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Background: Nursing homes face a critical need for competent healthcare professionals to deliver high-quality care. Focusing on clinical leadership is crucial for equipping healthcare professionals with the skills necessary to manage complex care needs, collaborate effectively within multidisciplinary teams, and improve care quality in nursing homes. Developing clinical leadership fosters professional growth and enhances healthcare professionals' ability to tackle the challenges unique to the nursing home environment. However, the concept of clinical leadership in nursing homes remains poorly defined and investigated. This study aimed to explore and define influencing factors for the development of clinical leadership within healthcare professionals in nursing homes. Methods: A qualitative study was conducted in Flanders, Belgium, using semi-structured focus group interviews (n = 5) with healthcare professionals (n = 41), including nurse assistants, licensed practical nurses, registered nurses, occupational therapists, recreational therapists, psychologists, and gerontologists. Interviews were audio-taped, transcribed, analysed and interpretated by using a thematic analysis based on descriptive phenomenology. Results: Clinical leadership development within healthcare professionals' hinges on four pivotal themes: (1) Cultivating an empowering working environment that fosters open feedback, encourages peer learning, and champions a stimulating learning climate. (2) Nurturing a supportive leadership style in formal leaders that exemplifies role modeling, accessibility, and a coaching approach. (3) Elevating well-developed professional identity through targeted training, experience, and a talent-oriented work approach. (4) Fostering team dynamics marked by commitment, collaboration, support, and trust. Conclusions: The study's findings on the influencing factors for clinical leadership development should be actively applied in nursing homes and guide the creation of targeted training programs and leadership development initiatives. Awareness of these factors are crucial to optimise and to support the development and implementation of clinical leadership in nursing homes in an attempt to reduce the workforce shortages. [ABSTRACT FROM AUTHOR]

Background: Systematic biases in group decision making (i.e., group biases) may result in suboptimal decisions and potentially harm patients. It is not well known how impaired group decision making in patient care may affect medical training. This study aimed to explore medical residents' experiences and perspectives regarding impaired group decision making and the role of group biases in medical decision making. Methods: This study used a qualitative approach with thematic analysis underpinned by a social constructionist epistemology. Semi-structured interviews of medical residents were conducted at a single internal medicine residency program. Residents were initially asked about their experiences with suboptimal medical decision making as a group or team. Then, questions were targeted to several group biases (groupthink, social loafing, escalation of commitment). Interviews were transcribed and transferred to a qualitative data analysis software. Thematic analysis was conducted to generate major themes within the dataset. Results: Sixteen interviews with residents revealed five major themes: (1) hierarchical influence on group decision making; (2) group decision making under pressure; (3) post-call challenges in decision making; (4) interactions between teamwork and decision making; and (5) personal and cultural influences in group decision making. Subthemes were also identified for each major theme. Most residents were able to recognize groupthink in their past experiences working with medical teams. Residents perceived social loafing or escalation of commitment as less relevant for medical team decision making. Conclusions: Our findings provide unique insights into the complexities of group decision making processes in teaching hospitals. Team hierarchy significantly influenced residents' experiences with group decision making—most group decisions were attributed to consultants or senior team members, while lower ranking team members contributed less and perceived fewer opportunities to engage in group decisions. Other factors such as time constraints on decision making, perceived pressures from other staff members, and challenges associated with post-call days were identified as important barriers to optimal group decision making in patient care. Future studies may build upon these findings to enhance our understanding of medical team decision making and develop strategies to improve group decisions, ultimately leading to higher quality patient care and training. [ABSTRACT FROM AUTHOR]

Background: In attempt to improve continuity of patient care and reduce length of stay, hospitals have placed an increased focus on reducing delayed discharges through discharge planning. Several benefits and challenges to team-based approaches for discharge planning have been identified. Despite this, professional hierarchies and power dynamics are common challenges experienced by healthcare providers who are trying to work as a team when dealing with delayed discharges. The objective of this study was to explore what was working well with formal care team-based discharge processes, as well as challenges experienced, in order to outline how teams can function to better support transitions for patients experiencing a delayed discharge.  METHODS: We conducted a descriptive qualitative study with hospital-based healthcare providers, managers and organizational leaders who had experience with delayed discharges. Participants were recruited from two diverse health regions in Ontario, Canada. In-depth, semi-structured interviews were conducted in-person, by telephone or teleconference between December 2019 and October 2020. All interviews were recorded and transcribed. A codebook was developed by the research team and applied to all transcripts. Data were analyzed inductively, as well as deductively through directed content analysis.Results: We organized our findings into three main categories - (1) collaboration with physicians makes a difference; (2) leadership should meaningfully engage with frontline providers and (3) partnerships across sectors are critical. Regular physician engagement, as equal members of the team, was recommended to improve consistent communication, relationship building between providers, accessibility, and in-person communication. Participants highlighted the need for a dedicated senior leader who ensured members of the team were treated as equals and advocated for the team. Improved partnerships across sectors included the enhanced integration of community-based providers into discharge planning by placing more focus on collaborative practice, combined discharge planning meetings, and having embedded and physically accessible care coordinators in the hospital.Conclusions: Team-based approaches for delayed discharge can offer benefits. However, to optimize how teams function in supporting these processes, it is important to consistently collaborate with physicians, ensure senior leadership engage with and seek feedback from frontline providers through co-design, and actively integrate the community sector in discharge planning. [ABSTRACT FROM AUTHOR]

