS AR simulators elicited similar stress responses to currently used manikin-based simulators, and we did not find any evidence of AR simulators causing excessive stress to participants. Therefore, AR simulators are a promising tool to be used in medical training, which can provide more emotionally realistic scenarios without the risk of additional harm.
Collapse
Affiliation(s)
- Shannon Toohey
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Alisa Wray
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - John Hunter
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Ian Waldrop
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Soheil Saadat
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Megan Boysen-Osborn
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Gabriel Sudario
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Jonathan Smart
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Warren Wiechmann
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Sarah D Pressman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| |
Collapse
|
4
|
Abildgren L, Lebahn-Hadidi M, Mogensen CB, Toft P, Nielsen AB, Frandsen TF, Steffensen SV, Hounsgaard L. The effectiveness of improving healthcare teams' human factor skills using simulation-based training: a systematic review. Adv Simul (Lond) 2022; 7:12. [PMID: 35526061 PMCID: PMC9077986 DOI: 10.1186/s41077-022-00207-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/05/2022] [Indexed: 01/08/2023] Open
Abstract
Background Simulation-based training used to train healthcare teams’ skills and improve clinical practice has evolved in recent decades. While it is evident that technical skills training is beneficial, the potential of human factor training has not been described to the same extent. Research on human factor training has been limited to marginal and acute care scenarios and often to validate instruments. This systematic review aimed to investigate the effectiveness of simulation-based training in improving in-hospital qualified healthcare teams’ human factor skills. Method A review protocol outlining the study was registered in PROSPERO. Using the PRISMA guidelines, the systematic search was conducted on September 28th, 2021, in eight major scientific databases. Three independent reviewers assessed title and abstract screening; full texts were evaluated by one reviewer. Content analysis was used to evaluate the evidence from the included studies. Results The search yielded 19,767 studies, of which 72 were included. The included studies were published between 2004 and 2021 and covered research from seven different in-hospital medical specialisms. Studies applied a wide range of assessment tools, which made it challenging to compare the effectiveness of human factor skills training across studies. The content analysis identified evidence for the effectiveness. Four recurring themes were identified: (1) Training human factor skills in qualified healthcare teams; (2) assessment of human factor skills; (3) combined teaching methods, and (4) retention and transfer of human factor skills. Unfortunately, the human factor skills assessments are variable in the literature, affecting the power of the result. Conclusion Simulation-based training is a successful learning tool to improve qualified healthcare teams’ human factor skills. Human factor skills are not innate and appear to be trainable similar to technical skills, based on the findings of this review. Moreover, research on retention and transfer is insufficient. Further, research on the retention and transfer of human factor skills from simulation-based training to clinical practice is essential to gain knowledge of the effect on patient safety. Supplementary Information The online version contains supplementary material available at 10.1186/s41077-022-00207-2.
Collapse
Affiliation(s)
- Lotte Abildgren
- Anesthesiology and Intensive Care Unit, Odense University Hospital, Odense, Denmark. .,OPEN, Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Emergency Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Odense, Denmark.
| | - Malte Lebahn-Hadidi
- Emergency Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Odense, Denmark.,Centre for Human Interactivity, Department of Language and Communication, University of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Emergency Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Odense, Denmark
| | - Palle Toft
- Anesthesiology and Intensive Care Unit, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Bo Nielsen
- OPEN, Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,SimC, Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark
| | - Tove Faber Frandsen
- Department of Design and Communication, University of Southern Denmark, Kolding, Denmark
| | - Sune Vork Steffensen
