Mayo High Performance Teamwork Scale Research Articles

Development and Evaluation of a Rural Longitudinal NRP® Telesimulation Program (MOOSE: Maine Ongoing Outreach Simulation Education).

Neonatal resuscitation is a high acuity, low-occurrence (HALO) event and many rural pediatricians report feeling underprepared for these events. We piloted a longitudinal telesimulation (TS) program with a rural hospital's interprofessional delivery room teams aimed at improving adherence to Neonatal Resuscitation Program (NRP®) guidelines and teamwork. A TS study was conducted monthly in one rural hospital over a ten month period from November 2020 to August 2021. TS sessions were remotely viewed and debriefed by experts. Sessions were video recorded and assessed using a scoring tool with validity evidence for NRP® adherence. Teamwork was assessed using both TeamSTEPPS 2.0 Team Performance Observation Tool and Mayo High-Performance Teamwork Scale. We conducted ten TS sessions in one rural hospital. There were 24 total participants, who rotated through monthly sessions, ensuring interdisciplinary team composition was reflective of realistic staffing. NRP® adherence rate for full code scenarios improved from a baseline of 39% to 95%. Compared with baseline data for efficiency, multiple NRP® skills improved (e.g. cardiac lead placement occurred 12x faster). Teamwork scores showed improvement in all domains. Our results demonstrate that a TS program aimed at improving NRP® and team performance is possible to implement in a rural setting. Our pilot study showed a trend towards improved NRP® adherence, increased skill efficiency, and higher quality teamwork and communication in one rural hospital. Additional research is needed to analyze program efficacy on a larger scale and to understand the impact of training on patient outcomes.

Assessing Team Performance in a Longitudinal Neonatal Resuscitation Simulation Training Program: Comparing Validity Evidence to Select the Best Tool.

Introduction Neonatal resuscitation is a high-acuity, low-occurrence event that requires ongoing practice by interprofessional teams to maintain proficiency.Simulation provides an ideal platform for team training and evaluation of team performance. Our simulation center supports a longitudinal in situ simulation training program for delivery room teams. In addition to adherence to the Neonatal Resuscitation Program standards, team performance assessment is an essential component of program evaluation and participant feedback. Multiple published teamwork assessment tools exist. Our objective was to select the tool with the best validity evidence for our program's needs. Methods We used Messick's framework to assess the validity of evidence for potential teamwork assessment tools. Four possible tools were identified from the literature: the Mayo High Performance Teamwork Scale (Mayo), Team Performance Observation Tool (TPOT), Clinical Teamwork Scale (CTS), and Team Emergency Assessment Measure (TEAM). Relevant context included team versus individual focus, external evaluator versus self-evaluation, and ease of use (which included efficiency, clarity of interpretation, and overall assessment). Three simulation experts identified consensus anchors for each tool and independently reviewed and scored 10 pre-recorded neonatal resuscitation simulations. Raters assigned each tool a rating according to efficiency, ease of interpretation, and completeness of teamwork assessment. Interrater reliability (IRR) was calculated using intraclass correlation for each tool across the three raters. Average team performance scores for each tool were correlated with neonatal resuscitation adherence scores for each video using Spearman's rank coefficient. Results There was a range of IRR between the tools, with Mayo having the best (single 0.55 and multi 0.78). Each of the three raters ranked Mayo optimally in terms of efficiency (mean 4.66 + 0.577) and ease of use (4+1). However, TPOT and CTS scored highest (mean 4.66 ± 0.577) for overall completeness of teamwork assessment. There was no significant correlation to NRP adherence scores for any teamwork tool. Conclusion Of the four tools assessed, Mayo demonstrated moderate IRR and scored highest for its ease of use and efficiency, though not completeness of assessment. The remaining three tools had poor IRR, which is not an uncommon problem with teamwork assessment tools. Our process emphasizes the fact that assessment tool validity is contextual. Factors such as a relatively narrow (and high) performance distribution and clinical context may have contributed to reliability challenges for tools that offered a more complete teamwork assessment.

Curriculum Innovation: Design, Implementation, and Evaluation of an Interdisciplinary Teamwork-Focused Neurocritical Care In Situ Simulation Training Program.

