Search

Background Team debriefing is an important teamwork development intervention for improving team outputs in healthcare. Debriefing is a key component of experiential team training teamwork development interventions such as simulation-based training. Improving the quality of debriefing of healthcare teams, therefore, has multiple benefits. We investigated whether the quality of student-led debriefing improved using a shortened guide. Methods Senior medical students, nurse anesthesia students, and senior undergraduate nursing students participated in student operating room team training at a health sciences center in the southeastern United States. Student teams participated in a dual-scenario simulation-based training session with immediate after-action debriefings after each scenario. In 2018, student teams conducted the second debriefing using as a guide the teamwork assessment scale, an 11-item, 3-subscale, 6-point Likert-type instrument. In 2019, they used a shortened, revised, 5-item version of the teamwork assessment scale, the quick teamwork assessment scale. Trained observers rated the quality of the student-led debriefings using the Objective Structured Assessment of Debriefing, an 8-item, 5-point instrument. The Wilcoxon-Mann-Whitney test was used to compare the teamwork assessment scale-guided and the quick teamwork assessment scale-guided mean item debriefing scores. Results Two observers rated 3 student-led team debriefings using the teamwork assessment scales as a guide in 2018, and 6 such debriefings happened using the quick teamwork assessment scale as a guide in 2019. For each debriefing, observer scores were averaged for each Objective Structured Assessment of Debriefing item; these mean scores were then averaged with other mean scores for each year. The use of the quick teamwork assessment scale resulted in a statistically significant higher mean score for the Analysis Objective Structured Assessment of Debriefing item compared with the use of the teamwork assessment scale (4.92 [standard deviation 0.20] versus 3.83 [standard deviation 0.76], P = .023). Conclusion The use of a shortened teamwork assessment instrument as a debriefing guide for student teams in student operating room team training was more effective in analysis of actions than the original, longer tool. Next steps include determining the efficacy of the quick teamwork assessment scale in an actual clinical setting.

Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3). The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.

Objectives To determine whether high fidelity simulation-based training (SBT) of interprofessional teams involving trauma transfers has an immediate impact on participants’ team-based attitudes and behaviors. Design A quasi-experimental, pre-/postintervention comparison design examined high fidelity SBT of inter-professional teams using a 2 scenario format with immediate after action structured debriefing. Pre-/postsession Readiness for Inter-Professional Learning Scale (RIPLS, 19 items, Likert-type) surveys as well as Interprofessional Teamwork (IPT, 15 items, Likert-type) questionnaires, and postscenario participant- and observer-rated Teamwork Assessment Scales (TAS, 3 subscales, 11 items, Likert-type) were completed during each training session. Mean RIPLS, IPT, and TAS scores were calculated and matched pre-/postscore differences compared using paired t-test or analysis of variance with Bonferroni adjustment. Setting A large, urban, academic, state health sciences institution in the Southeastern United States during the 2014 to 2015 academic year. Participants General surgery residents, emergency medicine residents, and senior undergraduate nursing students comprising ten interprofessional teams. Results From approximately 48 participants, matched pre-/postsession IPT surveys were available for 42 individuals; 45 had an observer TAS evaluation for both scenarios; and 40 completed TAS peer evaluations for both scenarios. 47 participants had matched RIPLS surveys. Statistically significant improvements in matched pre-/postscore differences occurred for all 15 IPT items. Observer TAS scores significantly improved on 2 of the 3 subscales comparing the second to the first scenario. Peer evaluations statistically improved comparing the second to the first scenario. Two of the 19 RIPLS items demonstrated statistically significant improvement. Conclusions Interprofessional trauma team transfer training using SBT changes attitudes toward key team-based competencies and leads to learning them in the simulated environment. Such improvement in team-based skill and attitudes is an important first step in adopting team-based behaviors in the actual clinical environment and improving transfer care.

