Interdisciplinary Team Training Program Research Articles

Debriefer cognitive load during Traditional Reflective Debriefing vs. Rapid Cycle Deliberate Practice interdisciplinary team training

BackgroundCognitive load impacts performance of debriefers and learners during simulations, but limited data exists examining debriefer cognitive load. The aim of this study is to compare the cognitive load of the debriefers during simulation-based team training (SbTT) with Rapid Cycle Deliberate Practice (RCDP) debriefing and Traditional Reflective Debriefing (TRD). We hypothesize that cognitive load will be reduced during RCDP compared to TRD.MethodsThis study was part of a large-scale, interdisciplinary team training program at Children’s Healthcare of Atlanta Egleston Pediatric Emergency Department, with 164 learners (physicians, nurses, medical technicians, paramedics, and respiratory therapists (RTs)). Eight debriefers (main facilitators and discipline-specific coaches) led 28 workshops, which were quasi-randomized to either RCDP or TRD. Each session began with a baseline medical resuscitation scenario and cognitive load measurement using the NASA Task Load Index (TLX), and the NASA TLX was repeated immediately following either TRD or RCDP debriefing. Raw scores of the NASA TLX before and after intervention were compared. ANOVA tests were used to compare differences in NASA TLX scores before and after intervention between the RCDP and TRD groups.ResultsFor all debriefers, mean NASA TLX scores for physical demands and frustration significantly decreased (− 0.8, p = 0.004 and − 1.3, p = 0.002) in TRD and mean perceived performance success significantly increased (+ 2.4, p < 0.001). For RCDP, perceived performance success increased post-debriefing (+ 3.6, p < 0.001), time demands decreased (− 1.0, p = 0.04), and frustration decreased (− 2.0, p < 0.001). Comparing TRD directly to RCDP, perceived performance success was greater in RCDP than TRD (3.6 vs. 2.4, p = 0.04). Main facilitators had lower effort and mental demand in RCDP and greater perceived success (p < 0.001).ConclusionRCDP had greater perceived success than TRD for debriefers. Main facilitators also report reduced effort and baseline mental demand in RCDP. For less experienced debriefers, newer simulation programs, or large team training sessions such as our study, RCDP may be a less mentally demanding debriefing methodology for facilitators.

Expectations and requests regarding team training interventions to promote interdisciplinary collaboration in medical rehabilitation--A qualitative study.

BackgroundInterdisciplinary teamwork and team interventions are highly valued in the rehabilitation sector because they can improve outcomes of care for persons with complex health problems. However, little is known about expectations and requests regarding team interventions, especially in medical rehabilitation. This study aimed to explore how clinical managers and health professionals within multidisciplinary rehabilitation teams describe their expectations and requests regarding team-training interventions in the field of medical rehabilitation.MethodsConsidering the methodology of qualitative research, data were collected using semi-structured interviews and focus groups at five rehabilitation clinics in Germany. We conducted face-to-face interviews with 5 clinical managers and 13 department heads of health care teams as well as five focus groups with a total of 35 members of interdisciplinary rehabilitation teams. Afterwards, the data were analyzed through qualitative content analysis encompassing data coding and using inductive thematic analysis.ResultsThe exploration of team members´ and clinical managers´ descriptions showed that, to them, interdisciplinary team training programs should include a wide array of training contents. Seven common core themes emerged from the interviews, including participation of employees, leadership, communication, team meetings, team composition, coordination, and equal esteem. Additionally, 13 themes were identified by either managers or team members. The body of expectations regarding team training content in healthcare spans the continuum of changes on the team and organizational levels. On the organizational level, a number of structural factors were mentioned (e.g. improving the general conditions for team meetings, organized workshops to exchange interdisciplinary experiences, and leadership training), and on the team level, changes in procedural factors were listed (e.g. optimizing the consecutive planning and coordination of patient treatments, clarity with regard to roles and responsibilities of team members, and mutual esteem and appreciation between different professions).ConclusionsThe synthesis underscores that there is meaningful heterogeneity in team training needs; training interventions should be locally adapted for each clinic in terms of training content and training strategies. Tailored team interventions are important for rehabilitation clinics. Future work should evaluate employed team training concepts over time as well as training contents, implementation strategies, and learning outcomes. This includes using robust study designs and evaluating team-training effects.