Neurocritical care (NCC) is a niche clinical subspecialty dependent on interdisciplinary cohesion to operate in critical situations. Team cohesion in an intensive care unit (ICU) depends not only on technical skills or medical knowledge but also on nontechnical skills such as teamwork, communication, and leadership. Developing and practicing these skills as an interdisciplinary team is not standard in most professional training programs. This project aimed to (1) design and implement a NCC in situ simulation program aimed at practicing teamwork, (2) demonstrate feasibility and acceptability of recurring in situ simulations, and (3) assess baseline teamwork scores and clinician preparedness to respond to a clinical emergency. The NLN Jeffries Simulation Theory was used to guide the simulation program design. A 1-year pilot project consisted of monthly NCC in situ simulations. Debriefing with Good Judgment was used to guide postsimulation reflection. Feasibility was evaluated by participation metrics and simulation schedule adherence. Acceptability was assessed through postsimulation evaluations. Teamwork and preparedness were measured using the Mayo High Performance Teamwork Scale (MHPTS) and 10-point Likert scale, respectively. Statistical comparison of MHPTS scores between disciplines and preparedness before vs after simulation was conducted. In 1 year, we conducted 12 in situ simulations, with 167 simulation learner encounters, representing 95 unique learners and 72% of our core NCC team (i.e., nurses, advanced practice providers [APPs], fellows, faculty). Analysis of program evaluations (84% survey completion rate) showed that 91% of all learners strongly agreed that the simulation provided an experiential, collaborative, trusting, and learner-centered environment. Overall, MHPTS scores were similar between disciplines, although in pairwise comparison, pharmacists rated teamwork significantly lower than both nurses (p = 0.01) and APPs (p = 0.004). Learners rated their preparedness to respond to a clinical emergency significantly higher after the simulation (p < 0.001). In situ simulation training is a feasible and acceptable method to introduce teamwork training into ICU culture. Team-based simulation improves self-reported preparation to respond to clinical emergencies. Simulation training that takes place in the clinical setting provides a powerful tool for enhancing teaching and addressing patient care gaps.

Assessment of Surgical Teams’ Teamwork Skills in Pediatric Surgery: A Cross-sectional Study

Background: The operating room is a high-risk environment in which practitioners with different educational backgrounds work together to provide safe care for surgical patients. The surgical team needs to use teamwork skills for safe performance and error prevention. Pediatric surgery is a very sensitive surgery type that needs special psychological skills. Objectives: This study aimed to assess surgical teams’ teamwork skills in pediatric surgery. Methods: This cross-sectional study was conducted on 154 surgical teams working in the pediatric operating rooms of two public hospitals in Shiraz, Iran, during the summer of 2021 using convenience sampling. The data were collected by the Mayo High-Performance Teamwork Scale. An operating room technologist collected the data by observing surgeries. Descriptive statistics were used for the analysis of the data. The data were analyzed using SPSS software (version 22). Results: The mean value of the teamwork score was 1.57 ± 0.20 (out of 2). The total teamwork score was 25.20 ± 3.31 (out of 32). The majority of items had a score of more than average. The team members had the highest score in recognizing a leader. The studied surgical teams had low scores in verbalizing their activities and repeating back the instructions. Conclusions: The overall teamwork score in the studied teams in the pediatric operating rooms was at an acceptable level. However, the studied teams did not do well in team communication behaviors. Interventions, such as educating, standardizing communications, and implementing a pediatric surgical safety checklist, can improve team communication skills.

Role Delineation of the Code Blue Team: A Quasi-Experimental Study During COVID-19

IntroductionThe purpose of this study was to assess if implementing a code role delineation intervention in an emergency department would improve the times to defibrillation and medication administration and improve the nurse perception of teamwork. MethodsA quantitative quasi-experimental study used a retrospective chart review to gather data. A pre- and post-test measured nurse perception of teamwork in a code using the Mayo High Performance Teamwork Scale (MHPTS) after a code role delineation intervention using a paired samples t-test. Pearson r correlations were used to determine relationships between nurse participant (N = 30) demographics and results of the MHPTS scores. ResultsA significant increase in teamwork was noted in 5 of the 16 items on the MHPTS regarding improved communication and identified roles in a code: the team leader assures maintenance of an appropriate balance between command authority and team member participation (t = −5.607, P < .001), team members demonstrated a clear understanding of roles (t = −5.415, P < .001), team members repeat back instructions and clarifications to indicate that they heard them correctly (t = −2.400, P = .029), all members of the team are appropriately involved and participate in the activity (t = −2.236, P = .041), and conflicts among team members are addressed without a loss of situation awareness (t = −2.704, P = .016). There was significance between total pre- and post-test scores (t = −3.938, P = .001). DiscussionImplementation of code role delineation identifiers is an effective method of improving teamwork in a code in an emergency department setting.

