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Ghanmi N, Bondok M, Etherington C, Saddiki Y, Lefebvre I, Berthelot P, Dion PM, Raymond B, Seguin J, Sekhavati P, Islam S, Boet S. Optimizing Teamwork in the Operating Room: A Scoping Review of Actionable Teamwork Strategies. Cureus 2024; 16:e60522. [PMID: 38883070 PMCID: PMC11180536 DOI: 10.7759/cureus.60522] [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] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regarding the actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.
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Affiliation(s)
- Nibras Ghanmi
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Mostafa Bondok
- Department of Anesthesiology, University of British Columbia, Faculty of Medicine, Vancouver, CAN
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, CAN
| | | | | | | | | | | | - Jeanne Seguin
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | | | - Sindeed Islam
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, CAN
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Weller JM, Mahajan R, Fahey-Williams K, Webster CS. Teamwork matters: team situation awareness to build high-performing healthcare teams, a narrative review. Br J Anaesth 2024; 132:771-778. [PMID: 38310070 DOI: 10.1016/j.bja.2023.12.035] [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: 08/22/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 02/05/2024] Open
Abstract
Healthcare today is the prerogative of teams rather than of individuals. In acute care domains such as anaesthesia, intensive care, and emergency medicine, the work is complex and fast-paced, and the team members are diverse and interdependent. Three decades of research into the behaviours of high-performing teams provides us with clear guidance on team training, demonstrating positive effects on patient safety and staff wellbeing. Here we consider team performance through the lens of situation awareness. Maintaining situation awareness is an absolute requirement for safe and effective patient management. Situation awareness is a dynamic process of perceiving cues in the environment, understanding what they mean, and predicting how the situation may evolve. In the context of acute clinical care, situation awareness can be improved if the whole team actively contributes to monitoring the environment, processing information, and planning next steps. In this narrative review, we explore the concept of situation awareness at the level of the team, the conditions required to maintain team situation awareness, and the relationship between team situation awareness, shared mental models, and team performance. Our ultimate goal is to help clinicians create the conditions required for high-functioning teams, and ultimately improve the safety of clinical care.
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Affiliation(s)
- Jennifer M Weller
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
| | - Ravi Mahajan
- Centre of Excellence in Critical Care, Apollo Hospitals Group, Chennai, India; Department of Anaesthesia and Intensive Care, University of Nottingham, Nottingham, UK
| | - Kathryn Fahey-Williams
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand
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3
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Totonchilar S, Aarabi A, Eftekhari N, Mohammadi M. Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study. Perioper Med (Lond) 2024; 13:1. [PMID: 38167373 PMCID: PMC10763043 DOI: 10.1186/s13741-023-00356-6] [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: 08/10/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND A high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals. METHODS This cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale. RESULTS A total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons. CONCLUSIONS The results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members' workload.
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Affiliation(s)
| | - Akram Aarabi
- Ardabil University of Medical Science, Ardabil, Iran.
- Isfahan University of Medical Sciences, Isfahan, Iran.
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Mathis MR, Janda AM, Yule SJ, Dias RD, Likosky DS, Pagani FD, Stakich-Alpirez K, Kerray FM, Schultz ML, Fitzgerald D, Sturmer D, Manojlovich M, Krein SL, Caldwell MD. Nontechnical Skills for Intraoperative Team Members. Anesthesiol Clin 2023; 41:803-818. [PMID: 37838385 PMCID: PMC10703542 DOI: 10.1016/j.anclin.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Nontechnical skills, defined as the set of cognitive and social skills used by individuals and teams to reduce error and improve performance in complex systems, have become increasingly recognized as a key contributor to patient safety. Efforts to characterize, quantify, and teach nontechnical skills in the context of perioperative care continue to evolve. This review article summarizes the essential behaviors for safety, described in taxonomies for nontechnical skills assessments developed for intraoperative clinical team members (eg, surgeons, anesthesiologists, scrub practitioners, perfusionists). Furthermore, the authors describe emerging methods to advance understanding of the impact of nontechnical skills on perioperative outcomes.
