Simulation-based Teamwork Training Research Articles

"Asking for help is a strength"-how to promote undergraduate medical students' teamwork through simulation training and interprofessional faculty.

The ability to team up and safely work in any kind of healthcare team is a critical asset and should be taught early on in medical education. Medical students should be given the chance to "walk the talk" of teamwork by training and reflecting in teams. Our goal was to design, implement and evaluate the feasibility of a simulation-based teamwork training (TeamSIM) for undergraduate medical students that puts generic teamwork skills centerstage. We designed TeamSIM to include 12 learning objectives. For this pre-post, mixed-methods feasibility study, third-year medical students, organized in teams of 11-12 students, participated and observed each other in eight simulations of different clinical situation with varying degrees of complexity (e.g., deteriorating patient in ward; trauma; resuscitation). Guided by an interprofessional clinical faculty with simulation-based instructor training, student teams reflected on their shared experience in structured team debriefings. Using published instruments, we measured (a) students' reactions to TeamSIM and their perceptions of psychological safety via self-report, (b) their ongoing reflections via experience sampling, and (c) their teamwork skills via behavior observation. Ninety four students participated. They reported positive reactions to TeamSIM (M = 5.23, SD = 0.5). Their mean initial reported level of psychological safety was M = 3.8 (SD = 0.4) which rose to M = 4.3 (SD = 0.5) toward the end of the course [T(21) = -2.8, 95% CI -0.78 to-0.12, p = 0.011 (two-tailed)]. We obtained n = 314 headline reflections from the students and n = 95 from the faculty. For the students, the most frequent theme assigned to their headlines involved the concepts taught in the course such as "10 s for 10 min." For the faculty, the most frequent theme assigned to their headlines were reflections on how their simulation session worked for the students. The faculty rated students' teamwork skills higher after the last compared to the first debriefing. Undergraduate medical students can learn crucial teamwork skills in simulations supported by an experienced faculty and with a high degree of psychological safety. Both students and faculty appreciate the learning possibilities of simulation. At the same time, this learning can be challenging, intense and overwhelming. It takes a team to teach teamwork.

All professions can benefit — a mixed-methods study on simulation-based teamwork training for operating room teams

BackgroundOperating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants’ reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace.MethodsIn a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team.Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years.Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis.ResultsAll occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one’s profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration.ConclusionSimulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.

Measuring teamwork for training in healthcare using eye tracking and pose estimation.

Teamwork is critical for safe patient care. Healthcare teams typically train teamwork in simulated clinical situations, which require the ability to measure teamwork via behavior observation. However, the required observations are prone to human biases and include significant cognitive load even for trained instructors. In this observational study we explored how eye tracking and pose estimation as two minimal invasive video-based technologies may measure teamwork during simulation-based teamwork training in healthcare. Mobile eye tracking, measuring where participants look, and multi-person pose estimation, measuring 3D human body and joint position, were used to record 64 third-year medical students who completed a simulated handover case in teams of four. On one hand, we processed the recorded data into the eye contact metric, based on eye tracking and relevant for situational awareness and communication patterns. On the other hand, the distance to patient metric was processed, based on multi-person pose estimation and relevant for team positioning and coordination. After successful data recording, we successfully processed the raw videos to specific teamwork metrics. The average eye contact time was 6.46 s [min 0 s - max 28.01 s], while the average distance to the patient resulted in 1.01 m [min 0.32 m - max 1.6 m]. Both metrics varied significantly between teams and simulated roles of participants (p < 0.001). With the objective, continuous, and reliable metrics we created visualizations illustrating the teams' interactions. Future research is necessary to generalize our findings and how they may complement existing methods, support instructors, and contribute to the quality of teamwork training in healthcare.

Implementation of a Virtual Simulation-based Teamwork Training Program for Emergency Events in the Perioperative Setting