Advanced Practice Providers as Leaders of a Rapid Response Team: A Prospective Cohort Study.

In view of the shortage of medical staff, the quality and continuity of care may be improved by employing advanced practice providers (APPs). This study aims to assess the quality of these APPs in critical care. In a large teaching hospital, rapid response team (RRT) interventions led by APPs were assessed by independent observers and intensivists and compared to those led by medical residents MRs. In addition to mortality, the MAELOR tool (assessment of RRT intervention), time from RRT call until arrival at the scene and time until completion of clinical investigations were assessed. Process outcomes were assessed with the crisis management skills checklist, the Ottawa global rating scale and the Mayo high-performance teamwork scale. The intensivists assessed performance with the handoff CEX recipient scale. Mortality, MAELOR tool, time until arrival and clinical investigation in both groups were the same. Process outcomes and performance observer scores were also equal. The CEX recipient scores, however, showed differences between MRs and APPs that increased with experience. Experienced APPs had significantly better situational awareness, better organization, better evaluations and better judgment than MRs with equal experience (p &lt; 0.05). This study shows that APPs perform well in leading an RRT and may provide added quality over a resident. RRTs should seriously consider the deployment of APPs instead of junior clinicians.

Who's Who in the PACU? Role Designation During Emergencies

<h3>Introduction</h3> There is ample evidence that high performance teams are vital to patient survival during emergency events. Role designation among clinicians is key for high-performing emergency response teams. <h3>Identification of the problem</h3> Poor team dynamics and communication breakdown is often the cause of preventable errors with patient mortality/morbidity occurring more often when team dynamics fail. Lack of role designation may lead to adverse patient outcomes during emergency events. <h3>EBP Question/Purpose</h3> Does role designation strategy impact PACU staff team dynamics during emergency situations? <i>Databases/Resources Utilized</i>: CINHAL PubMed UpToDate ASPAN 2021 Scope and Standards AHA 2020 Pediatric Advanced Life Support Guidelines finding 12 articles and selecting <i>Mayo High Performance Teamwork Scale.</i> Synthesized findings support role designation as an effective strategy for high performing emergency response teams and simulation as a learning tool to improve knowledge confidence and clinical skills. <i>Purpose</i>: Implement and evaluate the effectiveness of an evidence-based role designation strategy for PACU staff during emergency situations with aims to improve staff confidence staff knowledge and team dynamics. <h3>Methods/Evidence</h3> <i>Pre-intervention</i>: Survey distributed to PACU staff to assess knowledge of emergency skill/concepts with 5-point Likert scale measuring confidence of role assumption and skills needed for each role. Team dynamics evaluated using the validated <i>Mayo High Performance Teamwork Scale</i> during unit mock codes. <i>Intervention</i>: Education via skill stations for the following roles/concepts: Effective Team Dynamics Airway Management Crash Cart Compressions & Documentation. Roles and Designation Tool implemented during education. <i>Post-intervention</i>: Repeated survey of knowledge and confidence with staff. Comparative team dynamics evaluated with <i>Mayo High Performance Teamwork Scale</i> during unit mock codes. <h3>Significance of Findings/Outcomes</h3> Implementation of an evidence-based Role Designation Tool with education improved role delineation among PACU staff. Consistency in understanding assumed role during emergencies improved from 0% role-consistency (0/10 simulated events) to 87.5% role-consistency (7/8 simulated events) (p < 0.001). <h3>Implications for perianesthesia nurses and future research</h3> Implementation of a role designation tool in the PACU provides PACU staff with a clear plan for emergencies. This clear plan improves communication team dynamics and comfort among PACU staff during emergencies positively impacting patient outcomes.

Improving Ad Hoc Medical Team Performance with an Innovative "I START-END" Communication Tool.

