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Farquharson B, Cortegiani A, Lauridsen KG, Yeung J, Greif R, Nabecker S. Teaching team competencies within resuscitation training: A systematic review. Resusc Plus 2024; 19:100687. [PMID: 39006135 PMCID: PMC11239706 DOI: 10.1016/j.resplu.2024.100687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 07/16/2024] Open
Abstract
Objectives To evaluate the effectiveness of life support training with specific emphasis on team competencies on clinical and educational outcomes. Methods This systematic review was prospectively registered (PROSPERO CRD42023473154) and followed the PICOST (population, intervention, comparison, outcome, study design, timeframe) format. All randomized controlled trials and non-randomized studies evaluating learners undertaking life support training with specific emphasis on team competencies in any setting (actual and simulated resuscitations) were included. Unpublished studies were excluded. Medline, Embase and Cochrane databases as well as trial registries were searched from inception to August 2023 (updated January 18, 2024). Two researchers performed title and abstract screening, full-text screening, data extraction, assessment of risk of bias (using RoB2 and ROBINS-I) and certainty of evidence (using GRADE). PRISMA reporting checklist was used to report the results. No funding was obtained to perform this systematic review. Results The literature search identified 5470 manuscripts. After the removal of 2073 duplicates, reviewing the remaining articles' titles and abstracts yielded 31 articles for full-text review. Of these, 17 studies were finally included. The studies involved the following training levels: basic life support, adult advanced life support, paediatric and neonatal resuscitations. Most studies (n = 16) evaluated outcomes in simulated, and only one study in actual resuscitations. Studies included in all training contexts showed either neutrality and/or benefits of life support training with specific emphasis on team competencies. Team competencies training improved CPR skill performance and CPR quality. Specific team competencies that improved included leadership, communication, decision-making and task management. No undesirable effects were observed. Meta-analysis was not possible due to significant methodological heterogeneity. Sub-group analysis was impossible due to lack of data. Risk of bias assessment ranged from some concerns to serious. Overall certainty of evidence was rated as low to very low due to risk of bias and imprecision. Conclusion This systematic review identified very low and low certainty evidence, almost entirely derived from simulation studies. The studies and their findings were heterogenous but suggest that teaching team competencies can improve resuscitation skills performance and CPR quality, as well as improve team competencies, specifically leadership, communication, decision-making, and task management. Further research is required to understand optimal configuration of team competencies training interventions and to understand the effect on clinical outcomes and cost-effectiveness.
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Affiliation(s)
- Barbara Farquharson
- Faculty of Health Sciences & Sport, University of Stirling, Stirling, United Kingdom
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency. University Hospital Policlinico ’Paolo Giaccone’, Palermo, Italy
| | - Kasper G. Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Robert Greif
- Department of Surgical Science, University of Torino, Torino, Italy
- University of Bern, Bern, Switzerland
| | - Sabine Nabecker
- Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada
| | - Education Implementation Team Task Force of the International Liaison Committee on Resuscitation ILCOR1
- Faculty of Health Sciences & Sport, University of Stirling, Stirling, United Kingdom
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency. University Hospital Policlinico ’Paolo Giaccone’, Palermo, Italy
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Department of Surgical Science, University of Torino, Torino, Italy
- University of Bern, Bern, Switzerland
- Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada
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2
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Hartwell V, Edmunds K, Elliott L, Williams B, Menk PT, Geis GL. Validity evidence for a team-leading assessment tool in pediatric emergency resuscitations using video review. AEM EDUCATION AND TRAINING 2024; 8:e10985. [PMID: 38693936 PMCID: PMC11058601 DOI: 10.1002/aet2.10985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024]
Abstract
Background Effective leadership of health care action teams has demonstrated positive influence on team performance and patient care, but there is no consensus on how to assess these skills. We developed a novel team leadership assessment tool for leaders of interprofessional pediatric resuscitation teams and collected validity evidence for this tool using video review. Methods This was a prospective cohort study from November 2021 to October 2022. A novel team leadership assessment tool was developed using literature review and local expertise and then piloted and refined using medical simulation. Pediatric emergency medicine (PEM) fellows from a single tertiary care pediatric medical center were enrolled, and videos of one medical resuscitation and one trauma resuscitation were collected per fellow each month. Three reviewers underwent reviewer training and then scored the videos using the assessment tool. Raters provided feedback on feasibility and ease of use using a 5-point Likert scale. Inter-rater reliability for the assessment tool using Gwet's agreement coefficient and the association between performance and clinical level of training using generalized linear mixed model were calculated. Results Twelve PEM fellows enrolled and 146 videos were reviewed. The inter-rater reliability for each domain ranged from 0.45 (p < 0.0001) to 0.59 (p < 0.0001), with the inter-rater reliability of the total score being 0.49 (p < 0.0001). The reviewers' mean ratings of the elements of the tool were as follows: clarity of the domains (4.6/5), the independence of each domain from each other (3.9/5), the ease of use of the 5-point Likert scale (4.5/5), the usefulness of the provided examples for each domain (4.6/5), and the ability to assess each domain without having to rewatch (4.5/5). The tool differentiated between levels of clinical training for two of the six domains (p < 0.02). Conclusions We developed a novel team leadership assessment tool for pediatric resuscitation team leaders that demonstrated moderate inter-rater reliability. The tool was easy to use and feasible for educators to assess the performance of PEM trainees in complex high-stakes clinical situations.
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Affiliation(s)
- Victoria Hartwell
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Katherine Edmunds
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Laura Elliott
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Present address:
PM PediatricsNew Hyde ParkNYUSA
| | - Brenda Williams
- Center for Simulation and ResearchCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Paul T. Menk
- Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Present address:
Pediatric Emergency Medicine, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of MedicineAtlantaGAUSA
| | - Gary L. Geis
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Center for Simulation and ResearchCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
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Deodatus JA, Kratz MA, Steller M, Veeger N, Dercksen B, Lyon RM, Rehn M, Rognås L, Coniglio C, Sheridan B, Tschautscher C, Lockey DJ, Ter Avest E. Attributes of leadership skill development in high-performance pre-hospital medical teams: results of an international multi-service prospective study. Scand J Trauma Resusc Emerg Med 2024; 32:46. [PMID: 38773532 PMCID: PMC11107030 DOI: 10.1186/s13049-024-01221-1] [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: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUNDS Team leadership skills of physicians working in high-performing medical teams are directly related to outcome. It is currently unclear how these skills can best be developed. Therefore, in this multi-national cross-sectional prospective study, we explored the development of these skills in relation to physician-, organization- and training characteristics of Helicopter Emergency Medicine Service (HEMS) physicians from services in Europe, the United States of America and Australia. METHODS Physicians were asked to complete a survey regarding their HEMS service, training, and background as well as a full Leader Behavior Description Questionnaire (LBDQ). Primary outcomes were the 12 leadership subdomain scores as described in the LBDQ. Secondary outcome measures were the association of LBDQ subdomain scores with specific physician-, organization- or training characteristics and self-reported ways to improve leadership skills in HEMS physicians. RESULTS In total, 120 HEMS physicians completed the questionnaire. Overall, leadership LBDQ subdomain scores were high (10 out of 12 subdomains exceeded 70% of the maximum score). Whereas physician characteristics such as experience or base-specialty were unrelated to leadership qualities, both organization- and training characteristics were important determinants of leadership skill development. Attention to leadership skills during service induction, ongoing leadership training, having standards in place to ensure (regular) scenario training and holding structured mission debriefs each correlated with multiple LBDQ subdomain scores. CONCLUSIONS Ongoing training of leadership skills should be stimulated and facilitated by organizations as it contributes to higher levels of proficiency, which may translate into a positive effect on patient outcomes. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- J A Deodatus
- Department of Acute Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M A Kratz
- Emergency Medical Services, Centre for Prehospital Emergency Care, Department of Emergency, Anaesthesia and Pain Medicine, FinnHEMS 30 & 40, Tampere University, Tampere, Finland
| | - M Steller
- Department of Acute Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - N Veeger
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - B Dercksen
- Mobile Medical Team (MMT), Lifeliner 4, Eelde, the Netherlands
- Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R M Lyon
- Air Ambulance Kent Surrey Sussex & Department of Health Sciences, University of Surrey, Redhill, UK
| | - M Rehn
- Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - L Rognås
- The Danish Air Ambulance, Brendstrupgårdsvej 7, 2. Th, 8200, Aarhus N, Denmark
| | - C Coniglio
- Department of Anesthesia, Intensive Care and Pre-Hospital Emergency Medical Services, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - B Sheridan
- Department of Anaesthesia and Hunter Retrieval Service, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW, 2305, Australia
| | - C Tschautscher
- Department of Emergency Medicine, School of Medicine and Public Health, UW Health Med Flight and Berbee Walsh University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA
| | - D J Lockey
- London's Air Ambulance and Bart's Health NHS Trust, Royal London Hospital, London, E1 1FR, UK
| | - E Ter Avest
- Department of Acute Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- London's Air Ambulance and Bart's Health NHS Trust, Royal London Hospital, London, E1 1FR, UK.
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Sumera K, Ilczak T, Bakkerud M, Lane JD, Pallas J, Martorell SO, Sumera A, Webster CA, Quinn T, Sandars J, Niroshan Siriwardena A. CPR Quality Officer role to improve CPR quality: A multi-centred international simulation randomised control trial. Resusc Plus 2024; 17:100537. [PMID: 38261942 PMCID: PMC10796959 DOI: 10.1016/j.resplu.2023.100537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Background An out-of-hospital cardiac arrest requires early recognition, prompt and quality clinical interventions, and coordination between different clinicians to improve outcomes. Clinical team leaders and clinical teams have high levels of cognitive burden. We aimed to investigate the effect of a dedicated Cardio-Pulmonary Resuscitation (CPR) Quality Officer role on team performance. Methods This multi-centre randomised control trial used simulation in universities from the UK, Poland, and Norway. Student Paramedics participated in out-of-hospital cardiac arrest scenarios before randomisation to either traditional roles or assigning one member as the CPR Quality Officer. The quality of CPR was measured using QCPR® and Advanced Life Support (ALS) elements were evaluated. Results In total, 36 teams (108 individuals) participated. CPR quality from the first attempt (72.45%, 95% confidence interval [CI] 64.94 to 79.97) significantly increased after addition of the CPR Quality role (81.14%, 95% CI 74.20 to 88.07, p = 0.045). Improvement was not seen in the control group. The time to first defibrillation had no significant difference in the intervention group between the first attempt (53.77, 95% CI 36.57-70.98) and the second attempt (48.68, 95% CI 31.31-66.05, p = 0.84). The time to manage an obstructive airway in the intervention group showed significant difference (p = 0.006) in the first attempt (168.95, 95% CI 110.54-227.37) compared with the second attempt (136.95, 95% CI 87.03-186.88, p = 0.1). Conclusion A dedicated CPR Quality Officer in simulated scenarios improved the quality of CPR compressions without a negative impact on time to first defibrillation, managing the airway, or adherence to local ALS protocols.