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Affiliation(s)
- Michael R Mathis
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Allison M Janda
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Steven J Yule
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Roger D Dias
- Department of Emergency Medicine, Brigham & Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Korana Stakich-Alpirez
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Fiona M Kerray
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Megan L Schultz
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - David Fitzgerald
- Department of Clinical Sciences, Medical University of South Carolina College of Health Professions, A 151 Rutledge Avenue, Charleston, SC 29403, USA
| | - David Sturmer
- Department of Perfusion, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Milisa Manojlovich
- School of Nursing, University of Michigan, 426 N Ingalls Street, Ann Arbor, MI 48104, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Matthew D Caldwell
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Khoo DW, Roscoe AJ, Hwang NC. Beyond the self: a novel framework to enhance non-technical team skills for anesthesiologists. Minerva Anestesiol 2023; 89:1115-1126. [PMID: 38019175 DOI: 10.23736/s0375-9393.23.16729-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Human factors and non-technical skills (NTS) have been identified as essential contributors to both the propagation and prevention of medical errors in the operating room. Despite extensive study and interventions to nurture and enhance NTS in anesthesiologists, gaps to effective team practice and patient safety remain. Furthermore, the link between added NTS training and clinically significant improved outcomes has not yet been demonstrated. We performed a narrative review to summarize the literature on existing systems and initiatives used to measure and nurture NTS in the clinical operating room setting. Controlled interventions performed to nurture NTS (N.=13) were identified and compared. We comment on the body of current evidence and highlight the achievements and limitations of interventions published thus far. We then propose a novel education and training framework to further develop and enhance non-technical skills in both individual anesthesiologists and operating room teams. We use the cardiac anesthesiology environment as a starting point to illustrate its use, with clinical examples. NTS is a key component of enhancing patient safety. Effective framing of its concepts is central to apply individual characteristics and skills in team environments in the OR and achieve tangible, beneficial patient outcomes.
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Affiliation(s)
- Deborah W Khoo
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore -
| | - Andrew J Roscoe
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
- Department of Cardiothoracic Anesthesia, National Heart Center Singapore, Singapore, Singapore
| | - Nian C Hwang
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
- Department of Cardiothoracic Anesthesia, National Heart Center Singapore, Singapore, Singapore
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Verhoeff TL, Janssen JJ, Hietbrink F, Hoff RG. Team- and task-related knowledge in shared mental models in operating room teams: A survey study. Heliyon 2023; 9:e16990. [PMID: 37332942 PMCID: PMC10272475 DOI: 10.1016/j.heliyon.2023.e16990] [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: 11/07/2022] [Revised: 04/28/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The operating room is a highly complex environment, where patient care is delivered by interprofessional teams. Unfortunately, issues with communication and teamwork occur, potentially leading to patient harm. A shared mental model is one prerequisite to function effectively as a team, and consists of task- and team-related knowledge. We aimed to explore potential differences in task- and team-related knowledge between the different professions working in the operating room. The assessed team-related knowledge consisted of knowledge regarding other professions' training and work activities, and of perceived traits of a high-performing and underperforming colleague. Task-related knowledge was assessed by mapping the perceived allocation of responsibilities for certain tasks, using a Likert-type scale. Design A single sample cross-sectional study. Setting The study was performed in three hospitals in the Netherlands, one academic center and two regional teaching hospitals. Participants 106 health care professionals participated, of four professions. Most respondents (77%) were certified professionals, the others were still in training. Results Participants generally were well informed about each other's training and work activities and nearly everyone mentioned the importance of adequate communication and teamwork. Discrepancies were also observed. The other professions knew on average the least about the profession of anesthesiologists and most about the profession of surgeons. When assessing the responsibilities regarding tasks we found consensus in well-defined and/or protocolized tasks, but variation in less clearly defined tasks. Conclusions Team- and task-related knowledge in the operating room team is reasonably well developed, but irregularly, with potentially crucial differences in knowledge related to patient care. Awareness of these discrepancies is the first step in further optimization of team performance.
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Affiliation(s)
- Tessa L. Verhoeff
- Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 GA, Utrecht, the Netherlands
| | - Jeroen J.H.M. Janssen
- Department of Education, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 GA, Utrecht, the Netherlands
| | - Reinier G. Hoff
- Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 GA, Utrecht, the Netherlands
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Interprofessional Simulation in Cardiothoracic Surgery Improves Team Confidence. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2022; 54:250-254. [PMID: 36742219 PMCID: PMC9891484 DOI: 10.1182/ject-250-254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/17/2022] [Indexed: 02/07/2023]
Abstract
Interest in simulation has grown substantially, as has enthusiasm for team-based approaches to surgical training. In cardiothoracic surgery, the dynamic ability of the entire team is critical to emergent events. We developed innovative, interprofessional simulation events to improve team confidence. Two separate simulations event replicating critical steps and potential crises of cardiopulmonary bypass (CPB) were attended by members of the multidisciplinary cardiothoracic team. Standard CPB equipment, echocardiography, an app to control vital signs, and typical operating room tools for cannulation were all used. Participant started at their typical roles, then rotated into unfamiliar roles for subsequent simulations. Survey and Likert scale self-assessment tools were used to determine outcomes. Statistical analysis compared results. Two separate events were attended by a total of 37 team members (17 facilitators and 20 participants). Participants rotated roles through 12 routine and high-risk scenarios for instituting and separating from CPB. Participant evaluation results were highly favorable, with requests for further similar events. Objectively, the mean score for self-assessment rose significantly comparing the pre- and post-simulation assessments. Despite a small sample size, these differences did reach statistical significance in two categories: iatrogenic dissection (p 0.008), and emergent return to CPB (p 0.016). In our experience, high-fidelity interprofessional simulation promoted team communication and confidence for key scenarios related to institution of and separation from CPB.