PurposeTo study the effect of a communication tool entitled: “I START-END” (I-Identify; S-Story; T-Task; A-Accomplish/Adjust; R-Resources; T-Timely Updates; E-Exit; N-Next; D-Document and Debrief) in simulated urgent scenarios in non-operating room settings (referred to as “Ad Hoc”) with anesthesia residents. The “I START-END” tool was created by incorporating Crisis Resource Management (CRM) principles into a practical and user-friendly format.MethodsThis was a mixed methods pre/post observational study with 47 anesthesia resident volunteers participating from July 2014 to June 2016. Each resident served as their own control, and participated in three simulated Ad Hoc scenarios. The first simulation served as a baseline. The second simulation occurred 1–2 weeks after I START-END training. The third simulation occurred 3–6 months later. Simulation performance was videotaped and reviewed by trained experts using technical skill checklists and Anesthesia Non-Technical Skills (ANTS) score. Residents filled out questionnaires, pre-simulation, 1–2 weeks after I START-END training and 3–6 months later. Concurrently, resident performance at actual Code Blue events was scored by trained observers using the Mayo High Performance Teamwork Scale.Results80–90% of residents stated the tool provided an organized approach to Ad Hoc scenarios – specifically, information helpful to care of the patient was obtained more readily and better resource planning occurred as communication with the team improved. Residents stated they would continue to use the tool and apply it to other clinical settings. Resident video performance scores of technical skills showed significant improvement at the “late” session (3–6 months post exposure to the I START-END). ANTS scores were satisfactory and remained unchanged throughout. There was no difference between residents with and without I START-END training as measured by the Mayo High Performance Teamwork Scale, however, debriefing at Code Blues occurred twice as often when residents had I START-END training.ConclusionNon-operating room settings are fraught with unfamiliarity that create many challenges. The I START-END tool operationalizes key CRM elements. The tool was well received by residents; it enabled them to speak up more readily, obtain vital information and continually update each other by anticipating, planning, and debriefing in an organized and collaborative way.

Effect of Structured Briefing Prior to Patient Arrival on Interprofessional Communication and Collaboration in the Trauma Team.

PurposeTreating a multiple trauma patient is multidisciplinary team work. The performance of the trauma team is crucial to treating the patients safely and effectively. The fundamentals of the performance are the quality of interprofessional collaboration and the communication inside the team and its efficacy for patients’ safety and team’s well being. This is a prospective interventional study. The aim of this paper was to assess interprofessional collaboration and perceived efficacy inside the trauma team and to evaluate the effects of the implementation of a trauma team briefing tool before the arrival of the patient on perceived teamwork performance.Participants and MethodsThe study took place in the emergency department. Participants were members of the trauma team (emergency physicians and nurses). Two validated scales were selected that address interprofessional collaboration and team perceived efficacy: the TEAM survey (revised version) and the Mayo High Performance Teamwork Scale. A detailed and structured team briefing was used. The trauma team filled in the two scales (46 participants). Prior to every multiple trauma patient arrival, the briefing was then implemented for 3 months. At the end of the third month, the two scales were re-administered and the results analysed (31 participants). The main outcome was the variation of proportion of desirable answers. We considered significant only clearly separated confidence intervals (95% CI).ResultsAll items in the questionnaires had better responses in the second round. In 16 items, the differences found were statistically significant with a 95% confidence interval and p<0.05. The perceived communication and collaboration by healthcare professionals of the trauma team improved with the introduction of the tool.ConclusionA team briefing prior to the arrival of a multiple trauma patient enhances providers’ self perception of interprofessional collaboration in the management of multiple trauma patients.

Cross-cultural adaptation and validation of two crisis resource management scales

BackgroundSimulation training programs in crisis resource management must be evaluated using valid and reliable instruments. We translated into Spanish and linguistically validate The Mayo High Performance Teamwork Scale (MHPTS) and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS) non-technical skills assessment instruments. MethodWe performed a standardised cross-cultural adaptation process. The psychometric properties of both instruments in their versions adapted to Spanish were subsequently evaluated in a sample of 100 students by using exploratory factor analysis and assessing internal consistency and convergent validity through a total of 94 simulation scenarios in urgent medical situations ResultsOur results for the MHPTS showed a one-dimensional structure containing 8 items which explained a total variance of 72.84%; the Ottawa GRS also had a one-dimensional structure, this time with 5 items, which explained a total variance of 91.79%. According to the Cronbach alpha, the internal consistency for the MHPTS was 0.94 (1–8 items) and 0.98 for the Ottawa GRS. In addition, there was a strong correlation between the MHPTS and Ottawa GRS (r = 0.97; p < 0.001). ConclusionWe found strong evidence for the high validity and reliability of the Spanish versions of both these tools when tested in Spanish simulated emergency contexts.