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Affiliation(s)
- Kacper Sumera
- East Midlands Ambulance Service NHS Trust, Education, Nottingham NG11 8NS, UK
- European Pre-hospital Research Network, United Kingdom
| | - Tomasz Ilczak
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biała, Poland
- European Pre-hospital Research Network, United Kingdom
| | - Morten Bakkerud
- Oslo Metropolitan University, Department of Nursing and Health Promotion, Pilestredet 32, 0166 Oslo, Norway
- European Pre-hospital Research Network, United Kingdom
| | - Jon Dearnley Lane
- Edge Hill University, Allied Health, Social Work & Wellbeing, Ormskirk L39 4QP, UK
| | - Jeremy Pallas
- John Hunter Hospital, Emergency Department, NSW 2305, Australia
| | - Sandra Ortega Martorell
- Liverpool John Moores University, School of Computer Science and Mathematics, Liverpool L3 5UX, UK
| | - Agnieszka Sumera
- University of Chester, Faculty of Health, Medicine & Society, Chester CH1 1SL, UK
- European Pre-hospital Research Network, United Kingdom
| | - Carl A. Webster
- Nottingham Trent University, Institute of Health and Allied Professions, Nottingham NG11 8NS, UK
- European Pre-hospital Research Network, United Kingdom
| | - Tom Quinn
- Kingston University & St George’s, University of London, Centre for Health and Social Care Research, London KT2 7LB, UK
- European Pre-hospital Research Network, United Kingdom
| | - John Sandars
- Edge Hill University, Allied Health, Social Work & Wellbeing, Ormskirk L39 4QP, UK
| | - A. Niroshan Siriwardena
- University of Lincoln, School of Health and Social Care, Lincoln LN6 7TS, UK
- European Pre-hospital Research Network, United Kingdom
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Bernardino-Santos M, Arnal-Velasco D, Reboto-Cortés P, Garmendia-Fernandez C, Renilla-Sánchez E, Navalón-Liceras RJ, Botillo-Pérez E, Ortega MA, Gómez-Arnau Díaz-Cañabate JI, De León-Luis JA. Comparative Analysis of the Impact of Training through Simulation Using the Crisis Resource Management Tool for Primary Care Professionals. Healthcare (Basel) 2024; 12:230. [PMID: 38255117 PMCID: PMC10815590 DOI: 10.3390/healthcare12020230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
This was a prospective observational study based on clinical simulation courses taught in 2017 at the IDEhA Simulation Center of Alcorcón Foundation University Hospital. Two courses in metabolic emergencies (MEs) and respiratory emergencies (REs) were offered to primary care physicians all over Spain. The main objective was to teach nontechnical skills (crisis resource management). Using a modified five-level Kirkpatrick-Phillips education evaluation model, level I (reaction, K1), level II (learning, K2) and level III (behavioral change, K3) changes were evaluated through surveys at the end of the courses and one year later. Thirty courses were held (15 ME courses and 15 RE courses) with 283 primary care physicians. The overall satisfaction (K1) was high: ME courses, 9.5/10; RE courses, 9.6/10. More than 80% of the participants rated the organization, resources, content, debriefing and scenarios as excellent, with no significant differences between the two courses. After one year (156 responses), the respondents for both courses reported that they would repeat the training annually (K2), encourage debriefing with colleagues (K3) and have modified some aspects of their workplace (K3), citing improvements in procedures and in the organization of the health team as the most important. After the ME course, few participants, i.e., 5 (6%), reported providing improved care to patients; after the RE course, 15 (19%) participants reported providing improved care; the difference between groups was significant (p < 0.05). Compared with the ME course, the RE course imparted greater knowledge about patient safety (K2) (38 (49%) vs. 24 (31%) (p < 0.05)) and more useful tools for daily clinical practice (K3) (67% vs. 56.4%) and resulted in participants paying more attention to personal performance and to colleagues when working as a team (K2) (64% vs. 50%). Clinical simulation courses are highly valued and potentially effective for training primary care physicians in patient safety and CRM tools. Future studies with objective measures of long-term impact, behavior in the workplace (K3) and benefits to patients (K4) are needed. Based on the results of our study, the areas that are important are those aimed at improving procedures and the organization of health teams.
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Affiliation(s)
- Marta Bernardino-Santos
- Department of Anesthesiology and Reanimation, University Hospital Fundación Alcorcón, 28922 Madrid, Spain; (M.B.-S.); (D.A.-V.); (P.R.-C.); (R.J.N.-L.); (J.I.G.-A.D.-C.)
- IDEhA Simulation Center, University Hospital Fundación Alcorcón, 28922 Alcorcon, Spain;
| | - Daniel Arnal-Velasco
- Department of Anesthesiology and Reanimation, University Hospital Fundación Alcorcón, 28922 Madrid, Spain; (M.B.-S.); (D.A.-V.); (P.R.-C.); (R.J.N.-L.); (J.I.G.-A.D.-C.)
| | - Pilar Reboto-Cortés
- Department of Anesthesiology and Reanimation, University Hospital Fundación Alcorcón, 28922 Madrid, Spain; (M.B.-S.); (D.A.-V.); (P.R.-C.); (R.J.N.-L.); (J.I.G.-A.D.-C.)
| | | | | | - Ricardo Jose Navalón-Liceras
- Department of Anesthesiology and Reanimation, University Hospital Fundación Alcorcón, 28922 Madrid, Spain; (M.B.-S.); (D.A.-V.); (P.R.-C.); (R.J.N.-L.); (J.I.G.-A.D.-C.)
| | - Elena Botillo-Pérez
- IDEhA Simulation Center, University Hospital Fundación Alcorcón, 28922 Alcorcon, Spain;
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, University of Alcala, 28871 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Juan Ignacio Gómez-Arnau Díaz-Cañabate
- Department of Anesthesiology and Reanimation, University Hospital Fundación Alcorcón, 28922 Madrid, Spain; (M.B.-S.); (D.A.-V.); (P.R.-C.); (R.J.N.-L.); (J.I.G.-A.D.-C.)
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
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6
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Naylor K, Chrzanowska-Wąsik M, Okońska P, Kucmin T, Al-Wathinani AM, Goniewicz K. Adapting to a Pandemic: Web-Based Residency Training and Script Concordance Testing in Emergency Medicine During COVID-19. Disaster Med Public Health Prep 2023; 17:e541. [PMID: 38018433 DOI: 10.1017/dmp.2023.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The coronavirus disease (COVID-19) pandemic necessitated alternative methods to ensure the continuity of medical education. Our study explores the efficacy and acceptability of a digital continuous medical education initiative for medical residents during this challenging period. METHODS From September to December 2020, 47 out of 60 enrolled trainee doctors participated in this innovative digital Continuous Medical Education (CME) approach. We utilized the Script Concordance Test to bolster clinical reasoning skills. Three simulation scenarios, namely Advanced Trauma Life Support (ATLS), Advanced Life Support (ALS), and European Paediatric Life Support (EPLS), were transformed into interactive online sessions via Zoom™. Participant feedback was also collected through a survey. RESULTS Consistent Script Concordance Testing (SCT) scores among participants indicated the effectiveness of the online training module. Feedback suggested a broad acceptance of this novel training approach. However, discrepancies observed between formative SCT scores, and summative Multiple-Choice Questions (MCQ) assessments highlighted areas for potential refinement. CONCLUSIONS Our findings showcase the resilience and adaptability of medical education amidst challenges like the global pandemic. The success of methodologies such as SCT, endorsed by prestigious bodies like the European Resuscitation Council and the American Heart Association, suggests their potential in preparing health care professionals for emergent situations. This research offers valuable insights for shaping future online CME strategies.
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Affiliation(s)
- Katarzyna Naylor
- Independent Unit of Emergency Medical Services and Specialist Emergency, Medical University of Lublin, Lublin, Poland
| | | | - Patrycja Okońska
- Department of Emergency Medicine, Medical University of Lublin, Lublin, Poland
| | - Tomasz Kucmin
- Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
| | - Ahmed M Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Saudi Arabia
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Seelandt JC, Boos M, Kolbe M, Kämmer JE. How to enrich team research in healthcare by considering five theoretical perspectives. Front Psychol 2023; 14:1232331. [PMID: 37637888 PMCID: PMC10448055 DOI: 10.3389/fpsyg.2023.1232331] [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: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.
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Affiliation(s)
| | - Margarete Boos
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
| | - Michaela Kolbe
- Simulation Center, University Hospital Zürich, Zürich, Switzerland
- ETH Zurich, Zürich, Switzerland
| | - Juliane E. Kämmer
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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8
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Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
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Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
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9
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Analysis of Emergency Medical Response Team Performance during the International Winter Championships in Emergency Medicine. Medicina (B Aires) 2022; 58:medicina58111578. [DOI: 10.3390/medicina58111578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Objectives: Conducting advanced life support (ALS) according to the guidelines of the European Resuscitation Council (ERC) requires medical personnel to implement the appropriate emergency actions. In particular, these actions include chest compressions, airway management, artificial ventilation, defibrillation and the administering of medicines. An appropriate training system enables members of medical response teams (MRT) to acquire the essential knowledge and skills necessary to correctly conduct cardiopulmonary resuscitation (CPR). One way to improve the quality of interventions by MRT personnel is participation in emergency medicine championships. Materials and Methods: The research analysed assessment cards for tasks carried out during the International Winter Championships in Emergency Medicine in the years 2013–2020. The assessed tasks were prepared and led by European Resuscitation Council instructors of advanced life support. During ten-minute scenarios of simulated sudden cardiac arrest (SCA) in adults, the judges assessed the compliance of procedures with current ERC guidelines. This research analysed the performance of 309 teams from Poland made up of paramedics from medical response units from all over the country. Results: In most cases, the study showed significant differences in the percentage of correctly performed procedures between years. Most often, the highest percentage of correctly performed procedures was recorded in 2019 and 2020. The lowest percentage of correctly performed procedures was most often recorded in 2013. In subsequent years, the percentage of use of tracheal intubation decreased (from 54.76% to 31.25%) in favour of an increase in the use of supraglottic airway device SAD (from 35.71% to 59.38%). Conclusions: The research has shown that in subsequent years of the Championships, the quality of the majority of assessed procedures carried out by members of MRT gradually improved. The research authors also observed that in subsequent years, the percentage of intubations decreased in favour of SAD.
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Gartland R, Conlon L, Livingston S, Glick JE, Bach G, Abboud ME. Resuscitation Leadership Training: A Simulation Curriculum for Emergency Medicine Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11278. [PMID: 36300144 PMCID: PMC9550795 DOI: 10.15766/mep_2374-8265.11278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/08/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Throughout training, emergency medicine (EM) residents must learn to work within, and eventually lead, multidisciplinary teams in high-acuity dynamic situations. Most residents do not undergo formal resuscitation team leadership training but learn these skills through mentorship by and observation of senior physicians. We designed and implemented a formal simulation-based leadership training program for EM residents. METHODS We developed a resuscitation team leadership curriculum in which 24 junior EM residents participated in an initial simulation of a critically ill patient before undergoing a didactic presentation regarding crisis resource management (CRM) principles. Residents applied those principles in three subsequent simulations. Faculty observers evaluated each case using EM Milestones, the Ottawa Global Rating Scale (GRS), and critical actions checklists. Residents then completed surveys evaluating their own leadership and communication skills before and after the course. RESULTS Scores from the Ottawa GRS, critical actions checklists, and several of the EM Milestones were significantly better in the latter three cases (after completing the CRM didactics) than in the first case. After completing this curriculum, residents felt that their ability to both lead resuscitations and communicate effectively with their team improved. DISCUSSION Implementation of the resuscitation team leadership curriculum improved EM residents' leadership performance in critically ill patient scenarios. The curriculum also improved residents' comfort in leading and communicating with a team. Similar formal leadership development curricula, especially when combined with simulation, may enhance EM physician training. Future studies will include other multidisciplinary team members to create a more realistic and inclusive learning environment.