- Centre for Human Interactivity, Department of Language and Communication, University of Southern Denmark, Odense, Denmark.,Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark.,Center for Ecolinguistics, South China Agricultural University, Guangzhou, People's Republic of China.,College of International Studies, Southwest University, Chongqing, People's Republic of China
| | - Lise Hounsgaard
- OPEN, Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Institute of Nursing & Health Science, Ilisimartusarfik, University of Greenland, Nuuk, Greenland.,Center for Mental Health Nursing and Health Research (CPS), Mental Health Services, Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Abulfaraj MM, Jeffers JM, Tackett S, Chang T. Virtual Reality vs. High-Fidelity Mannequin-Based Simulation: A Pilot Randomized Trial Evaluating Learner Performance. Cureus 2021; 13:e17091. [PMID: 34527478 PMCID: PMC8432415 DOI: 10.7759/cureus.17091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/05/2022] Open
Abstract
Background Virtual Reality (VR) simulation has been found to be useful in learning technical and non-technical skills. However, empirical data about its efficacy in clinical education are limited. This pilot study compares the efficacy of VR to mannequin-based simulation for learners managing status epilepticus (SE). Methods Pediatric and emergency medicine interns at an academic tertiary care referral center were randomized to either VR (intervention, using an Oculus RiftⓇ (Occulus from Facebook, Facebook Inc., USA)) or mannequin-based (control) simulation for the same SE scenario. The control group participated in two mannequin-based simulation sessions while the intervention group had a VR session followed by a mannequin-based session. Sessions were one-one with an instructor and held three months apart. Performance was assessed by measuring the time-to-critical actions during the second session. Results Of 42 interns, 22 were in the intervention group and 20 in the control group. There was no statistical difference in time-to-critical actions for VR vs. standard groups; for example, VR times (in seconds) compared to standard times were 18.1 (SD 10.5) and 18.9 (SD 15.8) (p=.90) for oral suction, and 61.6 (SD 24.8) and 62.8 (SD 26.9) (p=.82) for IV lorazepam completion. Conclusion This pilot trial suggests that VR is feasible for clinical simulation. We did not find a significant difference between the two groups in learner performance. Larger studies are needed to corroborate our findings, investigate the best applications of VR in clinical training, and determine if it could lead to more rapid learning at a lower cost.
Collapse
Affiliation(s)
- Maher M Abulfaraj
- Pediatric Emergency Medicine, Taibah University School of Medicine, Madinah, SAU
| | - Justin M Jeffers
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, USA
| | - Todd Chang
- Emergency Medicine, Children's Hospital of Los Angeles, Los Angeles, USA
| |
Collapse
|
6
|
Ritter KA, Horne C, Nassar A, French JC, Prabhu AS, Lipman JM. Multidisciplinary Simulation Training Improves Surgical Resident Comfort With Airway Management. J Surg Res 2020; 252:57-62. [PMID: 32234569 DOI: 10.1016/j.jss.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/27/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Airway management is an essential element of surgical training, but with fewer procedures performed during residency, simulation is crucial to fill educational gaps. We evaluated the effect of a multidisciplinary airway simulation on the comfort of general surgery residents in managing airways. MATERIALS AND METHODS All residents PGY 2-5 at a large academic general surgery residency program participated in a multidisciplinary airway management simulation. Precourse surveys evaluated self-perception of skills in three areas of airway management: surgical airway, basic ventilator strategies, and endotracheal intubation. Simulation consisted of didactic and procedural components and used high- and low-fidelity models including silicon airways, ventilators, porcine trachea, and airway adjuncts. Instruction was provided by anesthesia and otolaryngology faculty. Postcourse assessment was performed with a four-level Likert questionnaire. Results were analyzed using paired t-tests. RESULTS Of the 19 residents surveyed, 37% of residents had 1-5 h and 32% had 5-10 h of prior airway instruction. Significant increases in mean comfort were observed across all three studied areas. Residents reported increased comfort performing a surgical airway (1.16 versus 1.95), P < 0.0001, and troubleshooting ventilator issues (1.59 versus 2.16), P < 0.0001. Comfort regarding overall airway management including endotracheal intubation demonstrated similar improvement (1.84 versus 2.32), P = 0.02. Subgroup analysis by PGY level showed the greatest impact on comfort level in junior residents. CONCLUSIONS Multidisciplinary airway simulation can be effectively implemented in a general surgery training program and positively affect trainee comfort with these techniques, particularly among junior residents.
