Interdisciplinary Team Training 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.

Exploring nurses’ experiences of performing basic life support in hospital wards: An inductive thematic analysis

AimThe aim of this study was to undertake an in-depth exploration of the lived experiences of in-hospital, non-intensive care, ward-based nurses’ experiences of real-life CPR events. BackgroundThere is growing evidence suggesting that may nurses not be able to successfully perform in a cardiac arrest situation. Reasons include a lack of clear leadership at the arrest, performance anxiety, role confusion and knowledge and skill degradation over time. MethodsIn-depth semi-structured interviews were conducted with fifteen ward-based hospital nurses from three hospitals. Interviews were recorded, transcribed verbatim and inductive thematic analysis was completed using NVivo 12 software. FindingsFour main themes emerged from data. The main themes are: (1) Not Being able to Perform When it Matters, (2) Working Really Well as a Team, (3) Reflecting on the Experience: The Good, the Bad & the Ugly and (4) Learning to get it Right for Next Time ConclusionPerforming BLS is a stressful and anxiety-provoking experience for ward-based nurses. Anxiety levels appear to decrease slightly only when nurses have had at least one previous real-life experience with resuscitation. Current BLS education does not prepare nurses for the complexities of resuscitation. Future BLS education should focus on in-depth scenarios, including interdisciplinary team training and with greater frequency than the current yearly mandatory sessions. Listening to the lived experiences of nurses who have performed BLS has given much needed insight into approaches that educators can use to improve BLS education delivery.

Geriatric Interprofessional Team Transformation for Primary Care overview.

The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.

A23Wrapping a gastroschisis baby: an MDT simulation programme

Gastroschisis is a congenital defect of the anterior abdominal wall characterized by the herniation of abdominal contents through a defect usually located to the right-side of the umbilical cord [1]. Team-working, collaboration and clear communication between the obstetric, neonatal, and paediatric surgical teams are critical to achieving optimal outcomes in gastrochisis [2]. A national cohort study of all surgical units in the UK and Ireland identified primary closure as the optimal surgical management for antenatally detected cases of simple gastroschisis [3]. A local retrospective audit in RBHSC identified a higher rate of staged gastroschisis repair in the last 10 years with 66% of patients requiring initial silo placement, when compared to 45% national average. Data also demonstrated that patient with silo placement took longer to achieve full feeds, prolonged TPN, delayed discharge, and increased complications rates. To create an interprofessional simulation programme for the preparation and management of a gastroschisis delivery, resuscitation, and initial stabilization. Aims of this project are to improve awareness of optimal stabilization management, efficiency of bowel wrapping and clear communication amongst the MDT with the overall goal of improving the rate of primary closure and outcomes in our unit. A gastroschisis simulation model was created using vegan-sausage casings, jelly, and food colouring to create the bowel. The simulation programme focused on; team education of optimal gastroschisis management, team and delivery room preparation, primary resuscitation and bowel wrapping with clingfilm. Following a lecture of gastroschisis management and demonstration of delivery room stabilization participants were divided into teams of five, given a scenario, asked to prepare equipment, allocate roles and work in sync to achieve effective resuscitation and stabilization of the new-born. Pre and Post simulation feedback was collected and course adapted using a PDSA cycle. For continued learning a post-course video for delivery room management of gastroschisis was created and available for everyone to reference at any time in any location. Pre-simulation: 56% of participants had no previous training or clinical experience of the management of gastroschisis and 78% didn’t feel confident in providing delivery suite management and stabilization. 100% of attendees felt the simulation training improved their confidence of initial management and stabilization of gastroschisis and all would recommend this course to their peers. Simulation-based interdisciplinary team training can serve as a channel for the acquisition and maintenance of clinical skills. It is crucial to improving the management of complex neonatal conditions. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

BEST – an ideal model for interdisciplinary team training

BEST – an ideal model for interdisciplinary team training

Staff perceptions of interdisciplinary team training and its effectiveness in reducing medical errors