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Affiliation(s)
- Rachel Gartland
- Instructor of Clinical Emergency Medicine, Department of Emergency Medicine, University of Rochester Medical Center
| | - Lauren Conlon
- Associate Professor, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Scott Livingston
- Second-Year Resident, Department of Emergency Medicine, Hospital of the University of Pennsylvania
| | - Joshua E. Glick
- Assistant Professor, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Gillian Bach
- First-Year Fellow, Department of Emergency Medicine, Hospital of the University of Pennsylvania
| | - Michael E. Abboud
- Assistant Professor, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania
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Silva JAM, Mininel VA, Fernandes Agreli H, Peduzzi M, Harrison R, Xyrichis A. Collective leadership to improve professional practice, healthcare outcomes and staff well-being. Cochrane Database Syst Rev 2022; 10:CD013850. [PMID: 36214207 PMCID: PMC9549469 DOI: 10.1002/14651858.cd013850.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Collective leadership is strongly advocated by international stakeholders as a key approach for health service delivery, as a response to increasingly complex forms of organisation defined by rapid changes in health technology, professionalisation and growing specialisation. Inadequate leadership weakens health systems and can contribute to adverse events, including refusal to prioritise and implement safety recommendations consistently, and resistance to addressing staff burnout. Globally, increases in life expectancy and the number of people living with multiple long-term conditions contribute to greater complexity of healthcare systems. Such a complex environment requires the contribution and leadership of multiple professionals sharing viewpoints and knowledge. OBJECTIVES: To assess the effects of collective leadership for healthcare providers on professional practice, healthcare outcomes and staff well-being, when compared with usual centralised leadership approaches. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 5 January 2021. We also searched grey literature, checked references for additional citations and contacted study authors to identify additional studies. We did not apply any limits on language. SELECTION CRITERIA Two groups of two authors independently reviewed, screened and selected studies for inclusion; the principal author was part of both groups to ensure consistency. We included randomised controlled trials (RCTs) that compared collective leadership interventions with usual centralised leadership or no intervention. DATA COLLECTION AND ANALYSIS Three groups of two authors independently extracted data from the included studies and evaluated study quality; the principal author took part in all groups. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We identified three randomised trials for inclusion in our synthesis. All studies were conducted in acute care inpatient settings; the country settings were Canada, Iran and the USA. A total of 955 participants were included across all the studies. There was considerable variation in participants, interventions and measures for quantifying outcomes. We were only able to complete a meta-analysis for one outcome (leadership) and completed a narrative synthesis for other outcomes. We judged all studies as having an unclear risk of bias overall. Collective leadership interventions probably improve leadership (3 RCTs, 955 participants). Collective leadership may improve team performance (1 RCT, 164 participants). We are uncertain about the effect of collective leadership on clinical performance (1 RCT, 60 participants). We are uncertain about the intervention effect on healthcare outcomes, including health status (inpatient mortality) (1 RCT, 60 participants). Collective leadership may slightly improve staff well-being by reducing work-related stress (1 RCT, 164 participants). We identified no direct evidence concerning burnout and psychological symptoms. We are uncertain of the intervention effects on unintended consequences, specifically on staff absence (1 RCT, 60 participants). AUTHORS' CONCLUSIONS: Collective leadership involves multiple professionals sharing viewpoints and knowledge with the potential to influence positively the quality of care and staff well-being. Our confidence in the effects of collective leadership interventions on professional practice, healthcare outcomes and staff well-being is moderate in leadership outcomes, low in team performance and work-related stress, and very low for clinical performance, inpatient mortality and staff absence outcomes. The evidence was of moderate, low and very low certainty due to risk of bias and imprecision, meaning future evidence may change our interpretation of the results. There is a need for more high-quality studies in this area, with consistent reporting of leadership, team performance, clinical performance, health status and staff well-being outcomes.
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Affiliation(s)
| | | | | | - Marina Peduzzi
- Professional Orientation Department, University of Sao Paulo, Sao Paulo, Brazil
| | - Reema Harrison
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Nabecker S, Huwendiek S, Seidl C, Hana A, Theiler L, Greif R. Assessment of Human Factors After Advanced Life Support Courses Comparing Simulated Team and Real Team Assessment: A Randomized Controlled Cohort Trial. Front Cardiovasc Med 2022; 9:840114. [PMID: 35911508 PMCID: PMC9335945 DOI: 10.3389/fcvm.2022.840114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
AimHuman factors are essential for high-quality resuscitation team collaboration and are, therefore, taught in international advanced life support courses, but their assessment differs widely. In Europe, the summative life support course assessment tests mainly adhere to guidelines but few human factors. This randomized controlled simulation trial investigated instructors’ and course participants’ perceptions of human factors assessment after two different summative assessments.MethodsAll 5th/6th-year medical students who attended 19 advanced life support courses according to the 2015 European Resuscitation Council guidelines during one study year were invited to participate. Each course was randomized to either: (1) Simulated team assessment (one instructor simulates a team, and the assessed person leads this “team” through a cardiac-arrest scenario test); (2) Real team assessment (4 students form a team, one of them is assessed as the team leader; team members are not assessed and act only on team leader’s commands). After the summative assessments, instructors, and students rated the tests’ ability to assess human factors using a visual analog scale (VAS, 0 = no agreement, 10 = total agreement).ResultsA total of 227 students participated in the 1-day Immediate Life Support courses, 196 students in the 2-day Advanced Life Support courses, additionally 54 instructors were included. Instructors judged all human factors significantly better in real team assessments; students rated leadership and situational awareness comparable between both assessments. Assessment pass rates were comparable between groups.ConclusionSummative assessment in real teams was perceived significantly better to assess human factors. These results might influence current summative assessment practices in advanced life support courses.
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Affiliation(s)
- Sabine Nabecker
- Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, ON, Canada
- ERC Research NET, Niel, Belgium
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
- *Correspondence: Sabine Nabecker,
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Christian Seidl
- EMS Rescue Service of the Canton Basel-Stadt, Basel, Switzerland
| | - Anisa Hana
- Department of Intensive Care Medicine, Laurentius Hospital, Roermond, Netherlands
| | - Lorenz Theiler
- Department of Anesthesia, Kantonsspital Aarau, Aarau, Switzerland
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- ERC Research NET, Niel, Belgium
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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13
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Peltan ID, Guidry D, Brown K, Kumar N, Beninati W, Brown SM. Telemedical Intensivist Consultation During In-Hospital Cardiac Arrest Resuscitation: A Simulation-Based, Randomized Controlled Trial. Chest 2022; 162:111-119. [PMID: 35063451 DOI: 10.1016/j.chest.2022.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High-quality leadership improves resuscitation for in-hospital cardiac arrest (IHCA), but experienced resuscitation leaders are unavailable in many settings. RESEARCH QUESTION Does real-time telemedical intensivist consultation improve resuscitation quality for IHCA? STUDY DESIGN AND METHODS In this multicenter randomized controlled trial, standardized high-fidelity simulations of IHCA conducted between February 2017 and September 2018 on inpatient medicine and surgery units at seven hospitals were assigned randomly to consultation (intervention) or simulated observation (control) by a critical care physician via telemedicine. The primary outcome was the fraction of time without chest compressions (ie, no-flow fraction) during an approximately 4- to 6-min analysis window beginning with telemedicine activation. Secondary outcomes included other measures of chest compression quality, defibrillation and medication timing, resuscitation protocol adherence, nontechnical team performance, and participants' experience during resuscitation participation. RESULTS No-flow fraction did not differ between the 36 intervention group (0.22 ± 0.13) and the 35 control group (0.19 ± 0.10) resuscitation simulations included in the intention-to-treat analysis (P = .41). The etiology of the simulated cardiac arrest was identified more often during evaluable resuscitations supported by a telemedical intensivist consultant (22/32 [69%]) compared with control resuscitations (10/34 [29%]; P = .001), but other measures of resuscitation quality, resuscitation team performance, and participant experience did not differ between intervention groups. Problems with audio quality or the telemedicine connection affected 14 intervention group resuscitations (39%). INTERPRETATION Consultation by a telemedical intensivist physician did not improve resuscitation quality during simulated ward-based IHCA. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03000829; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Ithan D Peltan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT.
| | - David Guidry
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT
| | - Katie Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT
| | - Naresh Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT
| | - William Beninati
- Telehealth Program, Intermountain Healthcare, Salt Lake City, UT; Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT
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Yang WS, Yen P, Wang YC, Chien YC, Chie WC, Ma MHM, Chiang WC. Objective performance of emergency medical technicians in the use of mechanical cardiopulmonary resuscitation compared with subjective self-evaluation: a cross-sectional, simulation-based study. BMJ Open 2022; 12:e062908. [PMID: 35768109 PMCID: PMC9244722 DOI: 10.1136/bmjopen-2022-062908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the subjective and objective resuscitation performance of emergency medical technicians (EMTs) using mechanical cardiopulmonary resuscitation (MCPR) devices. DESIGN AND SETTING This was a cross-sectional simulation-based study where participants installed the MCPR device on a training manikin. PARTICIPANTS We assessed EMT-Intermediates (EMT-Is) and EMT-Paramedics (EMT-Ps) of the Emergency Medical Services (Ambulance) Division of the Taipei City Fire Department. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the gap between self-perceived (subjective) and actual (objective) no-flow time during resuscitation, which we hypothesised as statistically insignificant. The secondary outcome was the association between resuscitation performance and personal attributes like knowledge, attitude and self-confidence. RESULTS Among 210 participants between 21 and 45 years old, only six were female. There were 144 EMT-Is and 66 EMT-Ps. During a simulated resuscitation lasting between four and a half and 5 min, EMTs had longer actual no-flow time compared with self-perceived no-flow time (subjective, 38 s; objective, 57.5 s; p value<0.001). This discrepancy could cause a 6.5% drop of the chest compression fraction in a resuscitation period of 5 min. Among the EMT personal factors, self-confidence was negatively associated with objective MCPR deployment performance (adjusted OR (aOR) 0.66, 95% CI 0.45 to 0.97, p=0.033) and objective teamwork performance (aOR 0.57, 95% CI 0.34 to 0.97, p=0.037) for EMT-Ps, whereas knowledge was positively associated with objective MCPR deployment performance (aOR 2.15, 95% CI 1.31 to 3.52, p=0.002) and objective teamwork performance (aOR 1.77, 95% CI 1.02 to 3.08, p=0.043) for EMT-Is. Moreover, regarding the self-evaluation of no-flow time, both self-satisfaction and self-abasement were associated with objectively poor teamwork performance. CONCLUSIONS EMTs' subjective and objective performance was inconsistent during the MCPR simulation. Self-confidence and knowledge were personal factors associated with MCPR deployment and teamwork performance. Both self-satisfaction and self-abasement were detrimental to teamwork during resuscitation.
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Affiliation(s)
- Wen-Shuo Yang
- Emergency Medical Services (Ambulance) Division, Taipei City Fire Department, Taipei City, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Ping Yen
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Yao-Cheng Wang
- Fourth District Headquarters, Taipei City Fire Department, Taipei City, Taiwan
| | - Yu-Chun Chien
- Emergency Medical Services Division, National Fire Agency, Ministry of the Interior, New Taipei City, Taiwan
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu City, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu City, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
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15
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Sabqat M, Khan RA, Yasmin R, Mahboob U. Exploring developmental assignments shaping experience-driven acquisition of leadership competencies in young clinicians. BMC MEDICAL EDUCATION 2022; 22:505. [PMID: 35761278 PMCID: PMC9238052 DOI: 10.1186/s12909-022-03544-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/02/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Experiential leadership development is well documented in the corporate sector, but those models cannot be applied as is, in the healthcare domain. The current study proposes a framework for the healthcare sector to enable experiential leadership development for young clinicians. The authors identify developmental assignments (DAs) and explore those characteristics [developmental assignment characteristics; DACs] therein that help develop leadership competencies in young clinicians. METHODS As part of a qualitative exploratory study in Pakistan, the authors conducted 16 semi-structured interviews with senior clinicians in leadership positions with post-graduate residents under their supervision from different medical specialties. The participants were selected through purposive sampling, ensuring a maximum variation sample. Focusing on participants' experiences and perspectives related to experience-driven leadership development, the authors used a multi-level theoretical framework for analysis. RESULTS The thematic analysis resulted in 19 subthemes with four overarching themes for both objectives. The authors categorized the developmental assignments (DAs) into clinical, academic, and administrative assignments. These assignments can be utilized for leadership development by ensuring that they have the requisite characteristics built into their context and structure. These developmental assignment characteristics (DACs) can range from learner-driven to supervisor-driven. The learner-driven characteristics include autonomy, high levels of responsibilities, unfamiliar assignments, working across boundaries, managing diversity, making a commitment, and creating change. The supervisor-driven characteristics include briefing, debriefing, accountability, and learner-assignment matching. The authors also developed a learner-assignment matching (LAM) framework to guide supervisors in customizing and adjusting the level of each DAC in a DA. CONCLUSION A modern healthcare educational system can utilize studies like this to enable supervisors to develop required leadership skills in young clinicians along with clinical skills.