Collapse
Affiliation(s)
- Kaitlin A Ritter
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charlotte Horne
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed Nassar
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Judith C French
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ajita S Prabhu
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M Lipman
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
7
|
Mirza N, Cinel J, Noyes H, McKenzie W, Burgess K, Blackstock S, Sanderson D. Simulated patient scenario development: A methodological review of validity and reliability reporting. NURSE EDUCATION TODAY 2020; 85:104222. [PMID: 31783266 DOI: 10.1016/j.nedt.2019.104222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/20/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Some healthcare scholars (educators and researchers) develop their own simulated patient scenarios to address specific learning objectives. Clear processes of validity and reliability are needed in the development of simulated scenarios for the purpose of replication and the transfer of findings to other contexts. METHODS This paper reports a methodological review of CINAHL to determine how valid and reliable simulated patient scenarios are developed. We reviewed 375 abstracts based on specific inclusion and exclusion criteria to yield 17 qualifying records. Data about the discipline, population, type of simulation, and validity and reliability processes were extracted. RESULTS Selected records were from nursing, medicine, and paramedicine. While some studies used high-fidelity simulations, some used low-fidelity or a combination of high- and low-fidelity simulations. Scholars validated scenarios by using personal experience, consulting experts, or requesting participant feedback. They also examined different types of validity (face, content, construct). Most studies did not address how reliability of scenarios was determined. To ensure consistency in scenario delivery, some studies piloted scenarios with participants, or examined performance through video-tapes or virtual patients. CONCLUSIONS This review shows that scholars use inconsistent processes to develop valid and reliable simulated patient scenarios, often overlooking evidence-based approaches to determining validity and reliability. Future practices pertaining to scenario development should use systematic processes in determining validity and reliability so simulation exercises can be replicated in other contexts.
Collapse
Affiliation(s)
- Noeman Mirza
- School of Nursing, Thompson Rivers University, Canada.
| | - Julie Cinel
- School of Nursing, Thompson Rivers University, Canada
| | - Heather Noyes
- Faculty of Science, Thompson Rivers University, Canada
| | | | - Kim Burgess
- School of Nursing, Thompson Rivers University, Canada
| | | | | |
Collapse
|
8
|
Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
Collapse
Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Ryan A, Rizwan R, Williams B, Benscoter A, Cooper DS, Iliopoulos I. Simulation Training Improves Resuscitation Team Leadership Skills of Nurse Practitioners. J Pediatr Health Care 2019; 33:280-287. [PMID: 30497891 DOI: 10.1016/j.pedhc.2018.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In the current era of limited physician trainee work hours, limited nurse practitioner orientation times, and highly specialized care settings, frontline providers have limited opportunities for mentored resuscitation training in emergency situations. We aimed to evaluate the effectiveness of a pilot program to improve resuscitation team leadership skills of nurse practitioners using simulation-based training. METHODS Seven nurse practitioners underwent a 4-hour simulation course in pediatric cardiac emergencies. Pre- and post-course surveys were conducted to evaluate previous emergency leadership experience and self-reported comfort in the team lead role. The time to verbalization of a shared mental model to the team was tracked during the simulations. RESULTS The increases in self-reported comfort level in team leading, sharing a mental model, and differential diagnosis were statistically significant. Average time to shared mental model significantly decreased between simulations. DISCUSSION Simulation can improve code leadership skills of nurse practitioners. These preliminary findings require confirmation in larger studies.
Collapse
|
11
|
Hardenberg J, Rana I, Tori K. Simulation Exposure Improves Clinical Skills for Postgraduate Critical Care Nurses. Clin Simul Nurs 2019. [DOI: 10.1016/j.ecns.2018.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
12
|
McLaughlin C, Wieck MM, Barin E, Rake A, Burke RV, Roesly HB, Young LC, Chang TP, Cleek EA, Morton I, Goodhue CJ, Burd RS, Ford HR, Upperman JS, Jensen AR. Impact of Simulation-Based Training on Perceived Provider Confidence in Acute Multidisciplinary Pediatric Trauma Resuscitation. Pediatr Surg Int 2018; 34:1353-1362. [PMID: 30324569 PMCID: PMC6353611 DOI: 10.1007/s00383-018-4361-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Simulation-based training has the potential to improve team-based care. We hypothesized that implementation of an in situ multidisciplinary simulation-based training program would improve provider confidence in team-based management of severely injured pediatric trauma patients. METHODS An in situ multidisciplinary pediatric trauma simulation-based training program with structured debriefing was implemented at a free-standing children's hospital. Trauma providers were anonymously surveyed 1 month before (pre-), 1 month after (post-), and 2 years after implementation. RESULTS Survey response rate was 49% (n = 93/190) pre-simulation, 22% (n = 42/190) post-simulation, and 79% (n = 150/190) at 2-year follow-up. These providers reported more anxiety (p = 0.01) and less confidence (p = 0.02) 1-month post-simulation. At 2-year follow-up, trained providers reported less anxiety (p = 0.02) and greater confidence (p = 0.01), compared to untrained providers. CONCLUSIONS Implementation of an in situ multidisciplinary pediatric trauma simulation-based training program may initially lead to increased anxiety, but long-term exposure may lead to greater confidence. LEVEL OF EVIDENCE II, Prospective cohort.