Testing the effects of checklists on team behaviour during emergencies on general wards: An observational study using high-fidelity simulation

IntroductionClinical teams struggle on general wards with acute management of deteriorating patients. We hypothesized that the Crisis Checklist App, a mobile application containing checklists tailored to crisis-management, can improve teamwork and acute care management. MethodsA before-and-after study was undertaken in high-fidelity simulation centres in the Netherlands, Denmark and United Kingdom. Clinical teams completed three scenarios with a deteriorating patient without checklists followed by three scenarios using the Crisis Checklist App. Teamwork performance as the primary outcome was assessed by the Mayo High Performance Teamwork scale. The secondary outcomes were the time required to complete all predefined safety-critical steps, percentage of omitted safety-critical steps, effects on other non-technical skills, and users’ self-assessments. Linear mixed models and a non-parametric survival test were conducted to assess these outcomes. Results32 teams completed 188 scenarios. The Mayo High Performance Teamwork scale mean scores improved to 23.4 out of 32 (95% CI: 22.4–24.3) with the Crisis Checklist App compared to 21.4 (20.4–22.3) with local standard of care. The mean difference was 1.97 (1.34–2.6; p < 0.001). Teams that used the checklists were able to complete all safety-critical steps of a scenario in more simulations (40/95 vs 21/93 scenarios) and these steps were completed faster (stratified log-rank test χ2 = 8.0; p = 0.005). The self-assessments of the observers and users showed favourable effects after checklist usage for other non-technical skills including situational awareness, decision making, task management and communication. ConclusionsImplementation of a novel mobile crisis checklist application among clinical teams was associated in a simulated general ward setting with improved teamwork performance, and a higher and faster completion rate of predetermined safety-critical steps.

Massive Hemorrhage Protocol Application and Teamwork Skills.

Massive hemorrhages (MHs) are rare but serious complications of pediatric trauma and obstetric cases. This study aimed to evaluate the impact of interprofessional simulation to improve adherence to a MH protocol (MHP), teamwork skills and confidence levels during a hemorrhagic crisis situation.Methods: This was a pre-post experimental study conducted at a tertiary care mother-child simulation center. Pediatric emergency and obstetric teams were submitted to simulated trauma and postpartum MH scenarios. Training consisted of two case scenarios followed by debriefing sessions and a lecture on the MHP. The primary outcome was adherence to MHP processes (checklist) measured prior to and 2weeks following training sessions. Other outcomes were the measure of teamwork skills (Mayo High Performance Teamwork Scale) and confidence of the participants. Sixty-two health care professionals were involved in eight interprofessional teams. Mean scores for adherence to the MHP improved from 19.1 in the pretraining phase to 25.8 in the posttraining phase (difference of 6.7; 95% confidence interval [CI]=4.4 to 8.9). Mean scores pertaining to teamwork skills also improved significantly between pre- and posttraining phases (difference=3.9; 95% CI=1.5 to 6.4). Confidence questionnaires showed significant improvements in the posttraining phase (difference=6.9; 95% CI=5.3 to 8.3). Targeted training involving simulation and protocol review improved participant adherence to MHP processes and teamwork skills. Confidence levels improved across all disciplines.

French Translation and Validation of the Mayo High Performance Teamwork Scale for Nursing Students in a High-Fidelity Simulation Context

BackgroundThe Mayo High Performance Teamwork Scale (MHPTS) was developed to measure teamwork skills in simulation. As no such tool was available in French, the main purpose was to translate the MHPTS. The secondary objective was to evaluate the reliability of this scale for use with French-Canadian nursing students. MethodThe cross-cultural adaptation followed four steps: (a) translation, (b) back-translation, (c) committee of experts, and (d) pretest. In regard to reliability, internal consistency was measured with coefficient alpha in a pilot study. ResultsThe committee of experts (n = 7) judged the content as clear and comprehensive. Comments from the pretest were used to improve the scale (n = 44). Internal consistency is acceptable (α = 0.74) among nursing students (n = 70). ConclusionThe Canadian French version of the MHPTS has demonstrated acceptable reliability and is now available to assess teamwork in nursing students.

Conceptualizing collaboration in nursing.