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Affiliation(s)
- Mashaal Sabqat
- Department of Health Professions Education, National University of Medical Sciences, Block C Police Foundation, Rawalpindi, Punjab, 968, Pakistan.
| | - Rehan Ahmed Khan
- Department of Surgery, Riphah International University, Rawalpindi, Pakistan
| | - Raheela Yasmin
- Medical Education and Dean Riphah Academy of Research and Education [RARE], Department of Medical Education, Riphah International University, Rawalpindi, Pakistan
| | - Usman Mahboob
- Department of Medical Education, Institute of Health Professions Education & Research, Khyber Medical University, Peshawar, Pakistan
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Lauridsen KG, Løfgren B, Brogaard L, Paltved C, Hvidman L, Krogh K. Cardiopulmonary Resuscitation Training for Healthcare Professionals: A Scoping Review. Simul Healthc 2022; 17:170-182. [PMID: 34652328 DOI: 10.1097/sih.0000000000000608] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT The optimal strategy for training cardiopulmonary resuscitation (CPR) for healthcare professionals remains to be determined. This scoping review aimed to describe the emerging evidence for CPR training for healthcare professionals.We screened 7605 abstracts and included 110 studies in this scoping review on CPR training for healthcare professionals. We assessed the included articles for evidence for the following topics: training duration, retraining intervals, e-learning, virtual reality/augmented reality/gamified learning, instructor-learner ratio, equipment and manikins, other aspects of contextual learning content, feedback devices, and feedback/debriefing. We found emerging evidence supporting the use of low-dose, high-frequency training with e-learning to achieve knowledge, feedback devices to perform high-quality chest compressions, and in situ team simulations with debriefings to improve the performance of provider teams.
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Affiliation(s)
- Kasper Glerup Lauridsen
- From the Department of Medicine (K.G.L., B.L.), Randers Regional Hospital, Randers; Research Center for Emergency Medicine (K.G.L., B.L., K.K.), Aarhus University Hospital, Aarhus, Denmark; Center for Simulation, Innovation, and Advanced Education (K.G.L.), Children's Hospital of Philadelphia, Philadelphia; Department of Clinical Medicine (B.L.), Aarhus University; Department of Obstetrics and Gynaecology (L.B., L.H.), Aarhus University Hospital; Corporate HR Midtsim (C.P.) Central Denmark Region; and Department of Anesthesiology, Aarhus University Hospital (K.K.), Aarhus University Hospital, Aarhus, Denmark
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17
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Rizkalla C, Garcia-Jorda D, Cheng A, Duff JP, Gottesman R, Weiss MJ, Koot DA, Gilfoyle E. The impact of clinical result acquisition and interpretation on task performance during a simulated pediatric cardiac arrest: a multicentre observational study. CAN J EMERG MED 2022; 24:529-534. [PMID: 35590088 PMCID: PMC9345827 DOI: 10.1007/s43678-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The acquisition and interpretation of clinical results during resuscitations is common; however, this can delay critical clinical tasks, resulting in increased morbidity and mortality. This study aims to determine the impact of clinical result acquisition and interpretation by the team leader on critical task completion during simulated pediatric cardiac arrest before and after team training. METHODS This is a secondary data analysis of video-recorded simulated resuscitation scenarios conducted during Teams4Kids (T4K) study (June 2011-January 2015); scenarios included cardiac arrest before and after team training. The scenario included either a scripted paper or a phone call delivery of results concurrently with a clinical transition to pulseless ventricular tachycardia. Descriptive statistics and non-parametric tests were used to compare team performance before and after training. RESULTS Performance from 40 teams was analyzed. Although the time taken to initiate CPR and defibrillation varied depending on the type of interruption and whether the scenario was before or after team training, these findings were not significantly associated with the leader's behaviour [Kruskal-Wallis test (p > 0.05)]. An exact McNemar's test determined no statistically significant difference in the proportion of leaders involved or not in interpreting results between and after the training (exact p value = 0.096). CONCLUSIONS Team training was successful in reducing time to perform key clinical tasks. Although team training modified the way leaders behaved toward the results, this behaviour change did not impact the time taken to start CPR or defibrillate. Further understanding the elements that influence time to critical clinical tasks provides guidance in designing future simulated educational activities, subsequently improving clinical team performance and patient outcomes.
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Affiliation(s)
- Carol Rizkalla
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland.
| | | | - Adam Cheng
- Pediatric Emergency Medicine, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jonathan P Duff
- Pediatrics, Stollery Children's Hospital, Edmonton, AB, Canada
| | | | - Matthew J Weiss
- Pediatrics, Université Laval Faculté de Médecine, Quebec, QC, Canada
| | - Deanna A Koot
- KidSIM Pediatric Simulation Program, Alberta Children's Hospital, Calgary, AB, Canada
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Hansen M, Harrod T, Bahr N, Schoonover A, Adams K, Kornegay J, Stenson A, Ng V, Plitt J, Cooper D, Scott N, Chinai S, Johnson J, Conlon LW, Salva C, Caretta-Weyer H, Huynh T, Jones D, Jorda K, Lo J, Mayersak R, Paré E, Hughes K, Ahmed R, Patel S, Tsao S, Wang E, Ogburn T, Guise JM. The Effects of Leadership Curricula With and Without Implicit Bias Training on Graduate Medical Education: A Multicenter Randomized Trial. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:696-703. [PMID: 34966032 DOI: 10.1097/acm.0000000000004573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians. METHOD This was a double-blind, randomized controlled trial among obstetrics-gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015-2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules.The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer. RESULTS One hundred ten obstetrics-gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from "average" to "good" ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the "average" category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome. CONCLUSIONS Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up.
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Affiliation(s)
- Matt Hansen
- M. Hansen is associate professor of emergency medicine and pediatrics, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Tabria Harrod
- T. Harrod is senior research associate, Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Nathan Bahr
- N. Bahr is senior research associate, Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Amanda Schoonover
- A. Schoonover is senior research assistant, Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Karen Adams
- K. Adams is professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Josh Kornegay
- J. Kornegay is associate professor of emergency medicine, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Amy Stenson
- A. Stenson is associate professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Vivienne Ng
- V. Ng is assistant professor of emergency medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Jennifer Plitt
- J. Plitt is assistant clinical professor of emergency medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Dylan Cooper
- D. Cooper is professor of clinical emergency medicine, Indiana University School of Medicine, Bloomington, Indiana
| | - Nicole Scott
- N. Scott is assistant professor of clinical obstetrics and gynecology, Indiana University School of Medicine, Bloomington, Indiana
| | - Sneha Chinai
- S. Chinai is assistant professor of emergency medicine, University of Massachusetts Chan Medical School, Boston, Massachusetts
| | - Julia Johnson
- J. Johnson is professor of obstetrics and gynecology, University of Massachusetts Chan Medical School, Boston, Massachusetts
| | - Lauren Weinberger Conlon
- L.W. Conlon is assistant professor of emergency medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Salva
- C. Salva is associate professor of clinical obstetrics and gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Holly Caretta-Weyer
- H. Caretta-Weyer is assistant director, Emergency Medicine Residency Program, Stanford University School of Medicine, Stanford, California
| | - Trang Huynh
- T. Huynh is associate professor of pediatrics, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - David Jones
- D. Jones is associate professor of emergency medicine, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Katherine Jorda
- K. Jorda is assistant professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Jamie Lo
- J. Lo is assistant professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Ryanne Mayersak
- R. Mayersak is assistant professor of emergency medicine, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Emmanuelle Paré
- E. Paré is associate professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Kate Hughes
- K. Hughes is assistant professor of emergency medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Rami Ahmed
- R. Ahmed is professor of emergency medicine, Indiana University School of Medicine, Bloomington, Indiana
| | - Soha Patel
- S. Patel is assistant professor of obstetrics and gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Suzana Tsao
- S. Tsao is associate professor of emergency medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eileen Wang
- E. Wang is professor of obstetrics and gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tony Ogburn
- T. Ogburn is professor and chair of obstetrics and gynecology, University of Texas Rio Grande Valley School of Medicine, Edinburgh, Texas
| | - Jeanne-Marie Guise
- J.-M. Guise is professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
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Ambati SR, Tamuz M, DeVoe B, Rotjan A, Lesser M, Gangadharan S. Improving Resuscitation Timing: Random Assignment of Interprofessional Team Leaders in Simulated Resuscitation. Pediatr Emerg Care 2022; 38:e978-e982. [PMID: 35100786 DOI: 10.1097/pec.0000000000002507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to assess whether preassigning a team leader influences resuscitation timing using simulation and to examine relationship between response timeliness and designated leader's profession, whether physician or nurse. METHODS This is a prospective study of intervention (leader assigned) and control (no assigned leader) teams of residents and nurses participating in a simulated scenario. The primary outcome was time to bag-valve-mask (BVM) ventilation. A secondary outcome measure compared difference in time to BVM between physician- and nurse-led teams. RESULTS We assessed 25 teams, leader assigned (n = 14) or control (n = 11), composed of 92 clinicians. Leaders emerged in most of the controls (10 of 11). The median time to BVM in the leader-assigned group was 41.5 seconds (interquartile range, 34-49 seconds) compared with 53 seconds (interquartile range, 27-85 seconds) for controls (P = 0.13). In the leader-assigned group, 85% (12 of 14) of teams initiated BVM in less than 1 minute compared with only 54% teams (6 of 11) in controls (P = 0.18). Among the leader-assigned teams, we randomly assigned residents to lead 8 teams and nurses to lead 6 teams. All the nurse-led teams (6 of 6) initiated BVM in less than 1 minute compared with fewer physician-led teams (6 of 8) and only approximately half of controls (6 of 11, P = 0.19). CONCLUSIONS The leader-assigned teams and controls did not differ in resuscitation timeliness. Among leader-assigned teams, the differences in time to BVM between physician- and nurse-led teams were not statistically significant. However, all 6 nurse-led teams demonstrated timely resuscitation, suggesting a direction for future research on the feasibility of bedside nurses taking the lead during resuscitation, pending code team arrival.
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Affiliation(s)
- Shashikanth R Ambati
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical Center, Albany
| | | | - Barbara DeVoe
- Patient Safety Institute, Center for Learning and Innovation
| | | | - Martin Lesser
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, New Hyde Park
| | - Sandeep Gangadharan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York City, NY
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Buljac-Samardžić M, Dekker-van Doorn CM, Maynard MT. What Do We Really Know About Crew Resource Management in Healthcare?: An Umbrella Review on Crew Resource Management and Its Effectiveness. J Patient Saf 2021; 17:e929-e958. [PMID: 34852415 PMCID: PMC8612906 DOI: 10.1097/pts.0000000000000816] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this article was to present an overview of the crew resource management (CRM) literature in healthcare. The first aim was to conduct an umbrella review on CRM literature reviews. The second aim was to conduct a new literature review that aims to address the gaps that were identified through the umbrella review. METHODS First, we conducted an umbrella review to identify all reviews that have focused on CRM within the healthcare context. This step resulted in 16 literature reviews. Second, we conducted a comprehensive literature review that resulted in 106 articles. RESULTS The 16 literature reviews showed a high level of heterogeneity, which resulted in discussing 3 ambiguities: definition, outcome, and information ambiguity. As a result of these ambiguities, a new comprehensive review of the CRM literature was conducted. This review showed that CRM seems to have a positive effect on outcomes at Kirkpatrick's level 1, 2, and 3. In contrast, whether CRM has a positive effect on level 4 outcomes and how level 4 should be measured remains undetermined. Recommendations on how to implement and embed CRM training into an organization to achieve the desired effects have not been adequately considered. CONCLUSIONS The extensive nature of this review demonstrates the popularity of CRM in healthcare, but at the same time, it highlights that research tends to be situated within certain settings, focuses on particular outcomes, and has failed to address the full scope of CRM as a team intervention and a management concept.
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Affiliation(s)
| | | | - M. Travis Maynard
- Department of Management, College of Business, Colorado State University, Fort Collins, Colorado
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21
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Klinische Notfallausbildung in der Pädiatrie. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Hintergrund und Fragestellung
Die klinische Notfallausbildung von WeiterbildungsassistentInnen (WBA) ist uneinheitlich. Pädiatrische Reanimationen sind seltener erforderlich als Reanimationen erwachsener Patienten; erstversorgende Teams treffen ad hoc zusammen und stehen initial oft unter der Leitung junger ÄrztInnen. Die Teamzusammenarbeit ist von besonderer Bedeutung für das Überleben und Outcome der PatientInnen.
