Rosemarie Fernandez

The presence of a family witness impacts physician performance during simulated medical codes.

Objective:To determine whether the presence and behavior of a family witness to cardiopulmonary resuscitation (CPR) impacts critical actions performed by physicians. Design:This was a randomized comparison study of physicians’ performance during a simulated cardiac arrest with three different family witness states. Setting:This study was conducted at the Wayne State University Eugene Applebaum College of Pharmacy and Health Science’s Center for Healthcare Simulation. Subjects:Second-year and third-year emergency medicine (EM) residents from the Wayne State University Department of Emergency Medicine–affiliated residency programs and Michigan State University–affiliated EM residency programs. Intervention:Thirty teams comprised of one second-year and one third-year EM resident were randomly assigned to one of the three groups: 1) no family witness; 2) a nonobstructive “quiet” family witness; and 3) a family witness displaying an overt grief reaction. Measurements and Main Results:Each pair was assessed for time to critical actions (e.g., minutes to CPR and drug administration) and for resuscitation-based performance outcomes (e.g., number of shocks) during a simulated cardiac arrest. The time to critical events was similar across groups with respect to initiating CPR, attempting to intubate the patient, and pronouncing the death of the patient. However, the time to deliver the first defibrillation shock was longer for the overt reaction witness group (2.57 minutes) as compared with the quiet (1.77 minutes) and no family witness (1.67 minutes) groups. Additionally, fewer total shocks were delivered in the overt reaction witness groups (4.0 minutes) vs. the quiet (6.5 minutes) and no family witness groups (6.0 minutes). Conclusion:The presence of a family witness may have a significant impact on physicians’ ability to perform critical actions during simulated medical resuscitations. Further study is necessary to see if this effect crosses over into real clinical practice and if training ameliorates this effect.

Simulation center accreditation and programmatic benchmarks: a review for emergency medicine.

Simulation-based education has grown significantly over the past 10 years. As a result, more professional organizations are developing or implementing accreditation processes to help define minimum standards and best practices in simulation-based training. However, the benefits and potential pitfalls of sponsoring and implementing such programs have yet to be fully evaluated across specialties. The board of directors of the Society for Academic Emergency Medicine (SAEM) requested an evaluation of the potential to create an emergency medicine (EM)-based Simulation Consultation and Accreditation Service. In response to this request, the Simulation Accreditation and Consultation Work Group, a subgroup of the Committee on Technology in Medical Education (now Simulation Academy), was created. The work group was charged with: 1) reviewing current benchmarks and standards set by existing simulation accreditation programs; 2) analyzing current EM simulation program structures, including leadership, administrative, and financial components; and 3) proposing a potential model for EM-based simulation accreditation. This article outlines currently existing and proposed accreditation models and identifies components that support best practices. It then goes on to describe three general programmatic models to better understand how simulation training can be operationalized in EM. Finally, the work group uses this collective information to propose how an accreditation process, in concert with the SAEM Simulation Consultation Service, can enhance and advance EM simulation training.

Going DEEP: guidelines for building simulation-based team assessments

Background Whether for team training, research or evaluation, making effective use of simulation-based technologies requires robust, reliable and accurate assessment tools. Extant literature on simulation-based assessment practices has primarily focused on scenario and instructional design; however, relatively little direct guidance has been provided regarding the challenging decisions and fundamental principles related to assessment development and implementation. Objective The objective of this manuscript is to introduce a generalisable assessment framework supplemented by specific guidance on how to construct and ensure valid and reliable simulation-based team assessment tools. The recommendations reflect best practices in assessment and are designed to empower healthcare educators, professionals and researchers with the knowledge to design and employ valid and reliable simulation-based team assessments. Overview Information and actionable recommendations associated with creating assessments of team processes (non-technical ‘teamwork’ activities) and performance (demonstration of technical proficiency) are presented which provide direct guidance on how to Distinguish the underlying competencies one aims to assess, Elaborate the measures used to capture team member behaviours during simulation activities, Establish the content validity of these measures and Proceduralise the measurement tools in a way that is systematically aligned with the goals of the simulation activity while maintaining methodological rigour (DEEP). Summary The DEEP framework targets fundamental principles and critical activities that are important for effective assessment, and should benefit healthcare educators, professionals and researchers seeking to design or enhance any simulation-based assessment effort.

Leadership training in health care action teams: a systematic review.

