Charlotte Paltved

Identifying content for simulation-based curricula in urology: a national needs assessment

Abstract Objective: Simulation-based training is well recognized in the transforming field of urological surgery; however, integration into the curriculum is often unstructured. Development of simulation-based curricula should follow a stepwise approach starting with a needs assessment. This study aimed to identify technical procedures in urology that should be included in a simulation-based curriculum for residency training. Materials and methods: A national needs assessment was performed using the Delphi method involving 56 experts with significant roles in the education of urologists. Round 1 identified technical procedures that newly qualified urologists should perform. Round 2 included a survey using an established needs assessment formula to explore: the frequency of procedures; the number of physicians who should be able to perform the procedure; the risk and/or discomfort to patients when a procedure is performed by an inexperienced physician; and the feasibility of simulation training. Round 3 involved elimination and reranking of procedures according to priority. Results: The response rates for the three Delphi rounds were 70%, 55% and 67%, respectively. The 34 procedures identified in Round 1 were reduced to a final prioritized list of 18 technical procedures for simulation-based training. The five procedures that reached the highest prioritization were cystoscopy, transrectal ultrasound-guided biopsy of the prostate, placement of ureteral stent, insertion of urethral and suprapubic catheter, and transurethral resection of the bladder. Conclusion: The prioritized list of technical procedures in urology that were identified as highly suitable for simulation can be used as an aid in the planning and development of simulation-based training programs.

Consensus on procedures to include in a simulation-based curriculum in ophthalmology: a national Delphi study

The number of available simulation‐based models for technical skills training in ophthalmology is rapidly increasing, and development of training programmes around these procedures should follow a structured approach. The aim of this study was to identify all technical procedures that should be integrated in a simulation‐based curriculum in ophthalmology.

Determining procedures for simulation-based training in radiology: a nationwide needs assessment

ObjectivesNew training modalities such as simulation are widely accepted in radiology; however, development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The study objective was to perform a nationwide needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum.MethodsA needs assessment using the Delphi method was completed among 91 key leaders in radiology. Round 1 identified technical procedures that radiologists should learn. Round 2 explored frequency of procedure, number of radiologists performing the procedure, risk and/or discomfort for patients, and feasibility for simulation. Round 3 was elimination and prioritization of procedures.ResultsResponse rates were 67 %, 70 % and 66 %, respectively. In Round 1, 22 technical procedures were included. Round 2 resulted in pre-prioritization of procedures. In round 3, 13 procedures were included in the final prioritized list. The three highly prioritized procedures were ultrasound-guided (US) histological biopsy and fine-needle aspiration, US-guided needle puncture and catheter drainage, and basic abdominal ultrasound.ConclusionA needs assessment identified and prioritized 13 technical procedures to include in a simulation-based curriculum. The list may be used as guide for development of training programs.Key Points• Simulation-based training can supplement training on patients in radiology.• Development of simulation-based training should follow a structured approach.• The CAMES Needs Assessment Formula explores needs for simulation training.• A national Delphi study identified and prioritized procedures suitable for simulation training.• The prioritized list serves as guide for development of courses in radiology.

Students’ Learning Experiences from Didactic Teaching Sessions Including Patient Case Examples as Either Text or Video: A Qualitative Study

ObjectivesThe aim of this study was to explore medical students’ learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students’ perceptions of psychiatric patients and students’ reflections on meeting and communicating with psychiatric patients.MethodsThe authors conducted group interviews with 30 medical students who volunteered to participate in interviews and applied inductive thematic content analysis to the transcribed interviews.ResultsStudents taught with text-based patient cases emphasized excitement and drama towards the personal clinical narratives presented by the teachers during the course, but never referred to the patient cases. Authority and boundary setting were regarded as important in managing patients. Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients.ConclusionThe format of patient cases included in teaching may have a substantial impact on students’ patient-centeredness. Video-based patient cases are probably more effective than text-based patient cases in fostering patient-centered perspectives in medical students. Teachers sharing stories from their own clinical experiences stimulates both engagement and excitement, but may also provoke unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry.

Designing in situ simulation in the emergency department: evaluating safety attitudes amongst physicians and nurses

BackgroundThis intervention study aimed to enhance patient safety attitudes through the design of an in situ simulation program based on a needs analysis involving thematic analysis of patient safety data and short-term ethnography. The study took place at an Emergency Department (ED) in the Central Region of Denmark. Research suggests that poor handover communication can increase the likelihood of critical incidents and adverse events in the ED. Furthermore, simulation is an effective strategy for training handover communication skills. Research is lacking, however, on how to use patient safety data and a needs analysis to the design of in situ simulation communication training.MethodsThis is a prospective pre-post study investigating the interventional effects of in situ simulation. It used a three-pronged strategy: (1) thematic analysis of patient safety data consisting of reported critical incidents and adverse events, (2) a needs analysis based on short-term ethnography in the ED, and (3) pre-post evaluation using the validated Safety Attitudes Questionnaire (SAQ) and the Trainee Reactions Score.ResultsSixteen different healthcare teams participated composed by 9 physicians and 30 nurses. In the SAQ, participating staff scored their safety attitudes in six categories (n = 39). Two measures where significantly higher for the post-SAQ than those for the pre-SAQ: teamwork climate (p < 0.001) and safety climate (p < 0.05). The Trainee Reactions Score showed that the training was positively evaluated.ConclusionsThis study designed a feasible strategy for implementing in situ simulation based on a needs analysis of critical incidents and adverse events and short-term ethnography.

A mixed methods observational simulation-based study of interprofessional team communication

Background Interprofessional team communication has been identified as an important focus for safety in medical emergency care. However, in-depth insight into the complexity of team communication is limited. Video observational studies might fill a gap in terms of understanding the meaning of specific communication interactions and link team performance to patient outcome. This study had two aims. First, to develop a theorybased evaluation instrument that measures and qualifies team communication. And second, to investigate the quality and content of summaries and re-evaluations evolving step wise and progressively when treating the critically ill patient.

Contents Vol. 91, 2016

414 Joint Annual Meeting of the Schweizerische Gesellschaft für Kardiologie / Société Suisse de Cardiologie Schweizerische Gesellschaft für Herzund thorakale Gefässchirurgie / Société Suisse de Chirurgie Cardiaque et Vasculaire Thoracique Schweizerische Gesellschaft für Pneumologie / Société Suisse de Pneumologie June 15–17, 2016, Lausanne

Insider action research and the microsystem of a Danish surgical ward

This insider action research project aimed to improve interprofessional team performance at a surgical ward. The purpose of the project was (1) to critically appraise potential deficiencies in staffs’ identification, clinical judgment, and management of deteriorating ward patients, (2) to develop an interprofessional change model, and (3) evaluate the impact of the change model and the AR process. The insider AR project took place at a large Danish surgical ward with 60 participating physicians and nurses. The study was conducted in three interconnected action and reflection cycles using mixed methods. Staff viewed the co-creation and co-inquiry as important resources in transforming the ward into a better microsystem. Microsystems as a theoretical framework was used to conceive the success of health system redesign as a matter of enabling the clinical team to meet patient needs. By combining insider AR with microsystems, this study highlights the importance of senior leaders to recognize the nature and power of using the microsystem approach for strategy, excellence, innovation, and research. Staff was able to formulate an overarching vision of interprofessionalism and this helped inspire changes in clinical practice for the benefit of our patients.

Board 397 - Research Abstract A Model for Capturing Team Adaptation in Simulated Emergencies: The Importance of Updates (Submission #950)

Introduction/Background Acute critical situations and emergencies are among the most challenging situations in medicine where acute care teams are often constituted on an ad hoc basis. In such types of teams, it is obvious that excellent performance depends on the ability of the team to function in a coordinated, effective matter. In this regard, interprofessional team communication plays a pivotal role for patient safety. In social psychological or organizational studies, communication is often oversimplified and treated statistically or mechanistically and often represented by simple communication events like closed-loop communication.1 A more nuanced understanding of team communication has the potential to enhance scholarship in interprofessional endeavours. In high risk environments, team performance depends on the ability of teams to quickly alter actions in response to rapidly changing conditions.2,3 However, research on team adaptation in healthcare is scarce.4 In this study, team adaptation in medical emergency teams was explored through the quality and content of updates. Updating is an ongoing process of incorporating interpretations based on new information with current beliefs.5 Research on how teams adapt to unforeseen changes or non-routine events supports the idea that updating is somehow difficult to accomplish.6,7 Methods Thirty emergency physicians and nurses participated in a Simulator Instructor Course at SkejSim Medical Simulation and Skills Training, Aarhus, Denmark in May-June 2012. The study was exempted from approval from the Danish National Committee of Health Research. The study has been reported to the Danish Data Protection Agency. All participants volunteered and written informed consent was obtained. Twenty nine simulation scenarios were recorded and reviewed. The research design used an explorative case study methodology to answer the research question: Which factors most strongly mediate adaptive team performance? Results Through an iterative, inductive process, data supported the building of the Team Adaptation Tool (TATool) that captures and conceptualizes team processes through recursive cycles of updates. In the 29 simulation scenarios, 94 updates were recorded. There were between 0 and 8 updates per scenario (mean 3,2). Level five was achieved in 13 scenarios, level four in 8 scenarios and finally, level two and three were achieved in four scenarios. Level one was not achieved as the highest level in any scenario. Teams were found to differ in ability to develop and perform updating processes, in their ability to adapt to unforeseen changes and adjust courses of action. These differences could be explained using the five-level TATool. Conclusion The trend in the literature is towards studying teamwork as a cluster of behaviours. However, we argue that communication between team members is the core concept in patient safety discourse to keep the team coordinated and at the right track. We found that those teams that were able to recognize changes, adjust priorities and implement adjusted strategies were more likely to perform successfully in environments with unforeseen changes, in other words adaptability is the generalization of trained knowledge and skills to new, more difficult and more complex tasks. An interpretative approach is required to meaningfully account for communication exchanges in context. As such, this theoretical framework might provide a vocabulary for operationalizing the differences between “effective and ineffective” communication. Moving beyond counting communication events or the frequency of certain communications, the empirical metric moves from how much communication to what messages are communicated and how are these messages interpreted.1 Despite the complexity of interprofessional team communication, the TATool might provide a significant framework for the construct of adaptive team performance. Further, the TATool can be applied as a team training tool to help practitioners develop effective team performance skills based on metacognition of adaptive team performance through effective team communication. References 1. Keyton J, Beck SJ, Asbury MB. Macrocognition: A communication perspective. Theor Issues Ergonomic Sci 2010; 11(4):272-286. 2. Burke CS, Stagl KC, Salas E, Pierce L, Kendall D. Understanding team adaptation: A conceptual analysis and model. J Appl Psychol 2006; 91(6):1189-1207. 3. Kozlowski SW, Watola DJ, Nowakowski JM, Kim BH, Botero IC. Developing adaptive teams: A theory of dynamic team leadership. In: Salas E, Goodwin GF, Burke CS, editors. Team effectiveness in complex organizations: Cross-disciplinary perspectives and approaches. 2009. 1-40. 4. Bedwell WL, Ramsay S, Salas E. Helping fluid teams work: A research agenda for effective team adaptation in healthcare. TBM 2012; 2:504-509. 5. Rudolph JW, Morrison JB, Carroll JS. The dynamics of action-oriented problem solving: Linking interpretation and choice. Acad Management Rev 2009; 34(4):733-756. 6. LePine JA. Adaptation of teams in response to unforeseen change: Effects of goal difficulty and team composition in terms of cognitive ability and goal orientation. J Appl Psychol 2005; 90(6):1153-1167. 7. LePine JA. Team adaptation and postchange performance: Effects of team composition in terms of members’ cognitive ability and personality. J Appl Psychol 2003; 88(1):27-39. Disclosures None.