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8
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Merry M, Riddle P, Warren J. A mental models approach for defining explainable artificial intelligence. BMC Med Inform Decis Mak 2021; 21:344. [PMID: 34886856 PMCID: PMC8656102 DOI: 10.1186/s12911-021-01703-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Wide-ranging concerns exist regarding the use of black-box modelling methods in sensitive contexts such as healthcare. Despite performance gains and hype, uptake of artificial intelligence (AI) is hindered by these concerns. Explainable AI is thought to help alleviate these concerns. However, existing definitions for explainable are not forming a solid foundation for this work. METHODS We critique recent reviews on the literature regarding: the agency of an AI within a team; mental models, especially as they apply to healthcare, and the practical aspects of their elicitation; and existing and current definitions of explainability, especially from the perspective of AI researchers. On the basis of this literature, we create a new definition of explainable, and supporting terms, providing definitions that can be objectively evaluated. Finally, we apply the new definition of explainable to three existing models, demonstrating how it can apply to previous research, and providing guidance for future research on the basis of this definition. RESULTS Existing definitions of explanation are premised on global applicability and don't address the question 'understandable by whom?'. Eliciting mental models can be likened to creating explainable AI if one considers the AI as a member of a team. On this basis, we define explainability in terms of the context of the model, comprising the purpose, audience, and language of the model and explanation. As examples, this definition is applied to regression models, neural nets, and human mental models in operating-room teams. CONCLUSIONS Existing definitions of explanation have limitations for ensuring that the concerns for practical applications are resolved. Defining explainability in terms of the context of their application forces evaluations to be aligned with the practical goals of the model. Further, it will allow researchers to explicitly distinguish between explanations for technical and lay audiences, allowing different evaluations to be applied to each.
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Affiliation(s)
- Michael Merry
- School of Computer Science, University of Auckland, Symonds St, Auckland, New Zealand
| | - Pat Riddle
- School of Computer Science, University of Auckland, Symonds St, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Symonds St, Auckland, New Zealand
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9
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Military Surgical Team Performance: The Impact of Familiarity, Team Size, and Nurse Anesthesia Students. J Perianesth Nurs 2021; 37:86-93. [PMID: 34819253 DOI: 10.1016/j.jopan.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/14/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To examine the key factors impacting surgical team performance in a military medical center. DESIGN A retrospective, exploratory, cross-sectional design. METHODS We reviewed 751 orthopedic surgical cases to determine the association of surgical team familiarity, surgical complexity, team size, and the presence of student registered nurse anesthetists (SRNAs) with the surgical performance measures of total operative time, turnover time, and on-time surgical start. FINDINGS We found increases in surgical team familiarity significantly reduced turnover time by 7.84% (1-0.9216 = 0.0784; P = .0260) after controlling for surgical complexity and the presence of an SRNA on the team. Familiarity did not significantly impact total operative time or the odds of a first case on-time start. With a significant interaction of surgical complexity and team size on total operative time, the surgical complexity marginal effect (at the mean of team size) showed that a one-point increase prolonged total operative time by 6.89% (P < .0001), after controlling for team familiarity and an SRNA. The team size marginal effect (at the mean of surgical complexity) showed that adding one member to the surgical team prolonged total operative time by 6.45% (P < .0001), after controlling for team familiarity and an SRNA. Higher surgical complexity not only increased turnover time by 1.46% (P = .0265) while holding surgical complexity and an SRNA presence constant, but also reduced the likelihood of an on-time surgical start by 0.9359 (P = .0060). Larger teams decreased the odds of an on-time start by 0.7750 (P = .0363). We found that SRNAs potentially offer efficiency benefits, as their presence on a surgical team was associated with a 0.82% (1-0.9185 = 0.0815; P = .0007) decrease in total operative time, and a 21.01% (1-0.7899=0.2101; P = .0002) reduction in expected turnover time, after adjusting for confounding variables. CONCLUSIONS Surgical efficiency is a modifiable function of surgical teams. Although we suggest additional research, surgical leaders can potentially improve team performance by improving familiarity and forming small and cohesive surgical teams. As OR inefficiencies degrade the financial vitality of healthcare systems, surgical leaders should engage in a multifaceted program to improve efficiency by building familiarity and optimizing team size.
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van Dalen ASHM, Strandbygaard J, van Herzeele I, Boet S, Grantcharov TP, Schijven MP. Six Sigma in surgery: how to create a safer culture in the operating theatre using innovative technology. Br J Anaesth 2021; 127:817-820. [PMID: 34593216 DOI: 10.1016/j.bja.2021.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/26/2021] [Accepted: 08/16/2021] [Indexed: 01/05/2023] Open
Abstract
Safe delivery of patient care in the operating theatre is complex and co-dependent of many individual, organisational, and environmental factors, including patient, task and technology, individual, and human factors. The Six Sigma approach aims to implement a data-driven strategy to reduce variability and consequently improve safety. Analytical data platforms such as a Black Box ought to be embraced to support process optimisation and ultimately create a higher level of Six Sigma safety performance of the operating theatre team.
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Affiliation(s)
| | | | - Isabelle van Herzeele
- Department of Thoracic and Vascular Surgery, UZ Gent, University of Gent, Ghent, Belgium
| | - Sylvain Boet
- Department of Anaesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Teodor P Grantcharov
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Marlies P Schijven
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Urpo M, Eskola S, Suominen T, Roos M. Teamwork: a perspective of perioperative nurses. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2021.12.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Nina V, Mendes AG, Sevdalis N, Marath A, Mejia OV, Brandão CMA, Monteiro R, Mendes VG, Jatene FB. Applicability of the Disruptions in Surgery Index in the Cardiovascular Management Scenarios - A Marker for Developing Functionally Efficient Teams. Braz J Cardiovasc Surg 2021; 36:445-452. [PMID: 34617425 PMCID: PMC8522325 DOI: 10.21470/1678-9741-2020-0685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction To support the development of practices and guidelines that might help to
reduce adverse events related to human factors, we aimed to study the
response and perception by members of a cardiovascular surgery team of
various error-driven or adverse features that might arise in the operating
room (OR). Methods A previously validated Disruptions in Surgery Index (DiSI) questionnaire was
completed by individuals working together in a cardiovascular surgical unit.
Results were submitted to reliability analysis by calculating the Cronbach’s
alpha coefficient. Non-parametric Kruskal-Wallis test and Dunn’s post-test
were performed to estimate differences in perceptions of adverse events or
outcomes between the groups (surgeons, nurses, anesthesiologists, and
technicians). P<0.05 was considered statistically
significant. Results Cronbach’s alpha reliability coefficients showed consistency within the
recommended range for all disruption types assessed in DiSI: an individual’s
skill (0.85), OR environment (0.88), communication (0.81), situational
awareness (0.92), patient-related disruption (0.89), team cohesion (0.83),
and organizational disruption (0.83). Nurses (27.4%) demonstrated
significantly higher perception of disruptions than surgeons (25.4%),
anesthetists (23.3%), and technicians (23.0%) (P=0.005).
Study participants were more observant of their colleagues’ disruptive
behaviors than their own (P=0.0001). Conclusion Our results revealed that there is a tendency among participants to hold a
positive self-perception position. DiSI appears to be a reliable and useful
tool to assess surgical disruptions in cardiovascular OR teams, identifying
negative features that might imperil teamwork and safety in the OR. And
human factors training interventions are available to develop team skills
and improve safety and efficiency in the cardiovascular OR.
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Affiliation(s)
- Vinicius Nina
- Department of Medicine I, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | - Augusto Gonçalves Mendes
- Health Service & Population Research, King's College London, London, London, United Kingdom of Great Britain and Northern Ireland
| | - Nick Sevdalis
- CardioStart International, Tampa, Florida, United States of America
| | - Aubyn Marath
- Department of Cardiovascular Surgery, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Omar Vilca Mejia
- Hospital do Câncer Tarquínio Lopes Filho, São Luís, Maranhão, Brazil
| | - Carlos Manuel A Brandão
- Department of Cardiac Surgery, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Rosangela Monteiro
- Department of Cardiovascular Surgery, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Fabio B Jatene
- Universidade de São Paulo Faculdade de Medicina Instituto do Coração São Paulo São Paulo Brazil Department of Cardiac Surgery, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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13
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Edgar L, Jones MD, Harsy B, Passiment M, Hauer KE. Better Decision-Making: Shared Mental Models and the Clinical Competency Committee. J Grad Med Educ 2021; 13:51-58. [PMID: 33936533 PMCID: PMC8078083 DOI: 10.4300/jgme-d-20-00850.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Shared mental models (SMMs) help groups make better decisions. Clinical competency committees (CCCs) can benefit from the development and use of SMMs in their decision-making as a way to optimize the quality and consistency of their decisions. OBJECTIVE We reviewed the use of SMMs for decision making in graduate medical education, particularly their use in CCCs. METHODS In May 2020, the authors conducted a narrative review of the literature related to SMMs. This review included the SMM related to teams, team functioning, CCCs, and graduate medical education. RESULTS The literature identified the general use of SMMs, SMMs in graduate medical education, and strategies for building SMMs into the work of the CCC. Through the use of clear communication and guidelines, and a shared understanding of goals and expectations, CCCs can make better decisions. SMMs can be applied to Milestones, resident performance, assessment, and feedback. CONCLUSIONS To ensure fair and robust decision-making, the CCC must develop and maintain SMMs through excellent communication and understanding of expectations among members.
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Affiliation(s)
- Laura Edgar
- Laura Edgar, EdD, CAE, is Vice President, Milestones Development, Accreditation Council for Graduate Medical Education (ACGME)
| | - M. Douglas Jones
- M. Douglas Jones Jr, MD, is Professor of Pediatrics, University of Colorado School of Medicine
| | - Braden Harsy
- Braden Harsy, MA, is Milestones Administrator, ACGME
| | - Morgan Passiment
- Morgan Passiment, MS, is Director, Institutional Outreach and Collaboration, ACGME
| | - Karen E. Hauer
- Karen E. Hauer, MD, PhD, is Associate Dean, Competency Assessment and Professional Standards, and Professor of Medicine, University of California, San Francisco
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Sewell JL, Santhosh L, O'Sullivan PS. How do attending physicians describe cognitive overload among their workplace learners? MEDICAL EDUCATION 2020; 54:1129-1136. [PMID: 32628785 DOI: 10.1111/medu.14289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/22/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Cognitive load theory (CLT) focuses on the limited bandwidth of working memory. Core to CLT is the concept of cognitive overload, which occurs when working memory demands exceed working memory capacity, and learning and performance suffer. Within health professions education (HPE), workplace learning settings are very complex, placing learners at high risk of cognitive overload. Although continuous monitoring of physiologic parameters can indicate states of high cognitive load, how to practically identify cognitively overloaded learners within everyday workplace settings is not well understood. We sought to characterise how attending physicians described their perceiving of cognitive overload among learners in two different workplace settings: the gastrointestinal endoscopy suite and the intensive care unit. METHODS We performed a secondary qualitative analysis of transcripts of interviews with workplace teachers that had been carried out during two previous studies. These studies had addressed different objectives but both were informed by CLT. Each included questions that prompted participants to reflect on how they perceived cognitive overload to manifest among learners in the workplace. To investigate the phenomenon of cognitive overload, we developed a new codebook and performed content analysis. RESULTS We analysed 42 interview transcripts (22 endoscopists, 12 hospitalists, eight intensivists). Participants described four behaviours they had witnessed among learners they thought were cognitively overloaded: poor performance on workplace tasks; non-verbal physical manifestations (including posture, eye and body movements and autonomic functions); verbal utterances (words and sounds), and interpersonal interactions with team members. Endoscopists often described individually oriented examples, whereas intensivists and hospitalists tended to frame examples within an interpersonal context. CONCLUSIONS We identified four overarching ways in which HPE workplace teachers perceived learners as appearing to be cognitively overloaded. Workplace teachers and learners should be mindful of and watch for these signs, which may signal states of cognitive overload. Earlier recognition of cognitive overload may facilitate timely action to reduce cognitive overload and promote learning.