Training program for the management of two obstetric emergencies within a French perinatal care network

To evaluate the effectiveness of an interdisciplinary team training program based on simulated scenarios and focusing on two obstetrical emergency situations: shoulder dystocia and complicated breech vaginal delivery (CBVD). These situations are rare, so there are few opportunities for real-life training, yet their competent and efficient management is crucial to minimizing the risks to mother and child. The target population for training comprised the 450 professionals working in the French regional perinatal care network ELENA. An expert committee defined the topics for the training program, selected the simulated scenarios and developed the evaluation grids. The training sessions were conducted by two qualified and experienced professionals in each maternity unit. They comprised a theoretical introduction followed by practical exercises in management of simulated emergency situations by the participant teams, with the aid of a mannequin. Each team completed the exercises twice, their performances being filmed, reviewed and evaluated in each case. The training sessions took place over 9 months between September 2012 and June 2013. A total of 298 professionals (obstetricians, residents in obstetrics, midwives and nursery nurses) were trained, representing 75% of the staff working in the ELENA perinatal care network. The results showed substantial and significant increases in the overall scores for management of the two emergency situations (from 74.5% to 91.4% for shoulder dystocia [p<0.0001], and from 67.2% to 88.4% [p<0.0001] for CBVD) as well as in the scores for all the specific areas of expertise assessed: safety, know-how, technique, team communication and communication with the patient. This study demonstrated the value of multidisciplinary team training for obstetric emergencies, encouraging the ELENA perinatal care network to implement an annual training program for its staff. Over and above our experience, the future establishment of a national education program to optimize the management of obstetric emergencies seems to be essential.

The Relationship between Interprofessional Leadership Education and Interprofessional Practice: How Intensive Personal Leadership Education Makes a Difference

The Relationship between Interprofessional Leadership Education and Interprofessional Practice: How Intensive Personal Leadership Education Makes a Difference

Didactic and Simulation Nontechnical Skills Team Training to Improve Perinatal Patient Outcomes in a Community Hospital

Birth trauma is a low-frequency, high-severity event, making obstetrics a major challenge for patient safety. Yet, few strategies have been shown to eliminate preventable perinatal harm. Interdisciplinary team training was prospectively evaluated to assess the relative impact of two different learning modalities to improve nontechnical skills (NTS)--the cognitive and interpersonal skills, such as communication and teamwork, that supplement clinical and technical skills and are necessary to ensure safe patient care. Between 2005 and 2008, perinatal morbidity and mortality data were prospectively collected using the Weighted Adverse Outcomes Score (WAOS) and a culture of safety survey (Safety Attitudes Questionnaire) at three small-sized community hospitals. In a small cluster randomized clinical trial conducted in the third quarter of 2007, one of the hospitals served as a control group and two served as the treatment intervention sites--one hospital received the TeamSTEPPS didactic training program and one hospital received both the TeamSTEPPS program along with a series of in-situ simulation training exercises. A statistically significant and persistent improvement of 37% in perinatal morbidity was observed between the pre- and postintervention for the hospital exposed to the simulation program. There were no statistically significant differences in the didactic-only or the control hospitals. Baseline perceptions of culture of safety were high at all three hospitals, and there were no significant changes. A comprehensive interdisciplinary team training program using in-situ simulation can improve perinatal safety in the hospital setting. This is the first evidence providing a clear association between simulation training and improved patient outcomes. Didactics alone were not effective in improving perinatal outcomes.

Exploring the Dynamics of Interdisciplinary Palliative Care Teams in Providing Psychosocial Care: “Everybody Thinks that Everybody Can Do It and They Can't”

There has recently been a call for an analysis of the way in which professionals see their role and status in the context of palliative care and the interdisciplinary team. This is particularly salient in the provision of psychosocial care. This study qualitatively explored team members' perceptions and experiences of team dynamics. An in-depth qualitative research design was adopted using semistructured interviews and was guided by a social constructivist framework. Seven palliative care team members were recruited from across three palliative care sites. Two palliative care nurses, a palliative care medical specialist, a consultant psychiatrist, a social worker, a counselor, and an occupational therapist comprised our prototypical interdisciplinary team. Analysis was conducted using a method of constant comparison. Two major themes emerged from our research: "Lack of clear role boundaries" and "Strategies for maintenance of role boundaries," which included: "Claiming access to specialist expertise and knowledge" and "Minimizing the knowledge of other professions and professionals." It is argued that effective team functioning can be enhanced through the development of interdisciplinary team training programs and policies, resources and structures that provide support for the interdisciplinary team model.