ABSTRACT The increasing complexity of healthcare systems and the growing need to coordinate efforts of multiple highly specialized experts toward a shared goal have emphasized the importance of interdisciplinary teams in patient care. While clinical training remains focused on individual responsibilities, the growing recognition of the advantages of the interdisciplinary team approach has highlighted the need for more opportunities for team training programs. To promote effective team functioning, it is vital to understand attitudes and perspectives of healthcare providers toward interdisciplinary team training (ITT). This empirical study utilizes a questionnaire survey of 51 direct care professionals who have previously participated in ITT to gauge the perceptions of U.S. clinicians concerning the value of ITT and its potential to improve patient outcomes and reduce medical errors. Overall, participants viewed ITT as effective in improving communication, teamwork, and patient safety. However, less than half of the respondents had favorable perceptions of the usefulness and appropriateness of ITT sessions for their current clinical setting. Less than two-thirds had positive perceptions of the sufficiency of training time and frequency. The biggest opportunity identified was in improving the quality of ITT sessions themselves and developing knowledgeable ITT facilitators who understand their audience and team dynamics.

Transforming Virtual Team-Based Learning for Rural Healthcare Staff: What the Pandemic Taught Us

During COVID-19, many training programs pivoted to virtual formats. For the Rural Interdisciplinary Team Training (RITT) Program, funded by the Veterans Health Administration as part of the Geriatric Scholars Program, there were unique challenges. Given a history of successful accredited in-person, team-based workshops for staff at rural and remote clinics, program developers needed to quickly devise a plan for an effective virtual training for team members working separately from each other. Without the ability to provide in-person education and training, rapid pivoting to virtual modalities was essential for ongoing education of those providing care for older adults. Using a web-based platform, team members and expert trainer facilitation, participants engaged in lively discussions and reflection using the chat feature. RITT adapted the curriculum to better meet the needs of busy healthcare providers working during the pandemic, including increased discussion of how COVID affects older Veterans. Three virtual RITT workshops were held between March 2020 and February 2021 with 64 participants from 12 rural clinics and medical centers. Over 90% of participants agreed or strongly agreed that they were satisfied with the virtual workshop, comparable to those participating in the in-person workshop in earlier years. Similar to others, we have found that the ability to flex a curriculum has benefits to both learners and educators and increases the reach of educational opportunities in gerontology and geriatrics. Particularly in rural areas where travel may be challenging, a virtual format may be a desirable long-term solution for the RITT program.

Barriers to and Facilitators of Neonatal Palliative Care Among Neonatal Professionals in China.

This study investigated institutional and personal barriers to and facilitators of neonatal palliative care facing neonatal professionals in China. A cross-sectional questionnaire surveyed 231 neonatal clinicians employed in 5 neonatal intensive care units from 2 children's hospitals and 3 medical centers in China. The translated modified version of the Neonatal Palliative Care Attitude Scale was used to survey neonatal clinicians' attitudes and beliefs regarding neonatal palliative care. Findings highlight 4 facilitators and 5 barriers among participating clinicians. Participants gave contradictory responses regarding the relative importance of curative treatment versus palliative care in the NICU. Negatively traumatic feelings, cultural issues and moral distress may impact this contradictory response and discourage clinicians from providing neonatal palliative care. Additionally, neonatologists and nurses held differing attitudes on several topics (p < 0.05). Further research should address strategies to improve knowledge and attitudes and relieve moral distress in NICU clinicians. Neonatal clinicians providing neonatal palliative care should receive regular palliative care training addressing culture-specific issues and communication skills. Study findings will be beneficial to inform clinical education and practice. Regular interdisciplinary team training is needed to enhance support for palliative care and decrease clinicians' moral distress during end-of-life care.