Background: Small group tutorials (SGT) promotes self-directed learning and is widely used in medical education. The coronavirus pandemic (COVID-19) has accelerated the trend toward SGT digitalization, with unclear effect. We hypothesize that team dynamics and facilitator support influence SGT satisfaction in digital versus conventional SGT. Methods: During the spring semester of year 2021, medical students (the second, third, and fourth year; n = 433) participating in conventional face-to-face and digital SGT curricula were enrolled. Participating students completed the collaborative learning attitude scale (including team dynamics, team acquaintance, and facilitator support dimensions) and teamwork satisfaction scale, previously validated for small-group collaborative learning, and chose preference between conventional or digital SGT in future curricula. Exploratory factor analysis (EFA) was performed to extract the essential structural factors of these scales. Paired t-tests were conducted to compare differences in different dimensions and satisfaction between the conventional and digital SGT settings. Two sets of multiple regression analyses were done; one with team satisfaction scale results and the other with preference for digital SGT as the dependent variable were used to evaluate determinants of these two variables. Results: The EFA results revealed that the original collaborative learning attitude scale was concentrated on two dimensions: team dynamics and facilitator support. No significant differences were noted between the SGT settings for the two dimensions and teamwork satisfaction. Regression analyses showed that teamwork dynamics was independently correlated with teamwork satisfaction in both conventional and digital SGT. Facilitator support was positively correlated with teamwork satisfaction in conventional, but not digital SGT. Higher teamwork satisfaction was an important determinant of preference for digital SGT among medical students. Conclusions: Team dynamics were closely linked to teamwork satisfaction among medical students in both conventional and digital SGT, while the role of facilitator support became less obvious during digital SGT. [ABSTRACT FROM AUTHOR]

Background: Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods: The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results: Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions: Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence: Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance. [ABSTRACT FROM AUTHOR]

Background: Although diversity, friction, and harmonisation in interprofessional teamwork are aspects frequently conceptualised, no empirical study discusses them in combination. Focusing on risk and function with respect to each aspect, this article empirically examines how dynamics between these aspects during interprofessional teamwork interactions fosters conditions for effective teamwork.Methods: An ethnographic study of three interprofessional teams, in the context of mental health and substance use, was conducted in Norway. Data were collected through observations of 14 team meetings and 18 in-depth interviews with health and social work professionals. Thematic analysis was applied to code the data.Results: A conceptual ideal-type model, which includes all three aspects was developed to represent the emergent findings. The results suggest that the diversity of professional perspectives inherent in interprofessional teams is the foundation of interprofessional teamwork. However, friction is needed to promote innovation, encourage new insights, and intensify discussions. In addition, harmonisation balances professional distinctions, fosters trust, and ties professionals together.Conclusion: This article presents a comprehensive model of how professionals work together in interprofessional teams. The model makes visible the functions and risks of each aspect and the dynamics between them. Furthermore, the article argues for mobilisation and balance of all three aspects in combination to maximise the capacity of interprofessional teamwork. Such insight can be used to support the development and successful implementation of interprofessional teamwork in health care. [ABSTRACT FROM AUTHOR]

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma's causes or the patient's personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients' and stakeholders' engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey's participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions. [ABSTRACT FROM AUTHOR]

Background: Peer review in Team-based learning (TBL) exists for three key reasons: to promote reflection on individual behaviours; provide opportunities to develop professional skills; and prevent ‘free riders’ who fail to contribute effectively to team discussions. A well-developed process that engages students is needed. However, evidence suggests it remains a difficult task to effectively incorporate into TBL. The purpose of this study was to assess medical students’ ability to provide written feedback to their peers in TBL, and to explore students’ perception of the process, using the conceptual framework of Biggs ‘3P model’. Methods: Year 2 students (n = 255) participated in peer review twice during 2019. We evaluated the quality of feedback using a theoretically derived rubric, and undertook a qualitative analysis of focus group data to seek explanations for feedback behaviors. Results: Students demonstrated reasonable ability to provide positive feedback, but were less prepared to identify areas for improvement. Their ability did not improve over time, and was influenced by the perceived task difficulty; social discomfort; and sense of responsibility in providing written feedback. Conclusions: To increase student engagement, we require a transparent process that incorporates verbal feedback and team discussion, with monitoring of outcomes by faculty and adequate training. [ABSTRACT FROM AUTHOR]