Collapse
Affiliation(s)
- Cory McLaughlin
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Minna M Wieck
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Erica Barin
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Alyssa Rake
- Division of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Rita V Burke
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Heather B Roesly
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - L. Caulette Young
- Division of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Todd P Chang
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Elizabeth A Cleek
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Inge Morton
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Catherine J Goodhue
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Randall S Burd
- Divisions of Trauma and Pediatric Surgery, Children’s National Medical Center, Washington, DC 20010
| | - Henri R Ford
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Jeffrey S Upperman
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Aaron R Jensen
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| |
Collapse
|
13
|
Armenia S, Thangamathesvaran L, Caine AD, King N, Kunac A, Merchant AM. The Role of High-Fidelity Team-Based Simulation in Acute Care Settings: A Systematic Review. Surg J (N Y) 2018; 4:e136-e151. [PMID: 30109273 PMCID: PMC6089798 DOI: 10.1055/s-0038-1667315] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/29/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction
High-fidelity team-based simulation has been identified as an effective way of teaching and evaluating both technical and nontechnical skills. Several studies have described the benefits of this modality in a variety of acute care settings, but a lack of standardized methodologies has resulted in heterogeneous findings. Few studies have characterized high fidelity simulation across a broad range of acute care settings and integrated the latest evidence on its educational and patient impact.
Methods
The MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases were searched for empirical studies from the last 10 years, investigating high fidelity team-based simulation in surgical, trauma, and critical care training curricula.
Results
Seventeen studies were included. Interventions and evaluations were comprehensively characterized for each study and were discussed in the context of four overarching acute care settings: the emergency department/trauma bay, the operating room, the intensive care unit, and inpatient ad hoc resuscitation teams.
Conclusions
The use of high-fidelity team-based simulation has expanded in acute care and is feasible and effective in a wide variety of specialized acute settings, including the emergency department/trauma bay, the operating room, the intensive care unit, and inpatient ad hoc resuscitation teams. Training programs have evolved to emphasize team-based, multidisciplinary education models and are often conducted in situ to maximize authenticity. In situ simulations have also provided the opportunity for system-level improvement and discussions of complex topics such as social hierarchy. There is limited evidence supporting the impact of simulation on patient outcomes, sustainability of simulation efforts, or cost-effectiveness of training programs. These areas warrant further research now that the scope of utilization across acute care settings has been characterized.
Collapse
Affiliation(s)
- Sarah Armenia
- Division of General Surgery, Department of Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey
| | - Loka Thangamathesvaran
- Division of General Surgery, Department of Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey
| | - Akia D Caine
- Division of General Surgery, Department of Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey
| | - Neil King
- Division of General Surgery, Department of Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey
| | - Anastasia Kunac
- Division of Trauma and Surgical Critical Care, Department of Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey
| | - Aziz M Merchant
- Division of General Surgery, Department of Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
14
|
|
15
|
Abstract
Given the meteoric rise in physician assistants and nurse practitioners in critical care units across the United States, identifying successful paradigms with which to train these clinicians is critical to help meet current and future demands. We describe an apprenticeship model of training that is deployable in any ICU including curriculum, didactic and procedural training, as well as 3- and 6-month benchmarks that embraces dedicated intensivist mentorship.