Quality Improvements Address Safety in Perinatal Care

Developing a culture of safety within health care has become a prime focus since the Institute of Medicine (IOM) released its report To Err is Human: Building a Safer Health System in 1999. The report defines the magnitude of errors in health care and outlines potential areas for change and recommends the establishment of interdisciplinary team training programs including the use of simulation for trainees and experienced practitioners. Upon promotion to a newly created position of Perinatal Clinical Nurse Specialist (CNS) in 2008, I faced the challenge of initiating team training to address safety issues in perinatal care.

Geriatric Interdisciplinary Team Training Program

Geriatric interdisciplinary team training has long been a goal in health education with little progress. In 1997, the John A. Hartford Foundation funded eight programs nationally to create Geriatric Interdisciplinary Team Training (GITT) programs. Faculty trained 1,341 health professions students. The results of the evaluation, including presentation of new measures developed to assess interdisciplinary knowledge, are presented, and the implications of the program as a model of interdisciplinary education are discussed. Evaluation data from 537 student trainees are presented. At posttest, GITT trainees demonstrated improvement on all measures of attitudinal change, no change on the geriatric care planning measure, and a change in some of the questions on the test of team dynamics that varied by discipline. Changes were greatest for all the attitudinal measures with the self-reported Team Skills Scale indicating the most significant change--a change that is significant across medicine, nursing, and social work trainees.

The Role of Teamwork in the Professional Education of Physicians: Current Status and Assessment Recommendations

The Institute of Medicine (IOM) has recommended that organizations establish interdisciplinary team training programs that incorporate proven methods for team management. Teamwork can be assessed during physician medical education, board certification, licensure, and continuing practice. Team members must possess specific knowledge, skills, and attitudes (KSAs), such as the ability to exchange information, which enable individual team members to coordinate. KSAs might be elicited and assessed across a physician's career, starting in medical school and continuing through licensure and board certification. Professional bodies should be responsible for the development of specific team knowledge and skill competencies and for promoting specific team attitude competencies. Tools are available to assess medical student, resident, and physician competence in these critical team KSAs. For teamwork skills to be assessed and have credibility, team performance measures must be grounded in team theory, account for individual and team-level performance, capture team process and outcomes, adhere to standards for reliability and validity, and address real or perceived barriers to measurement.

New aspects on critical care medicine training.

Recently, three fundamental changes have been introduced in medical education, all of particular importance to critical care medicine: (1) clinical teaching and medical practice now emphasize evidence-based medicine, (2) patient safety aspects are increasingly stressed, and (3) use of simulation in medical training is spreading rapidly. In 1999, the disturbingly high frequency of life-threatening or even lethal medical complications was emphasized by the Institute of Medicine in the book To Err Is Human. The Institute of Medicine recommended establishing interdisciplinary team training programs incorporating efficient methods such as simulation. Although simulation has been used by the aviation industry and the military for several decades, only during the past decade has this become a teaching method in medicine. Currently, two full-scale computerized simulators are available: METI, provided by Medical Education Technologies, Sarasota, Florida, and SimMan, manufactured by Laerdal Medical, in Stavanger, Norway. The simulation center at the University of Pittsburgh Medical Center was established in 1994 and has grown quickly to its current large facility, where, in academic year 2003 to 2004, approximately 8000 healthcare professionals were trained on the SimMan. Courses taught include clinical procedures and decision making in perioperative medicine, acute medicine, pharmacology, anesthesiology, airway management, bronchoscopy, pediatric versus adult crisis management, critical events in obstetrics, and crisis team training. Advantages of simulation training over traditional medical education methods include (1) provision of a safe environment for both patient and student during training in risky procedures, (2) unlimited exposure to rare but complicated and important clinical events, (3) the ability to plan and shape training opportunities rather than waiting for a suitable situation to arise clinically, (4) the ability to provide immediate feedback, (5) the opportunity to repeat performance, (6) the opportunity for team training, and (7) lower costs, both direct and indirect. Within the next decade, use of computerized simulators for evidence-based education and training in medicine is expected to develop considerably and spread rapidly into a very important domain of medical schools throughout the entire world.

Organizational Issues in Establishing Geriatrics Interdisciplinary Team Training

ABSTRACT The John A. Hartford Foundation-supported geriatrics interdisciplinary team training (GITT) initiative was a bold attempt to create a new educational agenda for the health professions. Although some components of GITT were previously in place at the eight institutions that participated in the Hartford initiative and at other institutions (e.g., Department of Veterans Affairs), never before has geriatrics interdisciplinary team training been so systematically planned, implemented, or evaluated. This paper focuses on four organizational factors essential to the establishment of a geriatrics interdisciplinary team training program: (1) organizational readiness to implement GITT, including the needs and existing resources of the organization; (2) partnerships, specifically the relationships between academic and clinical organizations; (3) institutional support, the tangible and intangible sources of support necessary at multiple levels within the organization; and (4) structure, the administrative and organizational requirements for team training programs. An analysis of these four factors and the influences upon them can help facilitate the successful implementation of interdisciplinary training programs at institutions considering this educational approach.