Purpose To identify and describe the design, implementation, and evidence of effectiveness of leadership training interventions for health care action (HCA) teams, defined as interdisciplinary teams whose members coordinate their actions in time-pressured, unstable situations. Method The authors conducted a systematic search of the PubMed/MEDLINE, CINAHL, ERIC, EMBASE, PsycINFO, and Web of Science databases, key journals, and review articles published through March 2012. They identified peer-reviewed English-language articles describing leadership training interventions targeting HCA teams, at all levels of training and across all health care professions. Reviewers, working in duplicate, abstracted training characteristics and outcome data. Methodological quality was evaluated using the Medical Education Research Study Quality Instrument (MERSQI). Results Of the 52 included studies, 5 (10%) focused primarily on leadership training, whereas the remainder included leadership training as part of a larger teamwork curriculum. Few studies reported using a team leadership model (2; 4%) or a theoretical framework (9; 17%) to support their curricular design. Only 15 studies (29%) specified the leadership behaviors targeted by training. Forty-five studies (87%) reported an assessment component; of those, 31 (69%) provided objective outcome measures including assessment of knowledge or skills (21; 47%), behavior change (8; 18%), and patient- or system-level metrics (8; 18%). The mean MERSQI score was 11.4 (SD 2.9). Conclusions Leadership training targeting HCA teams has become more prevalent. Determining best practices in leadership training is confounded by variability in leadership definitions, absence of supporting frameworks, and a paucity of robust assessments.

The Use of In Situ Simulation to Evaluate Teamwork and System Organization During a Pediatric Dental Clinic Emergency

Introduction: The purpose of this exercise was to use in situ simulation training to assess a pediatric dental clinics emergency response protocol, specifically evaluating overall team and system process effectiveness as well as clinical performance. Methods: Two high-fidelity simulation scenarios were developed to evaluate an existing clinic-wide multidisciplinary emergency code response for a freestanding pediatric dentistry clinic. Participants included all clinic faculty, trainees (dental residents), and staff (dental assistant and clerks). Each scenario was based on a routine patient care issue experienced by the clinicians in practice. The scenarios were executed in a regular patient care room with all clinical faculty and staff. A facilitated group debrief occurred after each scenario to identify areas of vulnerability and process failures. Key issues were recorded and evaluated by the investigators to determine potential causes and solutions. Results: Primary areas of vulnerability identified included (1) team communication, (2) equipment availability, (3) dosing errors, and (4) role assignment. Failure to stock needed equipment and ineffective use of a preexisting radio system was noted. Participants reported that they learned from the experience and that they would revisit the current system and address these issues. Implementation of mandatory simulation training was the most immediate outcome from the experience. Conclusions: In situ simulations can be leveraged to evaluate critical teamwork processes and system-based operations, both of which can impact dental team function during adverse patient events.

Evaluation of a computer-based educational intervention to improve medical teamwork and performance during simulated patient resuscitations

Objectives:To determine the impact of a low-resource-demand, easily disseminated computer-based teamwork process training intervention on teamwork behaviors and patient care performance in code teams. Design:A randomized comparison trial of computer-based teamwork training versus placebo training was conducted from August 2010 through March 2011. Setting:This study was conducted at the simulation suite within the Kado Family Clinical Skills Center, Wayne State University School of Medicine. Participants:Participants (n = 231) were fourth-year medical students and first-, second-, and third-year emergency medicine residents at Wayne State University. Each participant was assigned to a team of four to six members (nteams = 45). Interventions:Teams were randomly assigned to receive either a 25-minute computer-based training module targeting appropriate resuscitation teamwork behaviors or a placebo training module. Measurements:Teamwork behaviors and patient care behaviors were video recorded during high-fidelity simulated patient resuscitations and coded by trained raters blinded to condition assignment and study hypotheses. Teamwork behavior items (e.g., “chest radiograph findings communicated to team” and “team member assists with intubation preparation”) were standardized before combining to create overall teamwork scores. Similarly, patient care items (“chest radiograph correctly interpreted”; “time to start of compressions”) were standardized before combining to create overall patient care scores. Subject matter expert reviews and pilot testing of scenario content, teamwork items, and patient care items provided evidence of content validity. Main Results:When controlling for team members’ medically relevant experience, teams in the training condition demonstrated better teamwork (F [1, 42] = 4.81, p < 0.05; &eegr;2p = 10%) and patient care (F [1, 42] = 4.66, p < 0.05; &eegr;2p = 10%) than did teams in the placebo condition. Conclusions:Computer-based team training positively impacts teamwork and patient care during simulated patient resuscitations. This low-resource team training intervention may help to address the dissemination and sustainability issues associated with larger, more costly team training programs.