Ziel der Arbeit
Die subjektive Sicherheit im Notfallmanagement der WBA in sächsischen Kinderkliniken sollte ermittelt werden.
Material und Methoden
Hierzu wurde ein Erhebungsbogen für eine webbasierte Umfrage entwickelt, die folgende Aspekte umfasste: Berufserfahrung, innerhäusliche Ausbildung, Erfahrung und gefühlte Sicherheit im Management von Notfallsituationen.
Ergebnisse
Von geschätzten 230 Pädiatrie-WBA in Sachsen antworteten 66 (ca. 29 %). Es fühlten sich 14 % der WBA gut (3 % sehr gut) für Notfallsituationen ausgebildet, wobei 11 % auch eine (sehr) gute Sicherheit in der Teamleitung von Notfällen angaben. Demgegenüber hatten 42 % bereits eine oder mehrere Reanimationen als TeamleiterInnen erlebt. Von den befragten WBA gaben 42 % an, in den letzten 12 Monaten kein Simulationstraining absolviert zu haben; die Mehrzahl der WBA wünscht sich jedoch mehr Training.
Schlussfolgerung
Die Ergebnisse zeigen, dass sich viele WBA in sächsischen Kinderkliniken im Notfallmanagement unzureichend ausgebildet fühlen. Es besteht eine deutliche Diskrepanz zwischen den tatsächlichen Anforderungen und der innerklinischen Ausbildung.
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22
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Dewolf P, Clarebout G, Wauters L, Van Kerkhoven J, Verelst S. The Effect of Teaching Nontechnical Skills in Advanced Life Support: A Systematic Review. AEM EDUCATION AND TRAINING 2021; 5:e10522. [PMID: 34041431 PMCID: PMC8138104 DOI: 10.1002/aet2.10522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the effect of nontechnical skills (NTS) training on performance in advanced life support (ALS) simulation. Furthermore, we aimed to determine the ideal frequency of training sessions for an optimal retention and the value of debriefing. METHODS A systematic search was performed using PubMed, EMBASE, WoS, ERIC, CINAHL, and the Cochrane Library conducted through August 1, 2018. All primary studies mentioning NTS in ALS education were included. Three reviewers independently extracted data on study design and outcome. The MERSQI approach was used to evaluate the overall quality of evidence. RESULTS Of the 10,723 identified articles, 40 studies were included with a combined total of 3,041 participants, ranging from students to experts. Depending on the focus of the study, articles were categorized in NTS (n = 25), retention (n = 8), and feedback (n = 10). Incorporating NTS during ALS simulation showed significant improvements in timing for performing critical first steps. Furthermore, good leadership skills had a favorable effect on overall technical performance and teamwork during simulation improved team dynamics and performance. Finally, debriefing also had a beneficial effect on team performance. One particular type of debriefing does not appear to be superior to other types of debriefing. CONCLUSION Team simulation training resulted in improved NTS and a reduction in the time required to complete a simulated cardiac arrest. Therefore, a formal NTS program should be introduced into ALS courses. Feedback and repetitive practice are key factors to train NTS. The impact of training on team behaviors can persist for at least 3 to 6 months. In conclusion, understanding and improving NTS may help to create more effective teams. The effect on patient outcome requires further investigation.
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Affiliation(s)
- Philippe Dewolf
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
- Faculty of MedicineKU LeuvenLeuvenFlandersBelgium
| | - Geraldine Clarebout
- Faculty of Psychology and Pedagogical SciencesCentre for Instructional Psychology and TechnologyKU LeuvenLeuvenFlandersBelgium
| | - Lina Wauters
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
| | - Joke Van Kerkhoven
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
| | - Sandra Verelst
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
- Faculty of MedicineKU LeuvenLeuvenFlandersBelgium
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23
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van den Bos-Boon A, van Dijk M, Adema J, Gischler S, van der Starre C. Professional Assessment Tool for Team Improvement: An assessment tool for paediatric intensive care unit nurses' technical and nontechnical skills. Aust Crit Care 2021; 35:159-166. [PMID: 34167890 DOI: 10.1016/j.aucc.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 02/19/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Cardiorespiratory arrests are rare in paediatric intensive care units, yet intensive care nurses must be able to initiate resuscitation before medical assistance is available. For resuscitation to be successful, instant decision-making, team communication, and the coordinating role of the first responsible nurse are crucial. In-house resuscitation training for nurses includes technical and nontechnical skills. OBJECTIVES The aim of this study was to develop a valid, reliable, and feasible assessment instrument, called the Professional Assessment Tool for Team Improvement, for the first responsible nurse's technical and nontechnical skills. METHODS Instrument development followed the COnsensus-based Standards for the selection of health Measurement Instruments guidelines and professionals' expertise. To establish content validity, experts reached consensus via group discussions about the content and the operationalisation of this team role. The instrument was tested using two resuscitation assessment scenarios. Inter-rater reliability was established by assessing 71 nurses in live scenario sessions and videotaped sessions, using intraclass correlation coefficients and Cohen's kappa. Internal consistency for the total instrument was established using Cronbach's alpha. Construct validity was assessed by examining the associations between raters' assessments and nurses' self-assessment scores. RESULTS The final instrument included 12 items, divided into four categories: Team role, Teamwork and communication, Technical skills, and Reporting. Intraclass correlation coefficients were good in both live and videotaped sessions (0.78-0.87). Cronbach's alpha was stable around 0.84. Feasibility was approved (assessment time reduced by >30%). CONCLUSIONS The Professional Assessment Tool for Team Improvement appears to be a promising valid and reliable instrument to assess both technical and nontechnical skills of the first responsible paediatric intensive care unit nurse. The ability of the instrument to detect change over time (i.e., improvement of skills after training) needs to be established.
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Affiliation(s)
- Ada van den Bos-Boon
- Pediatric Intensive Care Unit and Department of Pediatric Surgery, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Monique van Dijk
- Pediatric Intensive Care Unit and Department of Pediatric Surgery, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jan Adema
- Cito, Institute for Educational Testing, Arnhem, the Netherlands
| | - Saskia Gischler
- Pediatric Intensive Care Unit and Department of Pediatric Surgery, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Cynthia van der Starre
- Pediatric Intensive Care Unit and Department of Pediatric Surgery, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands; Neonatal Intensive Care Unit, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
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24
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Kuyt K, Mullen M, Fullwood C, Chang TP, Fenwick J, Withey V, McIntosh R, Herz N, MacKinnon RJ. The assessment of a manikin-based low-dose, high-frequency cardiac resuscitation quality improvement program in early UK adopter hospitals. Adv Simul (Lond) 2021; 6:14. [PMID: 33883025 PMCID: PMC8058602 DOI: 10.1186/s41077-021-00168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adult and paediatric basic life support (BLS) training are often conducted via group training with an accredited instructor every 24 months. Multiple studies have demonstrated a decline in the quality of cardio-pulmonary resuscitation (CPR) performed as soon as 3-month post-training. The 'Resuscitation Quality Improvement' (RQI) programme is a quarterly low-dose, high-frequency training, based around the use of manikins connected to a cart providing real-time and summative feedback. We aimed to evaluate the effects of the RQI Programme on CPR psychomotor skills in UK hospitals that had adopted this as a method of BLS training, and establish whether this program leads to increased compliance in CPR training. METHODS The study took place across three adopter sites and one control site. Participants completed a baseline assessment without live feedback. Following this, participants at the adopter sites followed the RQI curriculum for adult CPR, or adult and infant CPR. The curriculum was split into quarterly training blocks, and live feedback was given on technique during the training session via the RQI cart. After following the curriculum for 12/24 months, participants completed a second assessment without live feedback. RESULTS At the adopter sites, there was a significant improvement in the overall score between baseline and assessment for infant ventilations (N = 167, p < 0.001), adult ventilations (n = 129, p < 0.001), infant compressions (n = 163, p < 0.001) adult compressions (n = 205, p < 0.001), and adult CPR (n = 249, p < 0.001). There was no significant improvement in the overall score for infant CPR (n = 206, p = 0.08). Data from the control site demonstrated a statistically significant improvement in mean score for adult CPR (n = 22, p = 0.02), but not for adult compressions (N = 18, p = 0.39) or ventilations (n = 17, p = 0.08). No statistically significant difference in improvement of mean scores was found between the grouped adopter sites and the control site. The effect of the duration of the RQI curriculum on CPR performance appeared to be minimal in this data set. Compliance with the RQI curriculum varied by site, one site maintained hospital compliance at 90% over a 1 year period, however compliance reduced over time at all sites. CONCLUSIONS This data demonstrated an increased adherence with guidelines for high-quality CPR post-training with the RQI cart, for all adult and most infant measures, but not infant CPR. However, the relationship between a formalised quarterly RQI curriculum and improvements in resuscitation skills is not clear. It is also unclear whether the RQI approach is superior to the current classroom-based BLS training for CPR skill acquisition in the UK. Further research is required to establish how to optimally implement the RQI system in the UK and how to optimally improve hospital wide compliance with CPR training to improve the outcomes of in-hospital cardiac arrests.
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Affiliation(s)
- Katherine Kuyt
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Montana Mullen
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Catherine Fullwood
- Medical Statistics Group, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Todd P Chang
- Division of Emergency Medicine and Transport, Children's Hospital of Los Angeles, Los Angeles, USA
| | - James Fenwick
- Resuscitation Service, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, UK
| | | | - Rod McIntosh
- Department of Resuscitation, Borders General Hospital, Borders NHS, Selkirk, UK
| | | | - Ralph James MacKinnon
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
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25
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Kuzovlev A, Monsieurs KG, Gilfoyle E, Finn J, Greif R. The effect of team and leadership training of advanced life support providers on patient outcomes: A systematic review. Resuscitation 2021; 160:126-139. [PMID: 33556422 DOI: 10.1016/j.resuscitation.2021.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/03/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
AIM To conduct a systematic review evaluating improvement in team and leadership performance and resuscitation outcomes after such a training of healthcare providers during advanced life support (ALS) courses. METHODS This systematic review asked the question of whether students taking structured and standardised ALS courses in an educational setting which include specific leadership or team training, compared to no such specific training in these courses, improves patient survival, skill performance in actual resuscitations, skill performance at 3-15 months (patient tasks, teamwork, leadership), skill performance at course conclusion (patient tasks, teamwork, leadership), or cognitive knowledge PubMed, Embase and the Cochrane database were searched until April 2020. Screening of articles, analysis of risk of bias, outcomes and quality assessment were performed according to the Grading of Recommendations Assessment, Development and Evaluation methodology. Only studies with abstracts in English were included. RESULTS 14 non-randomised studies and 17 randomised controlled trials, both in adults and children, and seven studies involving patients were included in this systematic review. No randomised controlled trials but three observational studies of team and leadership training showed improvement in the critical outcome of "patient survival". However, they suffered from risk of bias (indirectness and imprecision). The included studies reported many different methods to teach leadership skills and team behaviour. CONCLUSION This systematic review found very low certainty evidence that team and leadership training as part of ALS courses improved patient outcome. This supports the inclusion of team and leadership training in ALS courses for healthcare providers.
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Affiliation(s)
- A Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia.
| | - K G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Belgium
| | - E Gilfoyle
- Department of Paediatrics, University of Toronto, Canada
| | - J Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - R Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Jonsson K, Hultin M, Härgestam M, Lindkvist M, Brulin C. Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario. Simul Healthc 2021; 16:29-36. [PMID: 32433185 DOI: 10.1097/sih.0000000000000462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Healthcare teams and their performance in a complex environment such as that of intensive care units (ICUs) are influenced by several factors. This study investigates the relationship between team background characteristics and team as well as task performance. METHODS This study included 105 professionals (26 teams), working at the ICUs of 2 hospitals in Northern Sweden. The team-based simulation training sessions were video recorded, and thereafter, team performance and task performance were analyzed based on ratings of the TEAM instrument and the ABCDE checklist. RESULTS The final analyses showed that a higher age was significantly associated with better total team performance (β = 0.35, P = 0.04), teamwork (β = 0.04, P = 0.04), and task management (β = 0.04, P = 0.05) and with a higher overall rating for global team performance (β = 0.09, P = 0.02). The same pattern was found for the association between age and task performance (β = 0.02, P = 0.04). In addition, prior team training without video-facilitated reflection was significantly associated with better task performance (β = 0.35, P = 0.04). On the other hand, prior team training in communication was significantly associated with worse (β = -1.30, P = 0.02) leadership performance. CONCLUSIONS This study reveals that a higher age is important for better team performance when caring for a severely ill patient in a simulation setting in the ICU. In addition, prior team training had a positive impact on task performance. Therefore, on a team level, this study indicates that age and, to some extent, prior team training without video-facilitated reflection have an impact on team performance in the care of critically ill patients.