Nurses practicing at every level need a clear definition of collaboration before applying the concept in daily practice. Additionally, a conceptual definition of collaboration in nursing assists nurse researchers in finding or developing instruments for measuring collaboration and attributes of collaboration, which will enhance research findings. Collaboration extends beyond communication and includes sharing, teamwork, and respect. Multiple databases including CINAHL, PubMed, and ERIC were searched using the keywords collaboration, nursing, concept analysis, sharing, respect, and teamwork. For this analysis, using Walker and Avant's method, the conceptual definition of collaboration in nursing is an intraprofessional or interprofessional process by which nurses come together and form a team to solve a patient care or healthcare system problem with members of the team respectfully sharing knowledge and resources. Two instruments consistent with the conceptual definition of collaboration are The Mayo High Performance Teamwork Scale (MHPTS) and Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS) and these instruments are summarized in this study. Finally, case scenarios are given to illustrate exemplars of collaboration in clinical practice.

Using a Standardized Patient to Improve Collaboration and Problem Solving Skills With CPAP Usage in the Home.

A review of literature revealed a lack of research pertaining to nurses' or student nurses' knowledge of continuous positive airway pressure (CPAP) and the ability to troubleshoot CPAP malfunction. This study sought to answer the following questions: What are associate degree nursing (ADN) students' knowledge, interdisciplinary communication, and problem-solving skills regarding patients' home use of CPAP? Is there a change after participation in a simulation with a patient on CPAP in home setting? Twenty-one ADN students enrolled in small Midwest college participated. A preexperimental design of one group pretest posttest was used. Each student completed a demographic questionnaire, Mayo High Performance Teamwork Scale, Interprofessional collaborative simulation experience survey, and a CPAP knowledge base survey before and upon completion of the simulation. There were no changes in students' comfort, baseline knowledge, and basic understanding regarding CPAP. However, after the simulation, students described more detailed problem-solving skills, which included using respiratory therapists, durable medical equipment providers, and community resources. On the Mayo High Performance Teamwork Scale, all 16 items demonstrated improved scores (baseline mean = 21.65 and postsimulation mean = 25.6).

Use of High-Fidelity Simulation to Enhance Interdisciplinary Collaboration and Reduce Patient Falls

This pilot study aimed to determine the effect of nurse/physician interdisciplinary team training on patient falls. Specifically, we evaluated team training in a simulation center as a method for targeting and minimizing breakdowns in perceptions of respect, collaboration, communication, and role misunderstanding behaviors between care disciplines. Registered nurses (RNs) were randomly assigned to participate. Residents were divided into groups and assigned based on their availability and clinical responsibility. All participants completed a demographic form, the Professional Practice Environment Assessment Scale (PPEAS), and the Mayo High Performance Teamwork Scale (MHPTS) after consenting and before participation in simulation training. The PPEAS and the MHPTS were readministered at 2 and 6 months after the simulation experience. Differences in MHPTS and PPEAS scores between the baseline and 2- and 6-month assessments were analyzed; fall rates over time were evaluated using Cochran-Armitage trend tests. After the team training exercises, teamwork as measured by the MHPTS improved significantly at both 2 and 6 months (P = 0.01; P < 0.001) compared with baseline measurement. Practice environment subscores, with the exception of positive organizational characteristics, also increased when measured 6 months after training. The primary outcome, reduction in anticipated patient falls, improved significantly (P = 0.02) over the course of the study. Results of this pilot study show that team training exercises result in improvement in both patient safety (anticipated patient falls) and team member perception of their work environment. If validated by other studies, improvement in this patient safety metric would represent an important benefit of simulation and team training.

Examining the Feasibility and Predictive Validity of the SAGAT Tool to Assess Situation Awareness Among Medical Trainees.

Situational awareness (SA) describes a team's ability to perceive environmental elements, comprehend their meaning, and anticipate future events. Although SA is consistently described as a critical competency among surgical teams, there is a dearth of research identifying efficacious methods to assess and develop SA in such settings. The aim of this study was to investigate the feasibility of implementing an objective tool that has been used to measure SA in other intense and dynamic environments -the Situation Awareness Global Assessment Technique (SAGAT)-and to examine its ability to predict surgical trainee team performance. Ten team-training sessions were conducted involving 2 standardized high-fidelity trauma simulation scenarios. Teams consisted of 4 or 5 participants, and roles were randomly assigned. Team situational awareness was assessed using the SAGAT method, which involves intermittent freezes to probe trainee awareness of the situation. Team performance was assessed using the Mayo High-Performance Teamwork Scale. Hierarchical regression was used to examine SA-performance relationships for each scenario. Forty-three third-year medical students participated in the training sessions. Team SA ranged from 45% to 79% and 46% to 97% for the first and second scenarios, respectively. Additionally, team SA significantly predicted team performance for both the first scenario (F(1, 42)=19.57; P<0.001; R=0.30) and second scenario (F(1,42)=26.18, P<0.001; R=0.38). The SAGAT is a valid, reliable tool for assessing surgical trainee SA. Information provided by the SAGAT can help diagnose team performance problems, inform debriefing discussion points, and inform curriculum development endeavors.