Collapse
|
16
|
Boling B, Hardin-Pierce M, Jensen L, Hassan ZU. Evaluation of a High-Fidelity Simulation Training Program for New Cardiothoracic Intensive Care Unit Nurses. Semin Thorac Cardiovasc Surg 2016; 28:770-775. [PMID: 28417863 DOI: 10.1053/j.semtcvs.2016.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 11/11/2022]
Abstract
The objective of this article is to evaluate the effect of a high-fidelity simulation training program on knowledge and confidence as part of a nursing internship in the cardiothoracic intensive care unit. Ten nurse interns each completed a simulation scenario involving common postoperative complications followed by a group debriefing session. Knowledge and confidence were assessed using a multiple-choice test and modified self-efficacy scale, respectively. Both were administered precourse and postcourse and again 2 weeks later. The simulation effectiveness tool, a 0-2 scale with higher scores indicating higher degree of perceived effectiveness, was used to evaluate participants׳ perceptions of the program. Paired t-tests compared precourse and postcourse scores as well as postcourse and follow-up scores for both knowledge and confidence. Spearman rho compared subjective with objective assessment of learning and improvement in learning with improvement in confidence. Mean knowledge scores improved from 48.18% (standard deviation [SD] = 14.7) to 60.9% (SD = 22.6; P < 0.05) and confidence scores improved from 20.8 (SD = 5.17) to 25.9 (SD = 3.3; P < 0.05), both with insignificant changes 2 weeks later. The simulation effectiveness tool mean score was 1.64 (SD = 0.56). There was no correlation between the objective and subjective learning assessments or between the improvement in learning and improvement in confidence. The inclusion of a high-fidelity simulation course showed improvement in both learning and confidence among the new graduate nurses; however, objective assessment of learning is needed. It is also important to note that an improvement in confidence may not indicate an improvement in actual ability.
Collapse
Affiliation(s)
- Bryan Boling
- College of Nursing, University of Kentucky, Lexington, Kentucky; Cardiothoracic Intensive Care Unit, UK Healthcare, Lexington, Kentucky.
| | | | - Lynne Jensen
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Zaki-Udin Hassan
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
17
|
Jansson MM, Syrjälä HP, Ohtonen PP, Meriläinen MH, Kyngäs HA, Ala-Kokko TI. Randomized, controlled trial of the effectiveness of simulation education: A 24-month follow-up study in a clinical setting. Am J Infect Control 2016; 44:387-93. [PMID: 26708025 DOI: 10.1016/j.ajic.2015.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/30/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Critical care nurses' knowledge and skills in adhering to evidence-based guidelines for avoiding complications associated with intubation and mechanical ventilation are currently limited. We hypothesized that single simulation education session would lead to a long-lasting higher level of skills among critical care nurses. MATERIAL AND METHODS A randomized controlled trial was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland during the period February 2012-March 2014. Thirty out of 40 initially randomized critical care nurses participated in a 24-month follow-up study. Behavior and cognitive development was evaluated through a validated Ventilator Bundle Observation Schedule and Questionnaire at the baseline measurement and repeated 3 times during simulation and real-life clinic settings. RESULTS After simulation education, the average skills score increased from 46.8%-58.8% of the total score in the final postintervention measurement (Ptime < .001, Ptime × group = .040, and Pgroup = .11). The average knowledge scores within groups did not change significantly. The average between-group difference in skills scores was significant only at the measurement taken at 6 months (P = .006). CONCLUSIONS Critical care nurses' skills in adhering to evidence-based guidelines improved in both groups over time, but the improvements between the study groups was significantly different only at 6 months and was no longer evident after 2 years following a single simulation education.
Collapse
|
18
|
Boling B, Hardin-Pierce M. The effect of high-fidelity simulation on knowledge and confidence in critical care training: An integrative review. Nurse Educ Pract 2015; 16:287-93. [PMID: 26520213 DOI: 10.1016/j.nepr.2015.10.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 07/21/2015] [Accepted: 10/06/2015] [Indexed: 11/28/2022]
Abstract
Patient outcomes in critical care have long been linked to provider experience, but with older providers retiring, it is becoming difficult to maintain a high-level of experience among the ICU staff. Innovative training methods that improve providers' knowledge and confidence may be able to make up for deficiencies in clinical experience. High-fidelity simulation training mimics clinical experience and has been extensively studied in the training of procedural skills, but what is the effect of this type of training on knowledge and confidence? To answer this question, we conducted a review of the literature for studies examining the effect of simulation training on knowledge and confidence among critical care providers. Seventeen papers were identified that met the inclusion criteria and a systematic approach was used to review the papers and synthesize the data. All 17 studies demonstrated an improvement in knowledge and while only 13 of the included studies examined the effect on provider confidence, all found an improvement. We conclude that high-fidelity simulation is a useful tool for improving knowledge and confidence among critical care providers and merits consideration for inclusion in critical care training programs.