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Affiliation(s)
- Karin Jonsson
- From the Departments of Nursing (K.J., M.Ha., C.B.), Surgical and Perioperative Sciences, Anesthesiology and Critical Care Medicine (K.J., M.Hu.), and Epidemiology and Global Health (M.L.), Umeå University, Umeå, Sweden
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Ong ZH, Tan LHE, Ghazali HZB, Ong YT, Koh JWH, Ang RZE, Bok C, Chiam M, Lee ASI, Chin AMC, Zhou JX, Chan GWH, Nadarajan GD, Krishna LKR. A Systematic Scoping Review on Pedagogical Strategies of Interprofessional Communication for Physicians in Emergency Medicine. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211041794. [PMID: 34671703 PMCID: PMC8521417 DOI: 10.1177/23821205211041794] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Interprofessional communication (IPC) is integral to interprofessional teams working in the emergency medicine (EM) setting. Yet, the coronavirus disease 2019 pandemic has laid bare gaps in IPC knowledge, skills and attitudes. These experiences underscore the need to review how IPC is taught in EM. PURPOSE A systematic scoping review is proposed to scrutinize accounts of IPC programs in EM. METHODS Krishna's Systematic Evidence-Based Approach (SEBA) is adopted to guide this systematic scoping review. Independent searches of ninedatabases (PubMed, Embase, CINAHL, Scopus, PsycINFO, ERIC, JSTOR, Google Scholar and OpenGrey) and "negotiated consensual validation" were used to identify articles published between January 1, 2000 and December 31, 2020. Three research teams reviewed the data using concurrent content and thematic analysis and independently summarized the included articles. The findings were scrutinized using SEBA's jigsaw perspective and funneling approach to provide a more holistic picture of the data. RESULTS IN TOTAL 18,809 titles and abstracts were identified after removal of duplicates, 76 full-text articles reviewed, and 19 full-text articles were analyzed. In total, four themes and categories were identified, namely: (a) indications and outcomes, (2) curriculum and assessment methods, (3) barriers, and (4) enablers. CONCLUSION IPC training in EM should be longitudinal, competency- and stage-based, underlining the need for effective oversight by the host organization. It also suggests a role for portfolios and the importance of continuing support for physicians in EM as they hone their IPC skills. HIGHLIGHTS • IPC training in EM is competency-based and organized around stages.• IPC competencies build on prevailing knowledge and skills.• Longitudinal support and holistic oversight necessitates a central role for the host organization.• Longitudinal, robust, and adaptable assessment tools in the EM setting are necessary and may be supplemented by portfolio use.
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Affiliation(s)
- Zhi H. Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Lorraine H. E. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Yun T. Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jeffrey W. H. Koh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- National University of Singapore, Singapore
| | - Rachel Z. E. Ang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Chermaine Bok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Alexia S. I. Lee
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | | | - Jamie X. Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Duke-NUS Medical School, Singapore
| | - Gene W. H. Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Hospital, National University Health System, Singapore
| | | | - Lalit K. R. Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, UK
- Centre for Biomedical Ethics, National University of Singapore, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore
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Hands-On Times, Adherence to Recommendations and Variance in Execution among Three Different CPR Algorithms: A Prospective Randomized Single-Blind Simulator-Based Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217946. [PMID: 33138109 PMCID: PMC7662801 DOI: 10.3390/ijerph17217946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 01/01/2023]
Abstract
Background: Alternative cardiopulmonary resuscitation (CPR) algorithms, introduced to improve outcomes after cardiac arrest, have so far not been compared in randomized trials with established CPR guidelines. Methods: 286 physician teams were confronted with simulated cardiac arrests and randomly allocated to one of three versions of a CPR algorithm: (1) current International Liaison Committee on Resuscitation (ILCOR) guidelines (“ILCOR”), (2) the cardiocerebral resuscitation (“CCR”) protocol (3 cycles of 200 uninterrupted chest compressions with no ventilation), or (3) a local interpretation of the current guidelines (“Arnsberg“, immediate insertion of a supraglottic airway and cycles of 200 uninterrupted chest compressions). The primary endpoint was percentage of hands-on time. Results: Median percentage of hands-on time was 88 (interquartile range (IQR) 6) in “ILCOR” teams, 90 (IQR 5) in “CCR” teams (p = 0.001 vs. “ILCOR”), and 89 (IQR 4) in “Arnsberg” teams (p = 0.032 vs. “ILCOR”; p = 0.10 vs. “CCR”). “ILCOR” teams delivered fewer chest compressions and deviated more from allocated targets than “CCR” and “Arnsberg” teams. “CCR” teams demonstrated the least within-team and between-team variance. Conclusions: Compared to current ILCOR guidelines, two alternative CPR algorithms advocating cycles of uninterrupted chest compressions resulted in very similar hands-on times, fewer deviations from targets, and less within-team and between-team variance in execution.
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S222-S283. [PMID: 33084395 DOI: 10.1161/cir.0000000000000896] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL, Dainty KN, Diederich E, Lin Y, Leary M, Mahgoub M, Mancini ME, Navarro K, Donoghue A. Part 6: Resuscitation Education Science: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S551-S579. [PMID: 33081527 DOI: 10.1161/cir.0000000000000903] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC, Baldi E, Beck S, Beckers SK, Blewer AL, Boulton A, Cheng-Heng L, Yang CW, Coppola A, Dainty KN, Damjanovic D, Djärv T, Donoghue A, Georgiou M, Gunson I, Krob JL, Kuzovlev A, Ko YC, Leary M, Lin Y, Mancini ME, Matsuyama T, Navarro K, Nehme Z, Orkin AM, Pellis T, Pflanzl-Knizacek L, Pisapia L, Saviani M, Sawyer T, Scapigliati A, Schnaubelt S, Scholefield B, Semeraro F, Shammet S, Smyth MA, Ward A, Zace D. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A188-A239. [PMID: 33098918 DOI: 10.1016/j.resuscitation.2020.09.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Mitchell M, Newall F, Sokol J, Heywood M, Williams K. Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital. Adv Simul (Lond) 2020; 5:21. [PMID: 32817808 PMCID: PMC7425032 DOI: 10.1186/s41077-020-00139-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 07/22/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An increasing number of incidents involving aggressive behaviour in acute care hospitals are being witnessed worldwide. Acute care hospital staff are often not trained or confident in managing aggression. Competent management of clinical aggression is important to maintain staff and patient safety. Training programmes for acute care staff are infrequently described in the literature and rarely reported for paediatric staff. Simulation training allows practice of skills without patient risk and may be more effective than traditional teaching formats for aggression management. AIM AND DESIGN The aim of this proof of concept study was to develop a simulation-based education session on aggression management for acute care paediatric staff based on best practice principles, to evaluate the acceptability of this training programme and to gain an understanding of the impact of the training on participants' perceived confidence in managing clinical aggression. Two separate simulation exercises were delivered as a 2-h component of a hospital management of clinical aggression (MOCA) training day. Participants completed a written survey immediately prior to, at completion of the simulation-based group training, and at 3-6 months following the simulation training. FINDINGS Nine training days were conducted in 2017 for nursing, medical, allied health, education and security staff with a total of 146 participants (83% were acute care nurses). Two thirds (68%) of participants had experienced clinical aggression as part of their routine work, with 51% overall reporting a lack of confidence managing these patients. Immediately following the simulation training, 80% of all participants reported feeling more confident in managing clinical aggression, 47% reported a 1-point increase in confidence, whilst 33% of participants reported a 2- or 3-point increase. At 3-6 months post-training, 66% of respondents (N = 44) reported continued confidence in managing aggression with 100% of participants stating they would recommend simulation training to colleagues. CONCLUSIONS Simulation training is an acceptable method of training and shows promise to improve staff-perceived confidence for managing behavioural emergencies in acute paediatric health care settings. In addition, there were potential enduring positive impacts at 3 months after the study. Whilst resource and time intensive, further research assessing the benefits of utilising simulation training in this setting is warranted in order to minimise staff burn-out and improve outcomes for these very vulnerable patients.
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Affiliation(s)
- Marijke Mitchell
- Neurodevelopment & Disability, Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria, 3052 Australia
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052 Australia
- Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria, 3052 Australia
| | - Fiona Newall
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052 Australia
- Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria, 3052 Australia
- Department of Nursing, The University of Melbourne, 50 Flemington Road, Parkville, Victoria 3052 Australia
- Nursing Research, Nursing Education, Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria 3052 Australia
| | - Jennifer Sokol
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052 Australia
- The RCH Simulation Program, Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria 3052 Australia
| | - Melissa Heywood
- The RCH Simulation Program, Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria 3052 Australia
| | - Katrina Williams
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052 Australia
- Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria, 3052 Australia
- Department of Paediatrics, Education and Research, Monash Children’s Hospital, Monash University, 246 Clayton Road, Clayton, Victoria, 3168 Australia
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Hautz SC, Oberholzer DL, Freytag J, Exadaktylos A, Kämmer JE, Sauter TC, Hautz WE. An observational study of self-monitoring in ad hoc health care teams. BMC MEDICAL EDUCATION 2020; 20:201. [PMID: 32576185 PMCID: PMC7313223 DOI: 10.1186/s12909-020-02115-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Working in ad hoc teams in a health care environment is frequent but a challenging and complex undertaking. One way for teams to refine their teamwork could be through post-resuscitation reflection and debriefing. However, this would require that teams have insight into the quality of their teamwork. This study investigates (1) the accuracy of the self-monitoring of ad hoc resuscitation teams and their leaders relative to external observations of their teamwork and (2) the relationship of team self-monitoring and external observations to objective performance measures. METHODS We conducted a quantitative observational study of real-world ad hoc interprofessional teams responding to a simulated cardiac arrest in an emergency room. Teams consisting of residents, consultants, and nurses were confronted with an unexpected, simulated, standardized cardiac arrest situation. Their teamwork was videotaped to allow for subsequent external evaluation on the team emergency assessment measure (TEAM) checklist. In addition, objective performance measures such as time to defibrillation were collected. All participants completed a demographic questionnaire prior to the simulation and a questionnaire tapping their perceptions of teamwork directly after it. RESULTS 22 teams consisting of 115 health care professionals showed highly variable performance. All performance measures intercorrelated significantly, with the exception of team leaders' evaluations of teamwork, which were not related to any other measures. Neither team size nor cumulative experience were correlated with any measures, but teams led by younger leaders performed better than those led by older ones. CONCLUSION Team members seem to have better insight into their team's teamwork than team leaders. As a practical consequence, the decision to debrief and the debriefing itself after a resuscitation should be informed by team members, not just leaders.
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Affiliation(s)
- Stefanie C Hautz
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Daniel L Oberholzer
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Julia Freytag
- Simulated Patient Program, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Juliane E Kämmer
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
- Max Planck Institute for Human Development, Center for Adaptive Rationality (ARC), Lentzeallee 94, 14195, Berlin, Germany
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
- Lernzentrum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland.
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Zern SC, Marshall WJ, Shewokis PA, Vest MT. Use of simulation as a needs assessment to develop a focused team leader training curriculum for resuscitation teams. Adv Simul (Lond) 2020; 5:6. [PMID: 32514384 PMCID: PMC7251806 DOI: 10.1186/s41077-020-00124-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 05/14/2020] [Indexed: 11/25/2022] Open
Abstract
Background Many inpatients experience cardiac arrest and mortality in this population is extremely high. Simulation is frequently used to train code teams with the goal of improving these outcomes. A key step in designing such a training curriculum is to perform a needs assessment. We report on the effectiveness of a simulation-based training program for residents designed using unannounced in-situ simulation cardiac arrest data as a needs assessment. Methods In order to develop the curriculum for training, a needs assessment was done using in-situ simulation. Prior to instruction, residents were assessed in their ability to lead a simulated resuscitation using a standardized checklist. During the intervention phase, residents participated in didactic and team training. The didactic training consisted of pharmacology review, ACLS update and TeamSTEPPS training. Residents took turns as code team leader in three simulation sessions. Rapid cycle deliberate practice (RCDP) was employed as part of simulation sessions. All residents returned, for post-intervention assessment. Mean pre-post test scores were analyzed to determine if there was a significant difference. Results Twenty-seven residents participated. Mean pre-training assessment score was 47.6 (95% CI 37.5-57.9). The mean post-training assessment score was 84.4 (95% CI 79.0-89.5). The mean time to defibrillation after pads were placed in scenario with shockable rhythm decreased from 102.2 seconds (95% CI 74.0-130.5) to 56.3 (95% CI 32.7-79.8). Conclusion Using unannounced in-situ cardiac arrest simulations as a needs assessment, a simulation-based training program was developed that significantly improved resident performance as team leader. Future work is needed to determine if this improvement translates into patient benefits and is sustainable. However, in-situ simulation is a promising tool for curriculum development.
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Affiliation(s)
- Susan Coffey Zern
- Virtual Education and Simulation Training (VEST) Center, Christiana Care Health System, 4755 Ogletown-Stanton Road, Ammon MEC LE86B, Newark, Delaware 19718 USA
| | - William J Marshall
- Virtual Education and Simulation Training (VEST) Center, Christiana Care Health System, 4755 Ogletown-Stanton Road, Ammon MEC LE86B, Newark, Delaware 19718 USA
| | - Patricia A Shewokis
- Nutrition Sciences Department, College of Nursing and Health Professions; School of Biomedical Engineering, Science and Health Systems, and Department of Teaching, Learning & Curriculum, School of Education, Drexel University, 3rd Floor, Room 382, Parkway Building, 1601 Cherry Street, Mail Stop 31030, Philadelphia, PA 19102 USA
| | - Michael T Vest
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Christiana Care Health System, 4755 Ogletown-Stanton Road, Medical Intensive Care Unit, 3E, Newark, Delaware 19713 USA.,Sidney Kimmel Medical College, Philadelphia, PA USA
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Keilman A, Reid J, Thomas A, Uspal N, Stone K, Beardsley E, Burns B, Burns R. Enhancing paediatric resuscitation team performance: targeted simulation-based team leader training. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:44-46. [DOI: 10.1136/bmjstel-2019-000578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 11/04/2022]
Abstract
Effective team leadership is linked to improved resuscitation outcomes. Previous studies have focused primarily on trainee performance and simulation-based outcomes. We hypothesised that a targeted simulation-based educational intervention for experienced physicians focusing on specific process and communication goals would result in improved performance during actual resuscitations. We conducted an observational pilot study evaluating specific process metrics during clinical resuscitations before and after a 1-hour training intervention for paediatric emergency medicine (PEM) supervising physicians using rapid cycle deliberate practice simulation-based training. Videos of clinical resuscitations from before and after the intervention were retrospectively reviewed to assess time to patient transfer to emergency department stretcher, time to primary assessment and time to team leader summary statement. Between March and July 2018, 21/38 of PEM supervising physicians participated in a training session. After the intervention period, clinical resuscitation teams showed significant improvements in targeted process metrics: transfer of patient within 1 min (79% vs 100%, p=0.03), assessment completed within 3 min (28% vs 75%, p=0.01) and summary statement within 5 min (50% to 85%, p=0.03). Brief, focused simulation-based team leader training can improve the teamwork and communication performance of experienced clinicians during clinical resuscitations.
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Abstract
Background: Leadership and teamwork are critical to the performance of a multidisciplinary team responding to emergencies in the intensive care unit; yet, these skills are variably taught to pulmonary and critical care trainees. Currently, there is no standardized leadership curriculum in critical care training. Objective: We developed a longitudinal crisis leadership curriculum for first-year pulmonary and critical care fellows using high-fidelity simulation as a medium to practice and solidify skills. The goal was to improve leadership skills and trainee confidence when leading a team during life-threatening emergencies. Methods: Guided by a needs assessment of current and recently graduated fellows, we developed a leadership curriculum from a review of the available literature and local expert opinion. Four sessions were conducted over the academic years of 2016 to 2017 and 2017 to 2018, each including small-group teaching on effective leadership behaviors, followed by simulation with postsession leadership debriefing to review performance. Fellows were surveyed regarding their experiences with the curriculum. Results: Over two academic years, 100% of targeted fellows (N = 13) completed every session. Participants reported improved understanding of key elements of effective leadership, greater confidence in leading a multidisciplinary team, and increased preparedness to lead during a crisis. Simulation with debriefing was viewed as an effective medium for learning leadership skills, and fellows provided positive feedback regarding the experience. Conclusion: Implementation of a longitudinal crisis leadership curriculum within the first year of pulmonary and critical care fellowship was feasible and highly valued by learners. More research is needed to determine effective methods for teaching and assessing leadership skills.
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Vattanavanit V, Khwannimit B, Nilmoje T. Comparison of knowledge and confidence between medical students as leaders and followers in simulated resuscitation. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:19-24. [PMID: 31971916 PMCID: PMC7246126 DOI: 10.5116/ijme.5e01.f00c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/24/2019] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To compare both the knowledge and self-reported confidence levels between medical students as the team leaders and followers in shock resuscitation simulation training. METHODS A cross-sectional study was conducted with all fifth-year medical students participating in a shock resuscitation simulation-based training between May 2017 and March 2018. The simulation class was a 3-hour session that consisted of 4 shock type scenarios as well as a post-training debriefing. Medical students were assigned into groups of 4-5 members, in which they freely selected a leader, and the rest filled the roles of followers. Of 139 medical students, 32 students were leaders. A 10-question pre-test and post-test determined knowledge assessment. At the end of the class, the students completed a 5-point Likert scale confidence level evaluation questionnaire. A t-test was applied to compare knowledge scores and confidence levels between the leaders and followers. RESULTS At the end of the class, the knowledge scores between the leaders (M=6.72, SD=1.51) and followers (M=6.93, SD=1.26) were not different (t(137)= -0.81, p=0.42). In addition, the student confidence levels were also similar between the leaders (M=3.63, SD=0.55) and followers (M=3.41, SD=0.64) after training (t(137)=1.70, p=0.09). CONCLUSIONS The knowledge and confidence levels were not different between either the leaders or followers in simulated resuscitation. With time-limit simulation training, we suggested every student may not need to fulfil the leadership role, but a well-designed course and constructive debriefing are recommended. Future studies should evaluate skills and longitudinal effects of the leader role.
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Affiliation(s)
- Veerapong Vattanavanit
- Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Bodin Khwannimit
- Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thanapon Nilmoje
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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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: 186] [Impact Index Per Article: 37.2] [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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Kolbe M, Boos M. Laborious but Elaborate: The Benefits of Really Studying Team Dynamics. Front Psychol 2019; 10:1478. [PMID: 31316435 PMCID: PMC6611000 DOI: 10.3389/fpsyg.2019.01478] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.
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Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Margarete Boos
- Institute for Psychology, University of Göttingen, Göttingen, Germany
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Neuschwander A, Job A, Younes A, Mignon A, Delgoulet C, Cabon P, Mantz J, Tesniere A. Impact of sleep deprivation on anaesthesia residents' non-technical skills: a pilot simulation-based prospective randomized trial. Br J Anaesth 2018; 119:125-131. [PMID: 28974071 DOI: 10.1093/bja/aex155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/13/2022] Open
Abstract
Background Sleep deprivation is common in anaesthesia residents, but its impact on performance remains uncertain. Non-technical skills (team working, situation awareness, decision making, and task management) are key components of quality of care in anaesthesia, particularly in crisis situations occurring in the operating room. The impact of sleep deprivation on non-technical skills is unknown. We tested the hypothesis that in anaesthesia residents sleep deprivation is associated with impaired non-technical skills. Methods Twenty anaesthesia residents were randomly allocated to undergo a simulation session after a night shift [sleep-deprived (SLD) group, n =10] or after a night of rest [rested (R) group, n =10] from January to March 2015. The simulated scenario was a situation of crisis management in the operating room. The primary end point was a composite score of anaesthetists' non-technical skills (ANTS) assessed by two blinded evaluators. Results Non-technical skills were significantly impaired in the SLD group [ANTS score 12.2 (interquartile range 10.5-13)] compared with the R group [14.5 (14-15), P <0.02]. This difference was mainly accounted for by a difference in the team working item. On the day of simulation, the SLD group showed increased sleepiness and decreased confidence in anaesthesia skills. Conclusions In this randomized pilot trial, sleep deprivation was associated with impaired non-technical skills of anaesthesia residents in a simulated anaesthesia intraoperative crisis scenario. Trial registration NCT02622217.
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Affiliation(s)
- A Neuschwander
- Department of Anaesthesiology and Critical Care Medicine, Hôpital européen Georges Pompidou, AP-HP, Université Paris Descartes, Paris, France.,iLumens Healthcare Simulation Laboratory, Université Paris Descartes, Paris, France
| | - A Job
- LATI, Université Paris Descartes, Paris, France
| | - A Younes
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - A Mignon
- iLumens Healthcare Simulation Laboratory, Université Paris Descartes, Paris, France.,Department of Anaesthesiology and Critical Care Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - C Delgoulet
- LATI, Université Paris Descartes, Paris, France
| | - P Cabon
- LATI, Université Paris Descartes, Paris, France
| | - J Mantz
- Department of Anaesthesiology and Critical Care Medicine, Hôpital européen Georges Pompidou, AP-HP, Université Paris Descartes, Paris, France.,Histopathology and Animal Models Unit, Institut Pasteur, Paris, France
| | - A Tesniere
- iLumens Healthcare Simulation Laboratory, Université Paris Descartes, Paris, France.,Department of Anaesthesiology and Critical Care Medicine, Hôpital Cochin, AP-HP, Paris, France
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One-year mortality of patients admitted to the intensive care unit after in-hospital cardiac arrest: a retrospective study. J Crit Care 2018; 48:345-351. [DOI: 10.1016/j.jcrc.2018.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/30/2018] [Accepted: 09/23/2018] [Indexed: 11/23/2022]
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Larsen T, Beier-Holgersen R, Østergaard D, Dieckmann P. Training residents to lead emergency teams: A qualitative review of barriers, challenges and learning goals. Heliyon 2018; 4:e01037. [PMID: 30603684 PMCID: PMC6304469 DOI: 10.1016/j.heliyon.2018.e01037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/14/2018] [Accepted: 12/07/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE An investigation to determine any consensus in opinions and views in the literature about challenges or barriers in training leadership for emergencies. SUMMARY OF BACKGROUND DATA Leadership in emergencies is reported as being very important for patient outcome. A systematic review failed in 2016 to find any focused leadership training. In the literature, the research has described and focused on developing tools to evaluate leadership. METHOD Articles identified in the systematic review combined with other reviews and opinions were included to incorporate experiences, perceptions and emotions connected with leadership training in emergency situations. Two qualitative content analyses were conducted. The first analysis searched for opinions about leadership and leadership training in emergencies. The method was abductive - inductive qualitative content analysis. The second analysis searched, on the basis of an article written in 1986, statements about challenges regarding leadership training in all articles. This method was directed qualitative content analysis. FINDINGS In total 40 articles covering the years 1986-2016 were analysed. An explicit need for workable leadership training of team leaders in emergencies was identified. The importance of the teamleader in emergencies was repeatedly stressed by 31/40 articles, leadership training is needed or required was stated by 30/40 articles, 27/40 articles described the emergency situation as stressful, complex, chaotic or unpredictable, 17/40 described the importance of self-confidence by the teamleader, and 8/40 described that the situation was perceived as creating concern, anxiety or panic. CONCLUSIONS The literature recommends finding a solution to teach residents to gain courage and confidence in stressful surroundings. The literature recommends finding a way to work with body language, non-verbal communication, attitude and appearance in order to radiate credibility in a setting separated from medical knowledge.