Background InformationWorking in interprofessional teams in healthcare is listed as one of the four core competencies for interprofessional collaborative practice. Literature demonstrates that communication failures during emergencies are a large contributor to adverse clinical events that negatively impact patient outcomes. Additionally, The Joint Commission identifies poor communication as a key factor in sentinel events. A survey addressing teamwork and high-quality communication was distributed to the Perioperative Department, which revealed that the "communication openness" category received a score below AHRQ benchmark. The perioperative leadership team was tasked with developing strategic working groups in response to the poorly scored communication domain.Objectives of Project(1) Participants will be able to implement the communication tool represented within the TeamSTEPPS platform; (2) Participants will be able to discuss the importance of effective communication during emergency clinical events; (3) Participants will be able to optimize teamwork communication skills to improve patient outcomes during emergency clinical events.Process of ImplementationThe team discussed and leveraged the survey findings to develop innovative ways to improve communication for the Perioperative team, including physicians, nurses, and ancillary staff. As a part of the action plan, the team decided to use simulation education aimed toward effective communication during emergency clinical events. However, COVID-19 required social distancing-based learning. Therefore, the team developed an experiential-learning-rich presentation with pre-recorded clinical emergency videos of participatory, active simulation to demonstrate the main teamwork and communication tools represented within the TeamSTEPPS model. All disciplines participated in role-playing communication aids to demonstrate teamwork and handoff scenarios depicted within the observed simulation video clips.Statement of Successful PracticeOpen-ended anonymous surveys distributed after sessions demonstrated that individuals participating in the virtual simulation sessions has allowed for increased opportunities to effectively communicate based on shared goals, shared knowledge, and mutual respect during clinical emergency events and daily practice. Additionally, participants reported intentions to apply the TeamSTEPPS concepts, such as situational awareness, mutual support, and communication in their future practices.Implications for Advancing the Practice of Perianesthesia NursingUtilizing observed virtual simulation methods of team training allows for future opportunities of distributed learning for high fidelity team training sessions in efforts to improve communication between the perioperative team and optimize care of all Perianesthesia patient populations.

Impact of simulation training for teamwork and communication intervention on patient safety in the emergency department

Background: The emergency department (ED) is the hospital division that is most vulnerable to poor communication and teamwork-based medical errors that affect patient safety. One approach to prevent medical errors is by training and assessing healthcare workers using simulation-based (SB) teamwork and communication training. This study aimed to explore the extent to which SB training could improve teamwork and communication and reduce preventable medical errors in the ED. Method: The study was conducted at the Ministry of National Guard Health Affairs, a tertiary care center with a 39-bed ED, in Saudi Arabia. A total of 123 ED healthcare staff participated in the study. This study adopted a single-subject experimental design with the intervention of simulation training in ED cases. The methodology focused on three domains: 1) patient safety in the ED, 2) inter-professional and multidisciplinary simulation team training, and 3) team dynamic enhancement use. Staff perceptions regarding teamwork and communication pre-and post-intervention and the relationship between changes in their perception of performance in the ED and patient outcomes. The chi-square test was used for univariate analysis, and a generalized linear regression model was adjusted for demographics in multivariate analysis. Results: Staff perceptions were collected from all multidisciplinary team members before and after simulation training. The data revealed a significant improvement in overall staff perceptions toward teamwork and communication (8% to 34%, p-value = 0.001). Conclusion: SB communication and teamwork training in the ED resulted in a sustained and measurable improvement in ED staff perceptions toward teamwork and communication. The results suggest that simulation sessions may improve staff perceptions and multidisciplinary team communication during critical situations in the ED.

What Can Analytics for Teamwork Proxemics Reveal About Positioning Dynamics In Clinical Simulations?

Effective teamwork is critical to improve patient outcomes in healthcare. However, achieving this capabilityrequires that pre-service nurses develop the spatial abilities they will require in their clinical placements, suchas: learning when to remain close to the patient and to other team members; positioning themselves correctlyat the right time; and deciding on specific team formations (e.g. face-to-face or side-by-side) to enable effectiveinteraction or avoid disrupting clinical procedures. However, positioning dynamics are ephemeral and caneasily become occluded by the multiple tasks nurses have to accomplish. Digital traces automatically capturedby indoor positioning sensors can be used to address this problem for the purpose of improving nurses' reflection, learning and professional development. This paper presents; i) a qualitative study that illustrateshow to elicit spatial behaviours from educators' pedagogical expectations, and ii) a modelling approachthat transforms nurses' low-level position traces into higher-order proxemics constructs, informed by sucheducatos' expectations, in the context of simulation-based teamwork training. To illustrate our modellingapproach, we conducted an in-the-wild study with 55 undergraduate students and five educators from whompositioning traces were captured in eleven authentic nursing education classes. Low-levelx-ydata was usedto model three proxemic constructs: i) co-presence in interactional spaces, ii) socio-spatial formations (i.e.f-formations), and ii) presence in spaces of interest. Through a number of vignettes, we illustrate how indoorpositioning analytics can be used to address questions that educators and researchers have about teamwork inhealthcare simulation settings.

Development of a Novel and Scalable Simulation-Based Teamwork Training Model Using Within-Group Debriefing of Observed Video Simulation

Effective teamwork and communication skills are essential for safe and reliable health care. These skills require training and practice. Experiential learning is optimal for training adults, and the industry has recognized simulation training as an exemplar of this approach. Yet despite decades of investment, this training is inaccessible and underutilized for most of the more than 12 million health care professionals in the United States. This report describes the design process of an adapted simulation training created to overcome the key barriers to scaling simulation-based teamwork training: access to technology, time away from clinical work, and availability of trained simulation educators. The prototype training is designed for delivery in one-hour segments and relies on observation of video simulation scenarios and within-group debriefing, which are promising variations on traditional simulation training. To our knowledge, these two simulation approaches have not been previously combined. The resulting prototype minimizes the need for an on-site trained simulation educator. This report details the development of a training model, its subsequent modification based on pilot testing, and the evaluation of the resulting redesigned prototype. Participant evaluations of the redesigned prototype were highly positive, with 92% reporting that they would like to participate in additional, similar training sessions. Positive results were also found in assessment of feasibility, acceptability, psychological safety, and behavioral intention (reported intention to alter behavior).