Communication as a non‐technical skill in the operating room: A qualitative study

AimThe aim of this study was to explore how operating room nurses (ORNs) experience operating room (OR) team communication concerning non‐technical skills.DesignBased on the Scrub Practitioners List of Intraoperative Non‐Technical Skill (SPLINTS), qualitative individual in‐depth semi‐structured interviews were conducted with 11 ORNs in a Norwegian university hospital. Braun and Clarke's six analytic phases for thematic data analysis were used.ResultsSurgeons being unprepared or demanding different instruments than the preoperative information indicates, cause stress and frustration. So does noise and brusquely or poor communication. Ensuring good information flow within the entire team is important. When silence is required, the ORNs communicate with gestures, looks and nods. Creating a positive and secure team culture facilitates discussions, questions and information sharing.ConclusionInappropriate dynamics, inaccurate and/or disrespectful communication and noise may reduce patient safety. Interdisciplinary team training may bring attention to the value of communication as a non‐technical skill.

Effective and Evidence-Based: How the 4Ms Age-Friendly Framework Can Result in Improved Care in a Rural Primary Care Clinic

As healthcare providers struggle to reframe aging, framing Age-Friendly care is also occurring. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve clinical health outcomes of older adults (OA) in primary care settings. As a member of the 2020 Institute for Healthcare Improvement (IHI) Age-Friendly cohort, the AGEC has partnered with ARcare, an AR federally qualified healthcare clinic network, to implement the 4Ms in 4 rural clinics over 3 years. AGEC’s first goal of working with rural primary care clinics is to improve their knowledge of best practices of caring for OA. This was started by providing Geriatric Interdisciplinary Team Training to clinic staff, obtaining baseline data of common health related indicators for OA and starting regular geriatric focused training. Training on the 4Ms (Matters, Medication, Mentation Mobility) framework was next and completed followed by planning and implementation. The process was well received and results are promising. Year 1 data in one clinic show incremental improvements over baseline data in several areas including assessing Mobility with fall screens which has improved over 50% in one year and annual wellness visits (where all 4Ms are reviewed) have increased 30%. However, several areas of opportunities for improvement have also been noted and turned into quality improvement projects (QI). This includes an opportunity to improve depression screens for the clinic’s Mentation measure, which dropped almost 30% in one year. QI projects are ongoing to improve each of the elements of becoming age-friendly.

Characteristics of Hospice and Palliative Care Programs in US Prisons: An Update and 5-Year Reflection

Individuals with terminal illness are dying behind bars and many state prison administrators have incorporated on-site hospice and palliative care services. Little is known, however, about these programs since a 2010 study of prison hospice characteristics. We provide an updated description and reflection of current hospice and palliative care programs in state prisons serving incarcerated persons with terminal illness. A cross-sectional survey was sent to representatives of all known prisons offering hospice and palliative care programs and services (N = 113). Questions were drawn from an earlier iteration regarding interdisciplinary team (IDT) membership, training length and topics, peer caregivers, visitation policies, bereavement services, perceived stakeholder support, and pain management strategies. Additional questions were added such as estimated operational costs, peer caregiver input in patient care, and the strengths and weaknesses of such programs. Frequency distributions were calculated for all study variables. Responding representatives (n = 33) indicated IDTs remain integral to care, peer caregivers continue to support dying patients, and perceived public support for these programs remains low. Reduced enthusiasm for the programs may negatively influence administrative decision-making and program resources. Further, peer caregiver roles appear to be changing with caregivers charged with fewer of the identified tasks, compared with the 2010 study.

AN EVALUATION OF THE VA RURAL INTERDISCIPLINARY TEAM TRAINING PROGRAM: OUTCOMES AND IMPLICATIONS

The rural interdisciplinary team training (RITT) program has provided in-person training for almost 2000 VA providers and staff at 125 rural clinics since 2011. The multi-modal workshop, accredited for 6.5 hours for a number of disciplines, focuses on the recognition of common issues facing older Veterans, red flags prompting further assessment, how to administer screening instruments and team-based approaches for improving patient outcomes. Participants develop an improvement action plan improvement project based on common challenges faced by clinic patients. A program evaluation found an increase in geriatrics knowledge and a modest improvement in teamwork after the education program. It also found that participants self-identified an enhanced ability on average to use red flags after the 6.5 hour training in areas such as polypharmacy, falls and caregiver stress. The action plans were often not implemented at follow-up. The evaluation results will be discussed, as well as challenges, limitations, and implications.