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Affiliation(s)
- Ture Larsen
- Simulation Unit (SimNord), Department of Administration, Nordsjællands Hospital, Denmark
| | | | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
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A search for training of practising leadership in emergency medicine: A systematic review. Heliyon 2018; 4:e00968. [PMID: 30761367 PMCID: PMC6286301 DOI: 10.1016/j.heliyon.2018.e00968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/11/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022] Open
Abstract
Objective This systematic review examines the medical, psychological and educational literature for training in practising leadership of a team leader in emergencies. The objectives of this paper are (1) describe how literature addresses operational training in practising leadership for the emergency medical team-leader (2) enhance understanding of leadership training in the medical environment. Background Worldwide, medical supervisors find it difficult to get students to rise to the occasion as leaders of emergency teams. It appears that many residents feel unprepared to adopt the role as a leader in emergencies. Method A systematic review was conducted (May-December 2016) in accordance with the PRISMA 2009 Checklist. A literature search was conducted against a set of inclusion criteria. Databases searched included PubMed, Psycinfo (via Ovid), and ERIC. Results 27 articles covering the period 1986-2016 were analysed. Four sources of data were identified: Intervention studies practising leadership, intervention studies on simulation and leadership assessment, observation studies assessing leadership, interview/survey studies about the need for leadership training. No workable training in practising leadership in emergencies for doctors was found. The majority of the research projects focused on various different types of taxonomies. Conclusions No consistent and workable leadership training for the emergency medical teamleader was identified. One study for paramedics succeeded in training empowering leadership skills. For many years multiple taxonomies and leadership assessment tools have been developed but failed to come to terms with workable leadership training. The literature describes lack of leadership as highly detrimental to performance during a critical, clinical situation.
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The Development and Validation of a Concise Instrument for Formative Assessment of Team Leader Performance During Simulated Pediatric Resuscitations. Simul Healthc 2018; 13:77-82. [PMID: 29117092 DOI: 10.1097/sih.0000000000000267] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM The aim of this study was to assess the validity of a formative feedback instrument for leaders of simulated resuscitations. METHODS This is a prospective validation study with a fully crossed (person × scenario × rater) study design. The Concise Assessment of Leader Management (CALM) instrument was designed by pediatric emergency medicine and graduate medical education experts to be used off the shelf to evaluate and provide formative feedback to resuscitation leaders. Four experts reviewed 16 videos of in situ simulated pediatric resuscitations and scored resuscitation leader performance using the CALM instrument. The videos consisted of 4 pediatric emergency department resuscitation teams each performing in 4 pediatric resuscitation scenarios (cardiac arrest, respiratory arrest, seizure, and sepsis). We report on content and internal structure (reliability) validity of the CALM instrument. RESULTS Content validity was supported by the instrument development process that involved professional experience, expert consensus, focused literature review, and pilot testing. Internal structure validity (reliability) was supported by the generalizability analysis. The main component that contributed to score variability was the person (33%), meaning that individual leaders performed differently. The rater component had almost zero (0%) contribution to variance, which implies that raters were in agreement and argues for high interrater reliability. CONCLUSIONS These results provide initial evidence to support the validity of the CALM instrument as a reliable assessment instrument that can facilitate formative feedback to leaders of pediatric simulated resuscitations.
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Boet S, Etherington N, Larrigan S, Yin L, Khan H, Sullivan K, Jung JJ, Grantcharov TP. Measuring the teamwork performance of teams in crisis situations: a systematic review of assessment tools and their measurement properties. BMJ Qual Saf 2018; 28:327-337. [PMID: 30309910 DOI: 10.1136/bmjqs-2018-008260] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations. METHODS Searches were conducted in Embase (via OVID), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Medline and Medline In-Process (via OVID) (through 12 January 2017). Studies evaluating the measurement properties of teamwork assessment tools for teams in clinical or simulated crisis situations were included. Two independent reviewers screened studies based on predetermined criteria and completed data extraction. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS The search yielded 1822 references. Twenty studies were included, representing 13 assessment tools. Tools were primarily assessed in simulated resuscitation scenarios for emergency department teams. The Team Emergency Assessment Measure (TEAM) had the most validation studies (n=5), which demonstrated three sources of validity (content, construct and concurrent) and three sources of reliability (internal consistency, inter-rater reliability and test-retest reliability). Most studies of TEAM's measurement properties were at no risk of bias. CONCLUSIONS A number of tools are available for assessing teamwork performance of teams in crisis situations. Although selection will ultimately depend on the user's context, TEAM may be the most promising tool given its measurement evidence. Currently, there is a lack of tools to assess teamwork performance during intraoperative crisis situations. Additional research is needed in this regard.
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Affiliation(s)
- Sylvain Boet
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nicole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sarah Larrigan
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Li Yin
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Hira Khan
- Department of Health Sciences, Faculty of Science , Carleton University, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - James J Jung
- Division of General Surgery, St. Michael's Hospital, Toronto, Canada
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The Influence of Culture on Teamwork and Communication in a Simulation-Based Resuscitation Training at a Community Hospital in Honduras. ACTA ACUST UNITED AC 2018; 13:363-370. [DOI: 10.1097/sih.0000000000000323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Larsen T, Beier-Holgersen R, Dieckmann P, Østergaard D. Conducting the emergency team: A novel way to train the team-leader for emergencies. Heliyon 2018; 4:e00791. [PMID: 30263972 PMCID: PMC6156909 DOI: 10.1016/j.heliyon.2018.e00791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Worldwide, medical supervisors find it difficult to get students to rise to the occasion when called upon to act as leaders of emergency teams: many residents/rescuers feel unprepared to adopt the leadership role. The challenge is to address the residents very strong emotions caused by the extremely stressful context. No systematic leadership training takes this aspect into account. AIM The overall aim of the course is to investigate whether, in an emergency, a clinical team leader could apply a conductor's leadership skills. BACKGROUND An orchestral conductor is a specialist in practicing leadership focusing on non-verbal communication. The conductor works with highly trained specialists and must lead them to cooperate and put his interpretation into effect. The conductor works purposefully in order to appear calm, genuine and gain authority. METHOD A conductor and a consultant prepared a course for residents, medical students and nurses, n = 61. Ten × two course days were completed. The exercises were musical and thus safe for the students as there were no clinical skills at stake. The programme aimed to create stress and anxiety in a safe learning environment. CONCLUSION The transfer of a conductor's skills improved and profoundly changed the participating students', nurses' and residents' behaviour and introduced a method to handle anxiety and show calmness and authority. PERSPECTIVES If this course in leadership is to be introduced as a compulsory part of the educating of doctors, the ideal time would be after clinical skills have been acquired, experience gained and routines understood in the clinic.
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Affiliation(s)
- Ture Larsen
- Simulation Unit (SimNord), Department of Administration, Kvalitetsafdelingen, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Randi Beier-Holgersen
- Department of Gastrointestinal Surgery, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev Hospital, Herlev Ringvej 75, 25 etage, 2730 Herlev, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev Hospital, Herlev Ringvej 75, 25 etage, 2730 Herlev, Copenhagen, Denmark
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Siems A, Cartron A, Watson A, McCarter R, Levin A. Improving Pediatric Rapid Response Team Performance Through Crew Resource Management Training of Team Leaders. Hosp Pediatr 2017; 7:88-95. [PMID: 28119369 DOI: 10.1542/hpeds.2016-0111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Rapid response teams (RRTs) improve the detection of and response to deteriorating patients. Professional hierarchies and the multidisciplinary nature of RRTs hinder team performance. This study assessed whether an intervention involving crew resource management training of team leaders could improve team performance. METHODS In situ observations of RRT activations were performed pre- and post-training intervention. Team performance and dynamics were measured by observed adherence to an ideal task list and by the Team Emergency Assessment Measure tool, respectively. Multiple quartile (median) and logistic regression models were developed to evaluate change in performance scores or completion of specific tasks. RESULTS Team leader and team introductions (40% to 90%, P = .004; 7% to 45%, P = .03), floor team presentations in Situation Background Assessment Recommendation format (20% to 65%, P = .01), and confirmation of the plan (7% to 70%, P = .002) improved after training in patients transferred to the ICU (n = 35). The Team Emergency Assessment Measure metric was improved in all 4 categories: leadership (2.5 to 3.5, P < .001), teamwork (2.7 to 3.7, P < .001), task management (2.9 to 3.8, P < .001), and global scores (6.0 to 9.0, P < .001) for teams caring for patients who required transfer to the ICU. CONCLUSIONS Targeted crew resource management training of the team leader resulted in improved team performance and dynamics for patients requiring transfer to the ICU. The intervention demonstrated that training the team leader improved behavior in RRT members who were not trained.
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Affiliation(s)
- Ashley Siems
- Children's National Health System, Washington, DC
| | | | - Anne Watson
- Children's National Health System, Washington, DC
| | | | - Amanda Levin
- Children's National Health System, Washington, DC
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Doumouras AG, Hamidi M, Lung K, Tarola CL, Tsao MW, Scott JW, Smink DS, Yule S. Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises. Br J Surg 2017; 104:1028-1036. [DOI: 10.1002/bjs.10526] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/28/2017] [Accepted: 02/05/2017] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Deficiencies in non-technical skills (NTS) have been increasingly implicated in avoidable operating theatre errors. Accordingly, this study sought to characterize the impact of surgeon and anaesthetist non-technical skills on time to crisis resolution in a simulated operating theatre.
Methods
Non-technical skills were assessed during 26 simulated crises (haemorrhage and airway emergency) performed by surgical teams. Teams consisted of surgeons, anaesthetists and nurses. Behaviour was assessed by four trained raters using the Non-Technical Skills for Surgeons (NOTSS) and Anaesthetists' Non-Technical Skills (ANTS) rating scales before and during the crisis phase of each scenario. The primary endpoint was time to crisis resolution; secondary endpoints included NTS scores before and during the crisis. A cross-classified linear mixed-effects model was used for the final analysis.
Results
Thirteen different surgical teams were assessed. Higher NTS ratings resulted in significantly faster crisis resolution. For anaesthetists, every 1-point increase in ANTS score was associated with a decrease of 53·50 (95 per cent c.i. 31·13 to 75·87) s in time to crisis resolution (P < 0·001). Similarly, for surgeons, every 1-point increase in NOTSS score was associated with a decrease of 64·81 (26·01 to 103·60) s in time to crisis resolution in the haemorrhage scenario (P = 0·001); however, this did not apply to the difficult airway scenario. Non-technical skills scores were lower during the crisis phase of the scenarios than those measured before the crisis for both surgeons and anaesthetists.
Conclusion
A higher level of NTS of surgeons and anaesthetists led to quicker crisis resolution in a simulated operating theatre environment.
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Affiliation(s)
- A G Doumouras
- School of Public Health, Harvard University, Boston, Massachusetts, USA
- Departments of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - M Hamidi
- School of Public Health, Harvard University, Boston, Massachusetts, USA
- Departments of Surgery, Western University, London, Ontario, Canada
| | - K Lung
- School of Public Health, Harvard University, Boston, Massachusetts, USA
- Departments of Surgery, Western University, London, Ontario, Canada
| | - C L Tarola
- School of Public Health, Harvard University, Boston, Massachusetts, USA
- Departments of Surgery, Western University, London, Ontario, Canada
| | - M W Tsao
- Departments of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - J W Scott
- Neil and Elise Wallace STRATUS Center for Medical Simulation and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - D S Smink
- Neil and Elise Wallace STRATUS Center for Medical Simulation and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - S Yule
- Neil and Elise Wallace STRATUS Center for Medical Simulation and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Quality maternal care: a call for anesthesia leadership and collaboration. Curr Opin Anaesthesiol 2017; 30:277-279. [PMID: 28323669 DOI: 10.1097/aco.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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