A Comparison of Observed vs Self-Rated Teamwork During Simulated Cardiac Arrest and Rapid Response Scenarios

SESSION TITLE: Education SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 25, 2016 at 02:45 PM - 04:15 PM PURPOSE: The process of individual learning includes recognizing one’s own deficiencies. Likewise, identification of team deficiencies is fundamental to remediate them, in order to improve team performance especially for critical situations. Little is known regarding self-assessment of team leadership and teamwork skills. We hypothesized that physicians overestimate their leadership and teamwork skills when managing critical scenarios such as cardiac arrest and rapid response scenarios (CA/RRS), as compared to trained external observers. METHODS: First-year Internal Medicine residents (n=48) were divided into seven groups and each participated in 8 simulated RR/CA cases using high-fidelity simulation. Residents alternated between team leader and other team member roles. Each group participated in 2 cases, followed by a lecture on teamwork during CA/RRS, and then participated in 6 additional simulated cases. The 16-item validated Mayo High Performance Teamwork Scale was completed independently by an experienced faculty member observer and by each individual resident for each case. RESULTS: A total of 55 simulated cases were run, with a total of 55 observer and 269 resident self-assessment scores collected. Overall, the self-assessed teamwork score was significantly higher as compared to the experienced observer-graded teamwork score (1.541 +/- 0.36 vs 1.183 +/- 0.47, p-value <0.01). On 11 of the 16 Mayo scale items, self-assessment was significantly higher than observed scoring. There was no significant difference noted only in identifying team leadership, understanding own role in the team, good communication practices, solving conflicts without losing situation awareness, and demonstrating appropriate task management skills. CONCLUSIONS: Internal residents overestimate their teamwork and leadership skills when compared to an external observer’s assessment. However, there is good agreement between objective and self-assessment in identifying a leader, clarifying team roles, use of good communication and effective task management. CLINICAL IMPLICATIONS: Residents inflated self-assessment of their teamwork and leadership skills may produce false self-confidence and potentially hinder the learning of effective teamwork skills. DISCLOSURE: The following authors have nothing to disclose: Alfredo Lee Chang, Akiva Dym, Maneesha Bangar, Adam Keene, Marjan Rahmanian, Nida Qadir, Lewis Eisen No Product/Research Disclosure Information

The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment

ObjectivesTo examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these...

Mental practice: a simple tool to enhance team-based trauma resuscitation.

Effective trauma resuscitation requires the coordinated efforts of an interdisciplinary team. Mental practice (MP) is defined as the mental rehearsal of activity in the absence of gross muscular movements and has been demonstrated to enhance acquiring technical and procedural skills. The role of MP to promote nontechnical, team-based skills for trauma has yet to be investigated. We randomized anaesthesiology, emergency medicine, and surgery residents to two-member teams randomly assigned to either an MP or control group. The MP group engaged in 20 minutes of MP, and the control group received 20 minutes of Advanced Trauma Life Support (ATLS) training. All teams then participated in a high-fidelity simulated adult trauma resuscitation and received debriefing on communication, leadership, and teamwork. Two blinded raters independently scored video recordings of the simulated resuscitations using the Mayo High Performance Teamwork Scale (MHPTS), a validated team-based behavioural rating scale. The Mann-Whitney U-test was used to assess for between-group differences. Seventy-eight residents provided informed written consent and were recruited. The MP group outperformed the control group with significant effect on teamwork behaviour as assessed using the MHPTS: r=0.67, p<0.01. MP leads to improvement in team-based skills compared to traditional simulation-based trauma instruction. We feel that MP may be a useful and inexpensive tool for improving nontechnical skills instruction effectiveness for team-based trauma care.