158 Malnutrition Screening by an Interdisciplinary Integrated Care Team is an Essential Component of Comprehensive Geriatric Assessment

Abstract Background Malnutrition plays a key role in the pathogenesis of frailty and nutritional interventions may reduce the incidence. Comprehensive Geriatric Assessment (CGA) is the gold standard in assessment once frailty has been identified. Recent Nutritional Screening Data indicated that only 20% of Irish hospitals screened 76-100% of patients. Twenty-three percent of those aged 60-79 years and 30% of those &gt;80 years were at risk of malnutrition (Russell &amp; Elia, 2011). This emphasises the importance of a validated malnutrition screening tool as an integral component of CGA. This study evaluates the use of the Malnutrition Screening Tool (MST) by an integrated interdisciplinary team aimed at early identification of frail patients at risk of malnutrition. Methods A prospective study of consecutive frail patients, admitted through the emergency department (ED) to an acute hospital over five months was performed. Each patient had an interdisciplinary assessment (IA) performed. The IA included a MST tool. Patients were identified as frail using the Variable Indicative of Placement (VIP). Team members, consisting of a physiotherapist, speech and language therapist and advanced nurse practitioner candidates were trained by the team dietitian to use MST. Age, gender, Clinical Frailty Score (CFS) and MST were recorded in an excel datasheet. A patient scoring ≥2 on the MST indicated risk of malnutrition and the need for Dietetic Assessment (Wu et al. 2012). Results Three-hundred and sixty CGA’s were completed by an integrated interdisciplinary team over five months. The mean age (+/-SD) was 82.4 (+/-7). The male to female ratio was 1:1. The mean CFS (+/-SD) was 5.5 (+/-1.2) (mildly to moderately frail). Ninety-two percent (n=331) were screened using the MST. Thirty-five percent (n=115) were at risk of malnutrition. Conclusion Integrated interdisciplinary team training on the MST, resulted in successful identification of 35% (n=115) of frail patients “At Risk of Malnutrition”. Identification, combined with appropriate dietetic intervention, may reverse frailty in some of these patients.

Using in situ simulation to improve care of the acutely ill patient by enhancing interprofessional working: a qualitative proof of concept study in primary care in England

ObjectiveAcutely unwell patients in the primary care setting are uncommon, but their successful management requires involvement from staff (clinical and non-clinical) working as a cohesive team. Despite the advantages of...

If We Don't Learn from Our Critical Events, We're Likely to Relive Them: Debriefing Should Be the Norm.

If We Don't Learn from Our Critical Events, We're Likely to Relive Them: Debriefing Should Be the Norm.

Interdisciplinary Team Training at the Art Museum: Breaking Down Hierarchy and Building Resilience (TH314)

•Describe the evidence supporting the use of museum-based education (MBE) to develop core clinician competencies of perception, empathy, reflective practice, and resilience.•Recognize how MBE can improve interprofessional practice by decreasing perceived hierarchy and promoting team building.•Experience an MBE session. Burnout among palliative care practitioners can lead to poor performance and attrition. Museum-based education (MBE) is an innovative strategy that aims to reduce burnout by enhancing perception and empathy, flattening perceived hierarchy, and strengthening interprofessional teams. The goal of this session is to provide palliative care educators with evidence and approaches to use art as a strategy to promote team building and enhance clinically relevant observation and reflective competencies. MBE employs specific pedagogical strategies to train participants to intentionally, thoughtfully, and reflectively perceive patients and their unique situations. It is also a strategy to lessen a sense of hierarchy among teams by connecting participants to others’ personal perceptions and histories, irrespective of professional role. MBE participants have improved perception, comfort with ambiguity, and empathy, making this an important tool for palliative care teams and training programs as they seek to foster effective interprofessional teams and professional resilience. This session will highlight current evidence supporting MBE in healthcare, as well as ongoing work by palliative care programs with trainees and interprofessional teams. Finally, we will demonstrate examples of art-based teaching strategies with audience participation such that participants may begin to design MBE programs tailored to their home institution.

