Rebecca Lyons

Does Teamwork Improve Performance in the Operating Room? A Multilevel Evaluation

BACKGROUND Medical care is a team effort, especially as patient cases are more complex. Communication, cooperation, and coordination are vital to effective care, especially in complex service lines such as the operating room (OR). Team training, specifically the TeamSTEPPS training program, has been touted as one methodology for optimizing teamwork among providers and increasing patient safety. Although such team-training programs have transformed the culture and outcomes of other dynamic, high-risk industries such as aviation and nuclear power, evidence of team training effectiveness in health care is still evolving. Although providers tend to react positively to many training programs, evidence that training contributes to important behavioral and patient safety outcomes is lacking. METHOD A multilevel evaluation of the TeamSTEPPS training program was conducted within the OR service line with a control location. The evaluation was a mixed-model design with one between-groups factor (TeamSTEPPS training versus no training) and two within-groups factors (time period, team). The groups were located at separate campuses to minimize treatment diffusion. Trainee reactions, learning, behaviors in the OR, and proxy outcome measures such as the Hospital Survey on Patient Safety Culture (HSOPS) and Operating Room Management Attitudes Questionnaire (ORMAQ) were collected. RESULTS All levels of evaluation demonstrated positive results. The trained group demonstrated significant increases in the quantity and quality of presurgical procedure briefings and the use of quality teamwork behaviors during cases. Increases were also found in perceptions of patient safety culture and teamwork attitudes. DISCUSSION The hospital system has integrated elements of TeamSTEPPS into orientation training provided to all incoming hospital employees, including nonclinical staff.

Does Team Building Work

This research reports the results of a comprehensive investigation into the effectiveness of team building. The article serves to update and extend Salas, Rozell, Mullen, and Driskells (1999) team-building meta-analysis by assessing a larger database and examining a broader set of outcomes. Our study considers the impact of four specific team-building components (goal setting, interpersonal relations, problem solving, and role clarification) on cognitive, affective, process, and performance outcomes. Results (based on 60 correlations) suggest that team building has a positive moderate effect across all team outcomes. In terms of specific outcomes, team building was most strongly related to affective and process outcomes. Results are also presented on the differential effectiveness of team building based upon the team size.

The Anatomy of Health Care Team Training and the State of Practice: A Critical Review

Purpose As the U.S. health care system enters a new era, the importance of team-based care approaches grows. How is the health care community ensuring that providers and administrators are equipped with the knowledge, skills, and attitudes (KSAs) foundational for effective teamwork? Are these KSAs transferring into daily practice? This review summarizes the present state of practice for health care team training described in published literature. Drawing from empirical investigations of training effectiveness, the authors explore training design, implementation, and evaluation to provide insight into the shape, structure, and anatomy of team training in health care. Method A 2009 literature search yielded 40 peer-reviewed articles detailing health care team training evaluations. Guided by 11 focal questions, two trained raters extracted details regarding training design, implementation, evaluation metrics, and outcomes. Results Findings indicate that team training is being implemented across a wide spectrum of providers and is primarily targeting communication, situational awareness, leadership, and role clarity. Relatively few details indicate how training needs were established. Most studies collected data immediately posttraining; however, less than 30% collected data six months or more posttraining. Content analyses highlight the need for enhanced detail in published training evaluation reports. Conclusions In many respects, health care team training implementation and evaluation align with best practices suggested from the science of training, adult learning, and human performance; however, opportunities for improvement exist. The authors suggest several mechanisms for furthering the health care team training evidence base to enhance patient safety and work environment quality for clinicians.

Promoting Teamwork: An Event‐based Approach to Simulation‐based Teamwork Training for Emergency Medicine Residents

The growing complexity of patient care requires that emergency physicians (EPs) master not only knowledge and procedural skills, but also the ability to effectively communicate with patients and other care providers and to coordinate patient care activities. EPs must become good team players, and consequently an emergency medicine (EM) residency program must systematically train these skills. However, because teamwork-related competencies are relatively new considerations in health care, there is a gap in the methods available to accomplish this goal. This article outlines how teamwork training for residents can be accomplished by employing simulation-based training (SBT) techniques and contributes tools and strategies for designing structured learning experiences and measurement tools that are explicitly linked to targeted teamwork competencies and learning objectives. An event-based method is described and illustrative examples of scenario design and measurement tools are provided.