BackgroundThe evidence for the conventional wisdom that debriefing quality determines the effectiveness of learning in simulation-based training is lacking. We investigated whether the quality of debriefing in using simulation-based training in team training correlated with the degree of learning of participants.MethodsForty-two teams of medical and undergraduate nursing students participated in simulation-based training sessions using a two-scenario format with after-action debriefing. Observers rated team performance with an 11-item Teamwork Assessment Scales (TAS) instrument (three subscales, team-based behaviours (5-items), shared mental model (3-items), adaptive communication and response (3-items)). Two independent, blinded raters evaluated video-recorded facilitator team prebriefs and debriefs using the Objective Structured Assessment of Debriefing (OSAD) 8-item tool. Descriptive statistics were calculated, t-test comparisons made and multiple linear regression and univariate analysis used to compare OSAD item scores and changes in TAS scores.ResultsStatistically significant improvements in all three TAS subscales occurred from scenario 1 to 2. Seven faculty teams taught learners with all scores ≥3.0 (except two) for prebriefs and all scores ≥3.5 (except one) for debriefs (OSAD rating 1=done poorly to 5=done well). Linear regression analysis revealed a single statistically significant correlation between debrief engagement and adaptive communication and response score without significance on univariate analysis.ConclusionsQuality of debriefing does not seem to increase the degree of learning in interprofessional education using simulation-based training of prelicensure student teams. Such a finding may be due to the relatively high quality of the prebrief and debrief of the faculty teams involved in the training.

BACKGROUND: Effective use of nontechnical skills (NTS) contributes to the provision of safe, quality care in the fast-paced, dynamic setting of the operating room (OR). Inter-professional education of NTS to OR team members can improve performance. Such training requires the accurate measurement of NTS in order to identify gaps in their utilization by OR teams. Although several instruments for measuring OR NTS exist in the literature, each tool tends to define specific NTS differently. AIM: We aimed to determine commonalities in defined measurements among existing OR NTS tools. METHODS: We undertook a comprehensive literature review of assessment tools for OR NTS to determine the critical components common to these instruments. A PubMed search of the literature from May 2009 to May 2019 combined various combinations of keywords and Medical Subject Headings (MeSH) related to the following subjects: teamwork, teams, assessment, debriefing, surgery, operating room, nontechnical, communication. From this start, articles were selected describing specific instruments. Three reviewers then identified the common components measured among these assessment tools. Reviewers collated kin constructs within each instrument using frequency counts of similarly termed and conceptualized components. RESULTS: The initial PubMed search produced 119 articles of which 24 articles satisfied the inclusion criteria. Within these articles, 10 assessment tools evaluated OR NTS. Kin constructs were grouped into six NTS categories in the following decreasing frequency order: communication, situation awareness, teamwork, leadership, decision making, and task management/decision making (equal). CONCLUSION: NTS OR assessment tools in the literature have a variety of kin constructs related to the specific measured components within the instruments. Such kin constructs contain thematic cohesion across six primary NTS groupings with some variation in scale and scope. Future plans include using this information to develop an easy-to-use assessment tool to assist with debriefing in the clinical environment.

Advances in healthcare have enabled clinicians to help increasingly sicker patients recover from illness and disease. As a result, the timely identification and treatment of critically ill individuals by specialized interprofessional teams within acute care hospitals and settings is now an essential feature of care. From rapid response teams intervening in the treatment of a deteriorating patient before the development of cardiopulmonary arrest to trauma teams treating accident and assault victims with serious physiologic disturbances, these interprofessional teams must function as cohesive units in order to adapt to the dynamic changes seen in these dire situations. Simulation-based training (SBT) is an ideal modality for honing the team interactions and function of such specialized interprofessional squads. This chapter will examine the role of interprofessional SBT in preparing healthcare providers in their treatment of critically ill patients and for mass casualty situations. In doing so, it will briefly discuss key interprofessional competencies needed by modern healthcare acute care teams. It will then review applications of interprofessional SBT currently used in such settings. It will close with a discussion of potential obstacles to conducting such training and strategies to overcome them.

Interprofessional education (IPE) has become an important component of health professions curricula due to evidence that interprofessional collaborative practice improves health outcomes for patients. To increase opportunities for IPE for learners in our institutions, an IPE elective was developed for students in the schools within Louisiana State University Health Sciences Center and Xavier University College of Pharmacy in New Orleans, Louisiana. The IDEA framework, a published framework for IPE curriculum development, was utilized to design learning activities. To assess the effect of using the IDEA framework to target the Interprofessional Education Collaborative (IPEC) competency related to roles and responsibilities, the Readiness for Interprofessional Learning Scale (RIPLS) was administered to students before and after the course. Comparison of the results showed a significant positive difference on items within the roles and responsibilities subscale after participating in the course. Developing the curriculum using the IDEA framework likely contributed to this effect by intentionally providing ample time for interaction and designing learning activities aimed at helping students recognize one another's roles and contributions to health care.

ObjectiveIn surgery, dysfunctional teamwork is perpetuated by a ‘silo’ mentality modelled by students. Interprofessional education using high-fidelity simulation-based training (SBT) may counteract such modelling. We sought to determine whether SBT of interprofessional student teams (1) changes long-term teamwork attitudes and (2) is an effective form of team training.DesignA quasiexperimental, pre/postintervention comparison design was employed at an academic health sciences institution. High-fidelity simulation-based training of 42 interprofessional teams of third year surgery clerkship medical students and senior undergraduate nursing students was undertaken using a two-scenario format with immediate after action debriefing. Pre/postintervention TeamSTEPPS Teamwork Attitudes questionnaires (5 subscales, 30 items, Likert type) were given to the medical student and undergraduate nursing student classes. Pre/postsession Readiness for Inter-Professional Learning (RIPL; 19 items, Likert type) surveys and postscenario participant-rated and observer-rated Teamwork Assessment Scales (3 subscales, 11 items, Likert type) were given during each training session. Mean TeamSTEPPS Teamwork Attitudes Questionnaire, RIPL and Teamwork Assessment Scales scores were calculated; matched pre/postscore differences and trained versus non-trained TeamSTEPPS Teamwork Attitudes Questionnaire scores were compared using paired t-test or analysis of variance.ResultsBoth student groups had 10 significantly improved RIPL items as well as TeamSTEPPS Teamwork Attitudes Questionnaire (TTAQ) mutual support subscales. Medical students had a significantly improved TTAQ team structure subscale. Over a simulation-based training session, each observer-rated Teamwork Assessment Scales subscale and two self-rated Teamwork Assessment Scales subscales significantly improved. Trained students had significantly higher TTAQ team structure subscales than non-trained students.ConclusionsInterprofessional education using high-fidelity simulation-based training of students is effective at teaching teamwork, changing interprofessional attitudes and improving long-term teamwork attitudes.

Simulation-based training (SBT) is a powerful educational tool permitting the acquisition of surgical knowledge, skills, and attitudes at both the individual- and team-based level in a safe, nonthreatening learning environment at no risk to a patient. Interprofessional education (IPE), in which participants from 2 or more health or social care professions learn interactively, can help improve patient care through the promotion of efficient coordination, dissemination of advances in care across specialties and professions, and optimization of individual- and team-based function. Nonetheless, conducting SBT IPE sessions poses several tactical and strategic challenges that must be effectively overcome to reap IPE's benefits.

A growing body of evidence indicates interprofessional collaborative practice improves patient care. With this in mind, Louisiana State University Health Sciences Center formally committed to expanding interprofessional education (IPE) initiatives. Thirty-eight self-selected students enrolled in an IPE elective course during the fall of 2012. Students completed the Readiness for Interprofessional Learning Scale (RIPLS) pre- and post-course and also completed a post-course survey. Results indicated a significant change in the roles and responsibilities scale of the RIPLS. Analysis of the data from the post-course survey demonstrated students were able to identify key terms of an IPE definition, as related to their learning experience. In addition, themes of communication, learning/increased knowledge, and collaboration/contribution of other health care professionals were noted across all questions in the post-course survey. Based on the results of this study, an elective course is a promising educational opportunity to increase awareness and knowledge of IPE within academic medical centers.