Impact of simulation-based teamwork training on COVID-19 distress in healthcare professionals

ContextNon-technical skills such as leadership, communication, or situation awareness should lead to effective teamwork in a crisis. This study aimed to analyse the role of these skills in the emotional response of health professionals to the COVID-19 pandemic.MethodsBefore the COVID-19 outbreak, 48 doctors and 48 nurses participated in a simulation-based teamwork training program based on teaching non-technical skills through simulation. In May 2020, this group of professionals from a COVID-19 referral hospital was invited to participate in a survey exploring stress, anxiety, and depression, using the PSS-14 (Perceived Stress Scale) and the HADS (Hospital Anxiety and Depression Scale) measures. A control group that did not receive the training was included. We conducted a logistic regression to assess whether having attended a simulation-based teamwork training program modified the probability of presenting psychological distress (PSS-14 > 18 or HADS> 12).ResultsA total of 141 healthcare professionals were included, 77 in the intervention group and 64 in the control group. Based on the PSS-14, 70.1% of the intervention group and 75% of the control group (p = 0.342) had symptoms of stress. Having contact with COVID-19 patients [OR 4.16(1.64–10.52)]; having minors in charge [OR 2.75 (1.15–6.53)]; working as a doctor [0.39(0.16–0.95)], and being a woman [OR 2.94(1.09–7.91)] were related with PSS14 symptoms. Based on the HADS, 54.6% of the intervention group and 42.2% of the control group (p = 0.346) had symptoms of anxiety or depression. Having contact with COVID-19 patients [OR 2.17(1.05–4.48)] and having minors in charge [OR 2.14(1.06–4.32)] were related to HADS symptoms. Healthcare professionals who attended COVID-19 patients showed higher levels of anxiety and depression [OR 2.56(1.03–6.36) (p = 0.043)].ConclusionHealthcare professionals trained in non-technical skills through simulation tended towards higher levels of anxiety and depression and fewer levels of stress, during the COVID-19 pandemic.

Method matters: impact of in-scenario instruction on simulation-based teamwork training

BackgroundThe rationale for introducing full-scale patient simulators in training to improve patient safety is to recreate clinical situations in a realistic setting. Although high-fidelity simulators mimic a wide range of human features, simulators differ from the body of a sick patient. The gap between the simulator and the human body implies a need for facilitators to provide information to help participants understand scenarios. The authors aimed at describing different methods that facilitators in our dataset used to provide such extra scenario information and how the different methods to convey information affected how scenarios played out.MethodsA descriptive qualitative study was conducted to examine the variation of methods to deliver extra scenario information to participants. A multistage approach was employed. The authors selected film clips from a shared database of 31 scenarios from three participating simulation centers. A multidisciplinary research team performed a collaborative analysis of representative film clips focusing on the interplay between participants, facilitators, and the physical environment. After that, the entire material was revisited to further examine and elaborate the initial findings.ResultsThe material displayed four distinct methods for facilitators to convey information to participants in simulation-based teamwork training. The choice of method had impact on the participating teams regarding flow of work, pace, and team communication. Facilitators’ close access to the teams’ activities when present in the simulation suite, either embodied or disembodied in the simulation, facilitated the timing for providing information, which was critical for maintaining the flow of activities in the scenario. The mediation of information by a loudspeaker or an earpiece from the adjacent operator room could be disturbing for team communication.ConclusionsIn-scenario instruction is an essential component of simulation-based teamwork training that has been largely overlooked in previous research. The ways in which facilitators convey information about the simulated patient have the potential to shape the simulation activities and thereby serve different learning goals. Although immediate timing to maintain an adequate pace is necessary for professionals to engage in training of medical emergencies, novices may gain from a slower tempo to train complex clinical team tasks systematically.