Institutionalizing a Multi-Faceted Approach to Geriatric Interdisciplinary Team Training

ABSTRACT The process of needs assessment, program design, implementation, and institutionalization of a Geriatric Interdisciplinary Team Training Program is examined. Three program components target health care professionals and students/pre-professionals: a video-based geriatric interdisciplinary team training course that has portability and is appropriate for training in a variety of settings; a system of identifying, enhancing, and evaluating geriatric placements in interdisciplinary teamwork; and a series of training units leading to a Geriatric Interdisciplinary Team Training Certificate. Over the three-year program development period, 40 students completed the graduate course, 12 new clinical training sites were developed for training in interdisciplinary teamwork, and 39 half-day Geriatric Interdisciplinary Team Training sessions were developed, offered, and evaluated for 537 health professionals. Fifteen health-care professionals were certified through the 50-hour geriatric interdisciplinary team training program and three health-care professionals took the 40-hour program.

Interdisciplinary Approaches to Assisting with End-of-life Care and Decision Making

The importance of interdisciplinary care for patients and families facing the end of life is examined. Descriptions of varying forms of team functioning are provided with an emphasis on the characteristics of high-functioning interdisciplinary teams. The value of empowering the patient and family to direct the care they receive from their team is emphasized. Interdisciplinary team interventions in end-of-life care focus on the biopsychosocial and spiritual dimensions of human experience and facilitate growth and development in the last phase of life. Despite its great promise for improving patient care, the interdisciplinary model is not—with the exception of hospice care—widely implemented in today's health care system. The contributions of interdisciplinary teams to end-of-life care can be enhanced through the development of interdisciplinary team training programs, the creation of payment structures that support the interdisciplinary team model, and continuing research assessing the dynamics of team functioning and the benefits that interdisciplinary team care provides to patients and families near the end of life.

Creating Interdisciplinary Training for Health Care Professionals: The Challenges and Opportunities for Home Health Care

Training health care professionals to work together in managing the problems of elderly patients is an area where the home health care industry can make a crucialand substantial contribution. Since 1996, Rush Home Care Network, an affiliate agency of Rush-Presbyterian-St. Luke’s Medical Center in Chicago, has served as a clinical training site for an interdisciplinary education program. This program, the Rush Geriatric Interdisciplinary Team Training Program, was initially funded in 1996 through a grant from the John A. Hartford Foundation. Trainees from medicine, nursing, socialwork, pharmacy, occupationaltherapy, physicaltherapy, and clinical nutrition observe and work with Rush home care teams. They participate in team meetings, home visits, patient assessment and counseling, and in-service training. The Rush home care experience in interdisciplinary team training can be viewed as a modelfor other home health care organizations interested in becoming clinical training sites for team care.

Cross-Disciplinary Approaches to Teaching Interdisciplinary Teamwork and Geriatrics

The Mount Sinai Medical Center Geriatric Interdisciplinary Team Training Program prepares future health professionals to work on geriatrics interdisciplinary health care teams through structured educational and training experiences. This article describes the Program's educational goals and teaching methods. A number of cross-disciplinary approaches have been developed to facilitate learning, including team teaching, a seminar series, workshops, journaling, standardized patients, “real time” experiences, and other program enhancements. The Program has had considerable impact at the trainee, faculty, management and institutional levels, but issues and challenges to cross-disciplinary team training remain. Suggestions for overcoming learning, professional culture, and implementation barriers are given.

LOOSELY COUPLED SYSTEMS AS A CONCEPTUAL FRAMEWORK FOR INTERDISCIPLINARY TRAINING

To make interdisciplinary team training (IDTT) effective, educators need to understand how it works. We suggest that loosely coupled systems theory accounts for IDTT in ways that traditional frameworks do not and that effective IDTT programs function as loosely coupled systems. Loosely coupled systems theory facilitates an understanding of interdisciplinary training as a system in which (a) some elements of the training program conflict; (b) the learning activities may be disjointed or confusing; and (c) the learning goals of the various participants, both trainees and instructors, may diverge. Loosely coupled systems theory explains why these are the circumstances of IDTT and reassures that such systems manage to survive and be successful not only in spite of their loosely coupled nature, but because of it.