Simulation-based team training at the sharp end: A qualitative study of simulation-based team training design, implementation, and evaluation in healthcare

This article provides a qualitative review of the published literature dealing with the design, implementation, and evaluation of simulation-based team training (SBTT) in healthcare with the purpose of providing synthesis of the present state of the science to guide practice and future research. A systematic literature review was conducted and produced 27 articles meeting the inclusion criteria. These articles were coded using a low-inference content analysis coding scheme designed to extract important information about the training program. Results are summarized in 10 themes describing important considerations for what occurs before, during, and after a training event. Both across disciplines and within Emergency Medicine (EM), SBTT has been shown to be an effective method for increasing teamwork skills. However, the literature to date has underspecified some of the fundamental features of the training programs, impeding the dissemination of lessons learned. Implications of this study are discussed for team training in EM.

Sounding the call for team training in health care: Some insights and warnings

Health care is changing. Nearly a decade after initial calls regarding the importance of teamwork in optimizing patient safety,1 team training efforts to enhance both interdisciplinary and intradisciplinary medical teamwork are being integrated into formal standards, regulations, and curricula. For example, the Joint Commission’s second National Patient Safety Goal for 2009 was to “improve the effectiveness of communication among caregivers,” a core component of teamwork. The National Quality Forum’s3 third safe practice for 2009 directed health care organizations was to “establish a proactive, systematic, organization-wide approach to developing team-based care through teamwork training, skill building, and team-led performance interventions that reduce preventable harm to patients,” and in 2002 the Accreditation Council for Graduate Medical Education4 formally recognized communication and interpersonal skills as core requirements for residents by creating the interpersonal and communication skills competency.

Optimal learning in a virtual patient simulation of cranial nerve palsies: The interaction between social learning context and student aptitude

Background: Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. Aim: To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Methods: Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the Neurological Exam Rehearsal Virtual Environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. Results: An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤ 50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). Conclusion: The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students.

Virtual patient simulations and optimal social learning context: A replication of an aptitude–treatment interaction effect

Abstract Background: Virtual patients (VPs) offer valuable alternative encounters when live patients with rare conditions, such as cranial nerve (CN) palsies, are unavailable; however, little is known regarding simulation and optimal social learning context. Aim: Compare learning outcomes and perspectives between students interacting with VPs in individual and team contexts. Methods: Seventy-eight medical students were randomly assigned to interview and examine four VPs with possible CN damage either as individuals or in three-person teams, using Neurological Examination Rehearsal Virtual Environment (NERVE). Learning was measured through diagnosis accuracy and pre-/post-simulation knowledge scores. Perspectives of learning context were collected post-simulation. Results: Students in teams submitted correct diagnoses significantly more often than students as individuals for CN-IV (p = 0.04; team = 86.1%; individual = 65.9%) and CN-VI (p = 0.03; team = 97.2%; individual = 80.5%). Knowledge scores increased significantly in both contexts (p < 0.001); however, a significant aptitude–treatment interaction effect was observed (p = 0.04). At pre-test scores ≤25.8%, students in teams scored significantly higher (66.7%) than students as individuals (43.1%) at post-test (p = 0.03). Students recommended implementing future NERVE exercises in teams over five other modality-timing combinations. Conclusion: Results allow us to define best practices for integrating VP simulators into medical education. Implementing NERVE experiences in team environments with medical students in the future may be preferable.

The impact of social context on learning and cognitive demands for interactive virtual human simulations

Interactive virtual human (IVH) simulations offer a novel method for training skills involving person-to-person interactions. This article examines the effectiveness of an IVH simulation for teaching medical students to assess rare cranial nerve abnormalities in both individual and small-group learning contexts. Individual (n = 26) and small-group (n = 30) interaction with the IVH system was manipulated to examine the influence on learning, learner engagement, perceived cognitive demands of the learning task, and instructional efficiency. Results suggested the IVH activity was an equally effective and engaging instructional tool in both learning structures, despite learners in the group learning contexts having to share hands-on access to the simulation interface. Participants in both conditions demonstrated a significant increase in declarative knowledge post-training. Operation of the IVH simulation technology imposed moderate cognitive demand but did not exceed the demands of the task content or appear to impede learning.

Towards a Reflective Practicum of Embodied Conversational Agent Experiences

A reflective practicum is a low-pressure, low-risk learning environment. In a reflective practicum a learner is educated in a professional practice and how to use reflection in the setting of that professional practice. An example of a low-pressure and low-risk learning environment is the use of embodied conversational agents (ECAs) in medicine to provide training for interviewing and diagnostic skills. However, such ECA experiences have not been used to teach how to use reflection in the setting of a professional practice. In this paper we present a framework that supports explicit reflective learning for ECA experiences. Using this framework, ECA experiences become a reflective practicum. This framework was applied to an ECA experience called the Neurological Examination Rehearsal Virtual Environment (NERVE), and created a sample experience called the NERVE Reflective Practicum (NERVE-RP). We conducted a user study in which second-year medical students (n = 76) used NERVE-RP and engaged in reflection based on the experience. The results of the user study show that students engage in valuable reflections during the experience including instances of critical reflection.