Collapse
|
19
|
Miyasaka KW, Martin ND, Pascual JL, Buchholz J, Aggarwal R. A Simulation Curriculum for Management of Trauma and Surgical Critical Care Patients. JOURNAL OF SURGICAL EDUCATION 2015; 72:803-10. [PMID: 25921186 PMCID: PMC4540678 DOI: 10.1016/j.jsurg.2015.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/25/2015] [Accepted: 03/03/2015] [Indexed: 05/11/2023]
Abstract
BACKGROUND Expectations continue to rise for residency programs to provide integrated simulation training to address clinical competence. How to implement such training sustainably remains a challenge. We developed a compact module for first-year surgery residents integrating theory with practice in high-fidelity simulations, to reinforce the preparedness and confidence of junior residents in their ability to manage common emergent patient care scenarios in trauma and critical care surgery. METHODS The 3-day module features a combination of simulated patient encounters using standardized patients and electronic manikins, didactic sessions, and hands-on training. Manikin-based scenarios developed in-house were used to teach trauma and critical care management concepts and skills. Separate scenarios in collaboration with the regional organ donation program addressed communication in difficult situations such as brain death. Didactic material based on contemporary evidence, as well as skills stations, was developed to complement the scenarios. Residents were surveyed before and after training on their confidence in meeting the 14 learning objectives of the curriculum on a 5-point Likert scale. RESULTS Data from 15 residents who underwent this training show an overall improvement in confidence across all learning objectives defined for the module, with confidence scores before to after training improving significantly from 2.8 (σ = 0.85, median = 3) to 3.9 (σ = 0.87, median = 4) of 5, p < 0.001. Although female residents reported higher posttraining confidence scores compared with male residents (average 4.2 female vs 3.8 male, p = 0.002), there were no other significant differences in confidence scores or changes to scores owing to resident sex or program status (categorical or preliminary). CONCLUSION We successfully implemented a multimodal simulation-based curriculum that provides skills training integrated with the clinical context of managing trauma and critical care patients, simultaneously addressing a range of clinical competencies. Results to date show consistent improvement in residents' confidence in meeting learning objectives. Development of the curriculum continues for sustainability, as well as measures to embed objective evaluations of resident competence.
Collapse
Affiliation(s)
- Kiyoyuki W Miyasaka
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Niels D Martin
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jose L Pascual
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Buchholz
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rajesh Aggarwal
- Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada; Arnold and Blema Steinberg Medical Simulation Centre, Faculty of Medicine, McGill University, Montreal, Canada
| |
Collapse
|
20
|
Management strategies to effect change in intensive care units: lessons from the world of business. Part III. Effectively effecting and sustaining change. Ann Am Thorac Soc 2014; 11:454-7. [PMID: 24601653 DOI: 10.1513/annalsats.201311-393as] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, but would be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating an ICU environment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICU to one that is well integrated into the rest of the institution. Creating a "pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends.
Collapse
|
21
|
Rosenman ED, Shandro JR, Ilgen JS, Harper AL, Fernandez R. Leadership training in health care action teams: a systematic review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1295-306. [PMID: 25006708 DOI: 10.1097/acm.0000000000000413] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To identify and describe the design, implementation, and evidence of effectiveness of leadership training interventions for health care action (HCA) teams, defined as interdisciplinary teams whose members coordinate their actions in time-pressured, unstable situations. METHOD The authors conducted a systematic search of the PubMed/MEDLINE, CINAHL, ERIC, EMBASE, PsycINFO, and Web of Science databases, key journals, and review articles published through March 2012. They identified peer-reviewed English-language articles describing leadership training interventions targeting HCA teams, at all levels of training and across all health care professions. Reviewers, working in duplicate, abstracted training characteristics and outcome data. Methodological quality was evaluated using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS Of the 52 included studies, 5 (10%) focused primarily on leadership training, whereas the remainder included leadership training as part of a larger teamwork curriculum. Few studies reported using a team leadership model (2; 4%) or a theoretical framework (9; 17%) to support their curricular design. Only 15 studies (29%) specified the leadership behaviors targeted by training. Forty-five studies (87%) reported an assessment component; of those, 31 (69%) provided objective outcome measures including assessment of knowledge or skills (21; 47%), behavior change (8; 18%), and patient- or system-level metrics (8; 18%). The mean MERSQI score was 11.4 (SD 2.9). CONCLUSIONS Leadership training targeting HCA teams has become more prevalent. Determining best practices in leadership training is confounded by variability in leadership definitions, absence of supporting frameworks, and a paucity of robust assessments.