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Affiliation(s)
- Justin L Sewell
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - Lekshmi Santhosh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Patricia S O'Sullivan
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Sustainable quality and safety improvement in healthcare: further lessons from the aviation industry. Br J Anaesth 2020; 125:425-429. [DOI: 10.1016/j.bja.2020.06.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
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Santhosh L, Sewell J. Hospitalist and Intensivist Experiences of the "Open" Intensive Care Unit Environment: a Qualitative Exploration. J Gen Intern Med 2020; 35:2338-2346. [PMID: 32462568 PMCID: PMC7253146 DOI: 10.1007/s11606-020-05835-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most U.S. academic medical centers employ "closed" intensive care units (ICUs), where critically ill patients are admitted under the supervision of intensivists managing dedicated ICU teams. Some centers utilize a unique "open" ICU structure, where primary services longitudinally follow patients who become critically ill into the ICU with intensivist comanagement. The impact of open ICUs on patient care and education of trainees has not been well-characterized. OBJECTIVE The objective of this study is to characterize affordances and barriers to education and patient care, from the perspectives of hospitalists and intensivists teaching in the ICU. DESIGN We conducted semi-structured interviews with hospitalist and intensivist faculty at a large academic medical center with an open ICU structure. We coded deidentified interview transcripts to inductively analyze the data for themes and subthemes. PARTICIPANTS We recruited hospitalist and intensivist faculty members who attend on teaching services in the open ICU system. APPROACH Given the complexity of multiple teachers and learners in the ICU environment, we selected shared mental models as our primary theoretical lens through which we analyzed and interpreted our data. KEY RESULTS We identified three main themes regarding education in the open ICU system: (1) communication challenges, (2) educational barriers and affordances, and (3) structural barriers and affordances. Hospitalists and intensivists agreed on some barriers and facilitators to education, such as continuity of care, yet they disagreed on others. Specifically, hospitalists and intensivists had a shared mental model regarding barriers to patient care and education in the open ICU structure, but had divergent opinions regarding the affordances of the structure, such as continuity and availability of ICU expertise. CONCLUSIONS The open ICU environment presents facilitators and barriers to trainee education and patient care. Our findings can be leveraged to improve communication, education, and patient care on both hospitalist and ICU teams.
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Affiliation(s)
- Lekshmi Santhosh
- Division of Pulmonary/Critical Care Medicine, University of California-San Francisco, S1183, 505 Parnassus Avenue, San Francisco, CA, 94143, USA. .,Division of Hospital Medicine, University of California-San Francisco, S1183, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Justin Sewell
- Division of Gastroenterology, Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, CA, USA
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Holmes T, Vifladt A, Ballangrud R. A qualitative study of how inter-professional teamwork influences perioperative nursing. Nurs Open 2020; 7:571-580. [PMID: 32089854 PMCID: PMC7024613 DOI: 10.1002/nop2.422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/18/2019] [Accepted: 11/05/2019] [Indexed: 11/30/2022] Open
Abstract
Aim To explore Norwegian operating room nurses' perceptions of how team skills in the inter-professional operating room team influence perioperative nursing in relation to patient safety. Design A qualitative, descriptive study based on interviews. Methods Ten operating room nurses (N = 10) employed in four Norwegian hospitals were interviewed individually. A qualitative inductive content analysis was conducted. The study was reported adhering to the Consolidated Criteria for Reporting Qualitative Research Checklist. Results Three generic categories, containing three subcategories each, were identified illuminate the operating room nurses' perceptions. The operating room team's team skills influence on (a) the quality of perioperative nursing, about task performance, result for the patient and learning; (b) the progress of perioperative nursing, by keeping focus on the task, being prepared and task distribution and (c) the operating room nurses' work environment in the operating room, including confidence, stress and energy use and irritation or job satisfaction.
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Affiliation(s)
- Thekla Holmes
- Department of Health Sciences GjøvikFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyGjøvikNorway
- Department of SurgeryInnlandet Hospital TrustGjøvikNorway
| | - Anne Vifladt
- Department of Health Sciences GjøvikFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyGjøvikNorway
| | - Randi Ballangrud
- Department of Health Sciences GjøvikFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyGjøvikNorway
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Beck S, Doehn C, Funk H, Kosan J, Issleib M, Daubmann A, Zöllner C, Kubitz JC. Basic life support training using shared mental models improves team performance of first responders on normal wards: A randomised controlled simulation trial. Resuscitation 2019; 144:33-39. [PMID: 31505232 DOI: 10.1016/j.resuscitation.2019.08.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/14/2019] [Accepted: 08/25/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Survival of in-hospital cardiac arrest (IHCA) depends on fast and effective action of the first responding team. Not only technical skills, but professional teamwork is required. Observational studies and theoretical models suggest that shared mental models of members improve teamwork. This study investigated if a training on shared mental models, improves team performance in simulated in-hospital cardiac arrest. METHODS On the background of an introduction of mandatory Basic Life Support (BLS) training for clinical staff a randomized controlled trial was performed to compare two training methods. Staff from clinical departments was randomised to receive either a conventional instructor led training (control group) or an interventional training (intervention group). The interventional training was based on self-directed learning of the group in order to develop shared mental models. Primary outcome were mean scores of the team assessment scale (TAS) and the hands-off time. Secondary outcome were mean scores for quality of BLS. RESULTS Performance of 75 teams of the interventional and 66 of the control group was analysed. The hands-off time was significantly lower in the interventional group (5.42% vs. 8.85%, p = 0.029). Scores of the TAS and the overall BLS score were high and not significantly different between the groups. Hands-off time correlated significantly negative with all TAS items. CONCLUSION BLS training for clinical staff which creates shared mental models reduces hands-off time in a simulated cardiac arrest scenario. Training methods establishing shared mental models of team members can be considered for effective team trainings without adding additional training time.