Simulation-Based Team Training Improves Team Performance among Pediatric Intensive Care Unit Staff.

Simulation training fosters collaborative learning and improves communication among interdisciplinary teams. In this prospective observational cohort study, we evaluated the impact of interdisciplinary simulation-based team training (SBTT) on immediate learning of team performance behaviors. In a 3-month period, 30 simulation sessions were conducted and 165 staff members, including physicians, nurses, and respiratory therapists, were trained. Regression analysis showed a statistically significant improvement in team performance ( p < 0.0001). Study results demonstrate that SBTT is effective in immediate acquisition of optimal team performance behaviors by multidisciplinary pediatric intensive care unit staff, including physicians with higher level subspecialty training in the simulation environment.

Commentary on Interdisciplinary Teamwork in Family Law Practice

This commentary discusses and expands upon Mosten and Traumm's extraordinary work on interdisciplinary teams. Focusing on the continuum between independence and interdependence in team formation, we explore the benefits of team members' shared responsibility and highlight potential challenges. We emphasize that regardless of where a team may fall on the continuum, establishing and adhering to a strong structure results in increased practitioner satisfaction and better client outcomes. This commentary identifies five best practices that promote highly functioning teams and urges family law practitioners to seek more advanced interdisciplinary team training opportunities.

Interdisciplinary team education promotes innovations in the home care of older people

ABSTRACTThis article describes a new type of team training that involves undergraduate students of medicine, students from the Aalto University (industrial engineering and management, architecture, information networks, collaborative and industrial design and bioinformation technology) and specialized home care nurses. During the course, the students learned interdisciplinary teamwork and created innovations in the care of older people. The 18 participants formed six microteams (three persons in each team: one specialized nurse, one medical student and one from Aalto University). The course consisted of two seminars and 3 full days of home visits to older people’s homes. Participants were encouraged to make one innovation in each home visit that would improve the older person’s well-being or streamline the processes of home care. During the course, the participants promptly formed tight teams. They valued the know-how of the other team members and learned openly from each other. They also created a number of practical innovations in home care which they presented to executives of older people’s care in a final seminar. The course received very good feedback from the students.This course is an encouraging example of how gerontological interdisciplinary team training may be successfully applied. The article describes both the learning outcomes and the innovations the students produced during their home visits. It also discusses the learning theories behind effective interdisciplinary team learning.

State of the Science: Interprofessional Approaches to Aging, Dementia, and Mental Health.

Interprofessional education (IPE) is essential to develop the healthcare workforce of the future. Geriatrics healthcare professionals have long championed innovations in IPE and patient care, but there is increased urgency to address challenges in aging, dementia, and geriatric mental health in America. In 2010, the Partnership for Health in Aging multidisciplinary competencies and a related position statement in the Journal of the American Geriatrics Society addressed interdisciplinary team (IDT) training in geriatrics. The position statement reported that training in higher education, academic, and continuing education settings has not been sufficiently responsive to workforce needs. In recent years, health professions educators and health systems leaders have increasingly recognized that IPE should be integrally linked with, and performed within, emerging models of team-based, value-driven health care. In this way, IPE will align with learning healthcare systems' pursuit of the Quadruple Aim: improving patient experience, provider experience, and the health of populations, and reducing per capita health care costs. Backed by decades of developing effective team care models and the skill set needed to care for older adults with complex needs, geriatrics healthcare providers from multiple disciplines are uniquely positioned to lead learning healthcare systems in a new effort to develop, implement, and sustain IPE and practice models congruent with these Aims. We provide recommendations for health professions educators, healthcare systems leaders, and policymakers to realize the potential of IPE and interprofessional collaborative practice (IPCP) to improve the health of all Americans in aging, dementia, and mental health.