Collapse
Affiliation(s)
- Elizabeth D Rosenman
- Dr. Rosenman is acting instructor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington. Dr. Shandro is associate professor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington. Dr. Ilgen is assistant professor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington. Ms. Harper is associate librarian, Health Sciences Library, University of Washington Library Services, Seattle, Washington. Dr. Fernandez is associate professor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | | | | | | |
Collapse
|
22
|
McLaughlin CA, Hockenberry MJ, Kurtzberg J, Hueckel R, Martin PL, Docherty SL. Standardization of health care provider competencies for intrathecal access procedures. J Pediatr Oncol Nurs 2014; 31:304-16. [PMID: 25057001 DOI: 10.1177/1043454214543019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION This quality improvement (QI) project addresses a method for experienced health care providers to maintain skill-based competence for intrathecal access procedures. METHODS A prospective QI design using intrathecal access simulation to assess, educate, and evaluate skill competency. Simulation was used as a strategy to promote patient safety and standardize practice patterns. Pretest and posttest methodology using paired t tests were performed to assess anxiety, confidence, and knowledge. RESULTS Fourteen pediatric providers participated in this QI project. There was a statistically significant improvement in confidence measuring intracranial pressure (ICP; t = -2.92, P = .013), performance-related overall anxiety (t = -2.132, P = .05) and administering intrathecal chemotherapy (t = -2.144, P = .053). Fifty percent of participants missed a medication error demonstrating confirmation bias. CONCLUSION This simulation strategy resulted in improved confidence in measuring ICP, performance-related overall anxiety, and confidence in administering chemotherapy. Confirmation bias occurred during simulation testing for a medication error. We propose this method for maintaining clinical competencies in health care providers and introducing new skills to existing practices.
Collapse
Affiliation(s)
| | | | | | - Rémi Hueckel
- Duke University School of Nursing, Durham, NC, USA
| | | | | |
Collapse
|
23
|
Dietz AS, Pronovost PJ, Mendez-Tellez PA, Wyskiel R, Marsteller JA, Thompson DA, Rosen MA. A systematic review of teamwork in the intensive care unit: what do we know about teamwork, team tasks, and improvement strategies? J Crit Care 2014; 29:908-14. [PMID: 25001565 DOI: 10.1016/j.jcrc.2014.05.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/13/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Teamwork is essential for ensuring the quality and safety of health care delivery in the intensive care unit (ICU). This article addresses what we know about teamwork, team tasks, and team improvement strategies in the ICU to identify the strengths and limitations of the existing knowledge base to guide future research. METHODS A keyword search of the PubMed database was conducted in February 2013. Keyword combinations focused on 3 areas: (1) teamwork, (2) the ICU, and (3) training/quality improvement interventions. All studies that investigated teamwork, team tasks, or team interventions within the ICU (ie, intradepartment) were selected for inclusion. RESULTS Teamwork has been investigated across an array of research contexts and task types. The terminology used to describe team factors varied considerably across studies. The most common team tasks involved strategy and goal formulation. Team training and structured protocols were the most widely implemented quality improvement strategies. CONCLUSIONS Team research is burgeoning in the ICU, yet low-hanging fruit remains that can further advance the science of teams in the ICU if addressed. Constructs must be defined, and theoretical frameworks should be referenced. The functional characteristics of tasks should also be reported to help determine the extent to which study results might generalize to other contexts of work.
Collapse
Affiliation(s)
- Aaron S Dietz
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Peter J Pronovost
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Pedro Alejandro Mendez-Tellez
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Rhonda Wyskiel
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Jill A Marsteller
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - David A Thompson
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Michael A Rosen
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA.
| |
Collapse
|
24
|
Johnson MP, Hickey KT, Scopa-Goldman J, Andrews T, Boerem P, Covec M, Larson E. Manikin Versus Web-Based Simulation for Advanced Practice Nursing Students. Clin Simul Nurs 2014. [DOI: 10.1016/j.ecns.2014.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
25
|
Eikeland Husebø SI, Bjørshol CA, Rystedt H, Friberg F, Søreide E. A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams. Scand J Trauma Resusc Emerg Med 2012; 20:23. [PMID: 22472128 PMCID: PMC3361478 DOI: 10.1186/1757-7241-20-23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 04/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR) in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance. METHODS We studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14) performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14) performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance. RESULTS Overall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio.We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables. CONCLUSION We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team-training of nursing students.
Collapse
|