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Affiliation(s)
- Stefanie Beck
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany
| | - Christoph Doehn
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany.
| | - Hayo Funk
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany
| | - Janina Kosan
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany
| | - Malte Issleib
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany
| | - Christian Zöllner
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany
| | - Jens Christian Kubitz
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany
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Saxena S, Krombach JW, Nahrwold DA, Pirracchio R. Anaesthesia-specific checklists: A systematic review of impact. Anaesth Crit Care Pain Med 2019; 39:65-73. [PMID: 31374366 DOI: 10.1016/j.accpm.2019.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/19/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022]
Abstract
Checklists are recognised as powerful tools to prevent avoidable errors in high-reliability organisations. In healthcare, the perioperative area has been a leading field in the development of a wide range of checklists. However, clinical literature on this subject is still sparse and heterogeneous, producing results that are sometimes conflicting. This systematic review assesses the current literature on perioperative routine and crisis checklists. Literature searches did not use a date limit and included articles up to March 2019. The methodological heterogeneity precluded combining data from the individual studies into a quantitative meta-analysis. Data are presented by means of a qualitative comparison with the reference groups based on a content analysis approach. Of the 874 identified articles, 25 were included in this review. Most identified studies (23, 92%) have shown that the use of checklists in anaesthesia can decrease human error, improve patient safety and teamwork, and increase quality of care. Beyond the WHO surgical time-out, anaesthesia-specific checklists have been shown to be useful for provider handoffs, emergencies, and routine anaesthesia procedures. However, literature on anaesthesia-specific checklists is still limited and very heterogeneous. More large-scale studies are necessary to identify an ideal anaesthesia checklist and its most appropriate implementation method.
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Affiliation(s)
- Sarah Saxena
- Department of Anaesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital & Trauma Centre, University of California, 1001, Potrero avenue, CA94110 San Francisco, CA, United States of America; Department of Anaesthesia, University Hospital of Charleroi, Charleroi, Belgium
| | - Jens W Krombach
- Department of Anaesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital & Trauma Centre, University of California, 1001, Potrero avenue, CA94110 San Francisco, CA, United States of America
| | - Daniel A Nahrwold
- Department of Anaesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital & Trauma Centre, University of California, 1001, Potrero avenue, CA94110 San Francisco, CA, United States of America
| | - Romain Pirracchio
- Department of Anaesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital & Trauma Centre, University of California, 1001, Potrero avenue, CA94110 San Francisco, CA, United States of America; Department of Anaesthesia and Critical Care Medicine, European Hospital Georges-Pompidou, Paris Descartes University, 75015 Paris, France; Inserm UMR 1153, ECSTRA Team, Department of Biostatistics and Medical Informatics, Saint Louis Hospital, Paris Diderot University, 75010 Paris, France.
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Gowda D, Dubroff R, Willieme A, Swan-Sein A, Capello C. Art as Sanctuary: A Four-Year Mixed-Methods Evaluation of a Visual Art Course Addressing Uncertainty Through Reflection. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:498-509. [PMID: 30365424 DOI: 10.1097/acm.0000000000002019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Engagement with visual art is a promising modality for addressing issues of uncertainty via reflective practice, one that is being increasingly used in health science education. An elective museum-based course for first-year medical students was created by two medical schools and led by an art educator experienced in medical education. The course, Observation and Uncertainty in Art and Medicine, sought to help students explore experiences of uncertainty and to develop reflective capacity through engagement with visual art. METHOD The course was run and evaluated from 2014 to 2017, with 47 students participating over the 4 years, with 12 students enrolled per year. Before and after the course, students were given the Groningen Reflection Ability Scale (GRAS) for reflective ability, the Tolerance for Ambiguity scale for ambiguity, and Best Intentions Questionnaire for personal bias awareness, and 35 students (74%) completed all of the scales. Focus group interviews and narrative postcourse evaluations were conducted, coded, and thematically analyzed. RESULTS Statistically significant improvement was found in GRAS scores. Qualitative themes included student enhancement of observational skills, awareness of the subjectivity and uncertainty of perception, exploration of multiple points of view, and recognition of the course as a place for restoration and connection to classmates. CONCLUSIONS Incorporating visual art into medical education is an effective pedagogical method for addressing competencies central to training, including observation, reflection, and self-care.