AIM The purpose of this study was to evaluate the efficacy of using crisis resource management (CRM) principles and high-fidelity human patient simulation (HFHPS) for interprofessional (IP) team training of students from undergraduate nursing, nurse anesthesia, medical, and respiratory therapy. BACKGROUND IP education using simulation-based training has the potential to transform education by improving teamwork and communication and breaking down silos in education. METHOD This one-year study used a quasi-experimental design to evaluate students' acquisition and retention of teamwork and communication skills. A convenience sample consisted of 52 students in the fall semester, with 40 students returning in the spring. RESULTS Mean scores increased after training, and skills were retained fairly well. Any loss was regained with repeat training in the spring. CONCLUSION The results suggest that using CRM and HFHPS is an effective pedagogy for teaching communication and teamwork skills to IP student ...

Background Effective teamwork in the operating room (OR) is often undermined by the "silo mentality" of the differing professions. Such thinking is formed early in one's professional experience and is fostered by undergraduate medical and nursing curricula lacking interprofessional education. We investigated the immediate impact of conducting interprofessional student OR team training using high-fidelity simulation (HFS) on students' team-related attitudes and behaviors. Study Design Ten HFS OR interprofessional student team training sessions were conducted involving 2 standardized HFS scenarios, each of which was followed by a structured debriefing that targeted team-based competencies. Pre- and post-session mean scores were calculated and analyzed for 15 Likert-type items measuring self-efficacy in teamwork competencies using the t -test. Additionally, mean scores of observer ratings of team performance after each scenario and participant ratings after the second scenario for an 11-item Likert-type teamwork scale were calculated and analyzed using one-way ANOVA and t -test. Results Eighteen nursing students, 20 nurse anesthetist students, and 28 medical students participated in the training. Statistically significant gains from mean pre- to post-training scores occurred on 11 of the 15 self-efficacy items. Statistically significant gains in mean observer performance scores were present on all 3 subscales of the teamwork scale from the first scenario to the second. A statistically significant difference was found in comparisons of mean observer scores with mean participant scores for the team-based behaviors subscale. Conclusions High-fidelity simulation OR interprofessional student team training improves students' team-based attitudes and behaviors. Students tend to overestimate their team-based behaviors.

Background: Effective teamwork and communication among healthcare professionals are essential to ensure quality patient care and safety. The use of high-fidelity human patient simulation scenarios enhances learning and has been used in various health professions education. The purpose of this study was to evaluate the efficacy and retention of teaching team-based competencies to interprofessional student teams using high-fidelity simulation. Methods: Quasi-experimental, pre/post-test design was used. The study was a teaching intervention using high-fidelity human patient simulation with crisis resource management techniques to teach team based competencies. A convenience sample of students from medicine, nurse anesthesia, undergraduate nursing, and physical therapy participated. There were pre/post data collected for fall and spring simulations from both participants and observers. Key variables were the various teamwork competencies. Participants and trained observers rated teamwork behaviors, each using two measures. Mean scores on participant and observer rated tools were compared using paired samples t -tests. Results: A total of 35 students underwent training in the fall of 2009 and 25 of the students returned in the spring of 2010 for repeat training. Participant paired samples t -tests showed a significant increase from simulation scenario one to two ( p < .05) in both the fall and spring. Observer data showed significant improvements in mean scores on one measure. Conclusions: High-fidelity simulation appears to improve both perceived and actual team-based competencies with retention over time. Findings support the benefit to students of repeat training in a six month period and provide some validation for faculty time and effort in repeated simulations.

The current nursing faculty shortage makes understanding intent to stay in academia a step toward slowing the exodus of faculty. The purpose of this study was to discover a parsimonious set of predictor variables from the variables of job satisfaction, mentoring, organizational commitment, and leadership behaviors for intent to stay in nursing education. A random cluster sample consisted of 39 schools of nursing in states within the Southern Regional Education Board (SREB). There were 316 responses from 782 potential participants for a response rate of 40.4%. Stepwise multiple regression results indicated that organizational commitment explained 19.7% of the variance in intent to stay one year and 21.2% of the variance in intent to stay five years. Further, mentored faculty scored significantly higher on organizational commitment. Intent to stay three years was not significantly correlated to any predictor variables suggesting it is a time to intervene to influence decisions to stay.