Medical students\u2019 situational motivation to participate in simulation based team training is predicted by attitudes to patient safety

BackgroundPatient safety education, as well as the safety climate at clinical rotations, has an impact on students’ attitudes. We explored medical students’ self-reported motivation to participate in simulation-based teamwork training (SBTT), with the hypothesis that high scores in patient safety attitudes would promote motivation to SBTT and that intrinsic motivation would increase after training.MethodsIn a prospective cohort study we explored Swedish medical students’ attitudes to patient safety, their motivation to participate in SBTT and how motivation was affected by the training. The setting was an integrated SBTT course during the surgical semester that focused on non-technical skills and safe treatment of surgical emergencies. Data was collected using the Situational Motivation Scale (SIMS) and the Attitudes to Patient Safety Questionnaire (APSQ).ResultsWe found a positive correlation between students’ individual patient safety attitudes and self-reported motivation (identified regulation) to participate in SBTT. We also found that intrinsic motivation increased after training. Female students in our study scored higher than males regarding some of the APSQ sub-scores and the entire group scored higher or on par with comparable international samples.ConclusionIn order to enable safe practice and professionalism in healthcare, students’ engagement in patient safety education is important. Our finding that students’ patient safety attitudes show a positive correlation to motivation and that intrinsic motivation increases after training underpins patient safety climate and integrated teaching of patient safety issues at medical schools in order to help students develop the knowledge, skills and attitudes required for safe practice.

Board #124 - Research Abstract How Simulation-based Teamwork Training Translates into Benefits for Patients (TOSTI study)

HypothesisSimulation-based teamwork training has been extensively implemented in medical education in order to improve patient safety.1-2 However, it is unclear whether, and how, such training improves patient outcome. Our main goal was to investigate the effectiveness of simulation-based obstetric

Assessing teamwork in the trauma bay: introduction of a modified “NOTECHS” scale for trauma

Background A modified nontechnical skills (NOTECHS) scale for trauma (T-NOTECHS) was developed to teach and assess teamwork skills of multidisciplinary trauma resuscitation teams. In this study, T-NOTECHS was evaluated for reliability and correlation with clinical performance. Methods Interrater reliability (intraclass correlation coefficient) and correlation with the speed and completeness of resuscitation tasks were assessed during simulation-based teamwork training and during actual trauma resuscitations. Results For T-NOTECHS ratings done in real time, intraclass correlation coefficients were .44 for simulated and .48 for actual resuscitations. Reliability was higher (intraclass correlation coefficient = .71) for video review of resuscitations. Better T-NOTECHS scores were correlated with better performance during simulations, evidenced by a greater number of completed resuscitation tasks ( r = .50, P < .01) and faster time to completion ( r = −.38, P < .05) In actual resuscitations, T-NOTECHS ratings improved after teamwork training ( P < .001). Higher T-NOTECHS scores were correlated with better clinical performance, evidenced by faster resuscitation ( r = −.13, P < .05) and fewer unreported resuscitation tasks ( r = −.16, P < .05). Conclusions Improvement in T-NOTECHS scores after teamwork training, and correlation with clinical parameters in simulated and actual trauma resuscitations, suggest its clinical relevance. Further evaluation, aiming to improve reliability, may be warranted.

Abstract 73: Improving Teamwork Perceptions and Cardiopulmonary Resuscitation Performance by High-Fidelity Simulation-Based Teamwork Training

Introduction: The quality of cardiopulmonary resuscitation (CPR) performance influences patient's outcome. Besides individual technical knowledge and skills, teamwork perceptions have an impact on team performance, and consequently on resuscitation quality. This study aimed to investigate the impacts of high-fidelity simulation (HFS)-based teamwork training on team perceptions and CPR performance. Methods: This was a prospective, case-controlled study. A four-scenario, HFS-based teamwork training program was developed and implemented from November 2007 to February 2008. In addition to resuscitation skills, the program focused on teaching teamwork competencies, including leadership, communication, situation monitoring, and mutual support. Case scenarios were simulated using a high-fidelity mannequin simulator in a simulated emergency department (ED) setting. Audio-visual assisted feedback was given by facilitators after each scenario. A standardized questionnaire for assessment of teamwork performance was developed, using 5-point Likert scales. All participants completed the questionnaires immediately after each scenario, according to their performance during that simulation session. Both the first and last case scenarios were patients of out-of-hospital cardiac arrest. CPR performance including compression rate, no-flow ratio, and initiation time of defibrillation was measured by reviewing the videos. Results: A total of 83 ED staffs, including 24 residents and 59 nurses, were enrolled. Teamwork perceptions improved significantly after the simulation training course ( p &lt;0.001). For CPR performance, there was a trend toward decreased hyperventilation rate (19.1±5.6 vs. 14.8±8.2 min -1 , p =0.10), increased chest compression rate (102.4±17.1 vs. 110.4±15.2 min -1 , p =0.12), and faster initiation of defibrillation (93.4±26.9 vs. 69.1±39.0 secs, p =0.09) after the training course. No-flow fraction (0.23±0.07 vs. 0.17±0.08, p =0.01), initiation of intubation (99.1±40.6 vs. 77.0±37.0 secs, p =0.02) and intravenous access (86.9±37.7 vs. 63.4±33.8 secs, p =0.02) were significantly improved. Conclusion: HFS-based teamwork training is effective in improving teamwork perceptions and some aspects of CPR performance.