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Affiliation(s)
- Deepthiman Gowda
- D. Gowda is director of clinical practice, Program in Narrative Medicine, director, Foundations of Clinical Medicine, and associate professor of medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: http://orcid.org/0000-0001-7124-7615. R. Dubroff is assistant professor of clinical medicine, Weill Cornell Medical College, New York, New York. A. Willieme is founder and director, ArtMed inSight, Cambridge, Massachusetts. A. Swan-Sein is director, Center for Education Research and Evaluation, and assistant professor of educational assessment in pediatrics and dental medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: http://orcid.org/0000-0002-3139-4626. C. Capello is associate director, Office of Curriculum and Educational Development, director, Office of Academic Assistance, and associate professor of geriatrics education in medicine, Weill Cornell Medical College, New York, New York
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22
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Gisick LM, Webster KL, Keebler JR, Lazzara EH, Fouquet S, Fletcher K, Fagerlund A, Lew V, Chan R. Measuring shared mental models in healthcare. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2018. [DOI: 10.1177/2516043518796442] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective To review common qualitative and quantitative methods of measuring shared mental models appropriate for use in the healthcare setting. Background Shared mental models are the overlap of individuals’ set of knowledge and/or assumptions that act as the basis for understanding and decision making between individuals. Within healthcare, shared mental models facilitate effective teamwork and theorized to influence clinical decision making and performance. With the current rapid growth and expansion of healthcare teams, it is critical that we understand and correctly use shared mental model measurement methods assess optimal team performance. Unfortunately, agreement on the proper measurement of shared mental models within healthcare remains diffuse. Method This paper presents methods appropriate to measure shared mental models within healthcare. Results Multiple shared mental model measurement methods are discussed with regard to their utility within this setting, ease of use, and difficulties in deploying within the healthcare operational environment. For rigorous analysis of shared mental models, it is recommended that a combination of qualitative and quantitative analyses be employed. Conclusion There are multitude of shared mental model measurement methods that can be used in the healthcare domain; although there is no perfect solution for every situation. Researchers can utilize this article to determine the best approach for their needs.
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Affiliation(s)
- Logan M Gisick
- Department of Human Factors and Systems, Embry Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Kristen L Webster
- The Armstrong Institute of Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Joseph R Keebler
- Department of Human Factors and Systems, Embry Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Elizabeth H Lazzara
- Department of Human Factors and Systems, Embry Riddle Aeronautical University, Daytona Beach, FL, USA
| | | | | | | | - Victoria Lew
- Department of Human Factors and Systems, Embry Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Raymond Chan
- Department of Psychology, Children’s Mercy, Kansas City, MI, USA
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Webster CS, Weller JM. Self-reported ratings appear to be the best for workload measurement. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 4:108-109. [DOI: 10.1136/bmjstel-2018-000330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 11/03/2022]
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Wakeman D, Langham MR. Creating a safer operating room: Groups, team dynamics and crew resource management principles. Semin Pediatr Surg 2018; 27:107-113. [PMID: 29548351 DOI: 10.1053/j.sempedsurg.2018.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The operating room (OR) is a special place wherein groups of highly skilled individuals must work in a coordinated and harmonious fashion to deliver optimal patient care. Team dynamics and human factors principles were initially studied by the aviation industry to better understand and prevent airline accidents. As a result, crew resource management (CRM) training was designed for all flight personnel to create a highly reliable industry with a commitment to a culture of safety. CRM has since been adapted to health care, resulting in care improvement and harm reduction across a wide variety of medical specialties. When implemented in the OR, CRM has been shown not only to improve communication and morale for OR staff, but also reduce morbidity and mortality for patients. As increasing focus is placed on quality, safety, and high-reliability, surgeons will be expected to participate and lead efforts to facilitate a team approach in this new era of patient care.
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Affiliation(s)
- Derek Wakeman
- Department of Surgery, University of Rochester School of Medicine, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA.
| | - Max R Langham
- Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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25
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