A Systematic Review of Tools Used to Assess Team Leadership in Health Care Action Teams.

Purpose To summarize the characteristics of tools used to assess leadership in health care action (HCA) teams. HCA teams are interdisciplinary teams performing complex, critical tasks under high-pressure conditions. Method The authors conducted a systematic review of the PubMed/MEDLINE, CINAHL, ERIC, EMBASE, PsycINFO, and Web of Science databases, key journals, and review articles published through March 2012 for English-language articles that applied leadership assessment tools to HCA teams in all specialties. Pairs of reviewers assessed identified articles for inclusion and exclusion criteria and abstracted data on study characteristics, tool characteristics, and validity evidence. Results Of the 9,913 abstracts screened, 83 studies were included. They described 61 team leadership assessment tools. Forty-nine tools (80%) provided behaviors, skills, or characteristics to define leadership. Forty-four tools (72%) assessed leadership as one component of a larger assessment, 13 tools (21%) identified leadership as the primary focus of the assessment, and 4 (7%) assessed leadership style. Fifty-three studies (64%) assessed leadership at the team level; 29 (35%) did so at the individual level. Assessments of simulated (n = 55) and live (n = 30) patient care events were performed. Validity evidence included content validity (n = 75), internal structure (n = 61), relationship to other variables (n = 44), and response process (n = 15). Conclusions Leadership assessment tools applied to HCA teams are heterogeneous in content and application. Comparisons between tools are limited by study variability. A systematic approach to team leadership tool development, evaluation, and implementation will strengthen understanding of this important competency.

Presence during cardiopulmonary resuscitation is beneficial to family members in the out-of-hospital setting

Commentary on: Jabre P, Belpomme V, Azoulay E, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med 2013;368:1008–18.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Inviting family members to be present during cardiopulmonary resuscitation (CPR) is increasingly common; however, it is still a controversial practice and has not been widely adopted in the USA. While a number of studies suggest that family members are amenable to this practice, robust, scientifically rigorous evidence demonstrating the psychological impact of witnessing a family members resuscitation is lacking. A total of 570 first-degree, adult family members of adult patients undergoing CPR in the home setting were included in this cluster-randomised controlled trial that was conducted in France. Family members in the intervention group were given the option of being present during … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.volume%253D368%26rft.spage%253D1008%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa1203366%26rft_id%253Dinfo%253Apmid%252F23484827%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa1203366&link_type=DOI [3]: /lookup/external-ref?access_num=23484827&link_type=MED&atom=%2Febmed%2F19%2F1%2F13.atom [4]: /lookup/external-ref?access_num=000315982100007&link_type=ISI

Development of a content valid tool for assessing end-of-life communication in acute care settings.

BACKGROUND Current recommendations throughout the literature require that physicians demonstrate proficiency in handling end-of-life care issues. However, current training and assessment tools are not easily translated to acutely decompensating emergency department patients with whom the practitioner is not familiar. Without these tools, robust assessment of physician performance cannot occur. OBJECTIVE To develop a content valid instrument to measure the critical care communication skills of emergency physicians in order to facilitate education and assessment of end-of-life communication skills in a time-sensitive acute care setting. METHODS A two-step modified Delphi methodology with emergency medicine palliative care subject matter experts was used. First, an extensive review of the literature was conducted to elucidate broad communication domains important to end-of-life care. Next, subject matter experts were asked open-ended questions to ascertain critical skills and behaviors that characterized these broad domains. Finally, both questions and domains were ranked as to their importance and relevance to end-of-life communication in an emergency department setting. RESULTS Literature review identified five domains of end-of-life care: (1) seek information, (2) assess life values, (3) educate family, (4) extend care in a consistent manner, and (5) respond to family questions and concerns. Within each domain, the expert panel identified subdomains with related behavioral examples that were consistently rated as important to end-of-life care for emergency practitioners. CONCLUSION The resulting assessment tool provides a list of skill domains with specific descriptors and clear behavioral examples that can be used as both a teaching and assessment tool. This represents an essential first step that will allow further validation of the assessment tool, ultimately producing a valid and reliable measure of physician skill in emergency medicine end-of-life care.

Developing Team Cognition: A Role for Simulation

Summary Statement Simulation has had a major impact in the advancement of healthcare team training and assessment. To date, most simulation-based training and assessments focus on the teamwork behaviors that impact team performance, often ignoring critical cognitive, motivational, and affective team processes. Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article, we synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition.