Team Leadership Skills Research Articles

Enhancing Team Dynamics and Leadership Skills for Residents Leading Multidisciplinary In-Patient Cardiac Arrest Teams

Background: Cardiac arrest is a prevalent event with low survival rates, both in out-of-hospital and in-hospital settings. There is a lack of specific training programs addressing team dynamics and leadership skills during resuscitation events, creating a clinical gap. This project aimed to enhance team dynamics and improve leadership skills during IHCA resuscitation events. Methods: We implemented the Mock Code Project for resident physicians from our Internal Medicine Residency Programs in the simulation center (i.e., in a controlled environment) to address this gap. Multidisciplinary team mock code scenarios were created for residents, allowing them to lead resuscitation simulations. The scenarios were based upon common conditions encountered during codes (Cardiac arrest). Trained evaluators provided real-time feedback, and pre-and post-surveys were conducted to assess team perception and gather feedback. Results: Baseline data revealed that 98.6% (143 of 145 residents total) felt uncertain or lacked confidence in leading effective codes in our hospital prior to the intervention. Post-test survey outcome data revealed that 95.1% of participants (136 residents of 143) reported that the sessions challenged their skills at leading codes and improved their skills at managing resuscitation teams. Conclusion: Organized codes with clear roles, responsibilities, bed positioning, and clear leadership significantly improve closed-loop communication, effective team interaction, and patient outcomes. The Mock Code Project fills the gap in training programs by focusing on team dynamics and leadership skills during IHCA resuscitation. Ongoing evaluations and feedback ensure continual improvement in resident confidence and skills. Implementing organized codes benefits residents and healthcare teams, ultimately improving patient care during IHCA. Well-designed mock code scenarios with real-time feedback from senior physicians are an effective way for trainees to develop these skills and this awareness without compromising patient safety.

Team Leadership Curriculum Development: A Descriptive Account of Employing Backward Design in a Cross-Cultural Setting

This article presents a curriculum design aimed at enhancing team leadership skills among the student leaders of a university choir in Central Asia. The unique context revolves around a university without a fine arts program where students establish various student clubs to explore creative interests. The focus is on the university choir, led by a director who struggled initially to align with the students’ preference for contemporary songs over classical repertoire. To address this challenge, a leadership team was formed, but the lack of formal training in leadership hindered their effectiveness. The curriculum design followed a backward design approach, emphasizing desired learning outcomes, including cognitive and affective domains. The design encompassed activities such as academic prompts, reflective exercises, and collaborative planning sessions spread over two sessions. Assessment involved informal checks, academic prompts, and observing behavioral changes post-workshop. The aim was to equip the leaders with practical leadership skills to improve overall team effectiveness.

Transforming the delivery of care from “I” to “We” by developing the crisis resource management skills in pediatric interprofessional teams to handle common emergencies through simulation

BackgroundThe healthcare system is highly complex, and adverse events often result from a combination of human factors and system failures, especially in crisis situations. Crisis resource management skills are crucial to optimize team performance and patient outcomes in such situations. Simulation-based training offers a promising approach to developing such skills in a controlled and realistic environment.MethodsThis study employed a mixed-methods (quantitative-qualitative) design and aimed to assess the effectiveness of a simulation-based training workshop in developing crisis resource management skills in pediatric interprofessional teams at a tertiary care hospital. The effectiveness of the intervention was evaluated using Kirkpatrick’s Model, focusing on reaction and learning levels, employing the Collaboration and Satisfaction about Care Decisions scale, Clinical Teamwork Scale, and Ottawa Global Rating Scale for pre- and post-intervention assessments. Focused group discussions were conducted with the participants to explore their experiences and perceptions of the training.ResultsThirty-nine participants, including medical students, nurses, and residents, participated in the study. Compared to the participants’ pre-workshop performance, significant improvements were observed across all measured teamwork and performance components after the workshop, including improvement in scores in team communication (3.16 ± 1.20 to 7.61 ± 1.0, p < 0.001), decision-making (3.50 ± 1.54 to 7.16 ± 1.42, p < 0.001), leadership skills (2.50 ± 1.04 to 5.44 ± 0.6, p < 0.001), and situation awareness (2.61 ± 1.13 to 5.22 ± 0.80, p < 0.001). No significant variations were observed post-intervention among the different teams. Additionally, participants reported high levels of satisfaction, perceived the training to be highly valuable in improving their crisis resource management skills, and emphasized the importance of role allocation and debriefing.ConclusionsThe study underscores the effectiveness of simulation-based training in developing crisis resource management skills in pediatric interprofessional teams. The findings suggest that such training can impact learning transfer to the workplace and ultimately improve patient outcomes. The insights from our study offer additional valuable considerations for the ongoing refinement of simulation-based training programs. There is a need to develop more comprehensive clinical skills evaluation methods to better assess the transferability of these skills in real-world settings. The potential challenges unveiled in our study, such as physical exhaustion during training, must be considered when refining and designing such interventions.

Maximizing Mentorship Throughout Your Breast Imaging Career.

Unlike many other subspecialties in radiology, breast radiologists practice in a patient-facing and interdisciplinary environment where team building, communication, and leadership skills are critical. Although breast radiologists can improve these skills over time, strong mentorship can accelerate this process, leading to a more successful and satisfying career. In addition to providing advice, insight, feedback, and encouragement to mentees, mentors help advance the field of breast radiology by contributing to the development of the next generation of leaders. During the mentorship process, mentors continue to hone their listening, problem-solving, and networking skills, which in turn creates a more supportive and nurturing work environment for the entire breast care team. This article reviews important mentorship skills that are essential for all breast radiologists. Although some of the principles apply to all mentoring relationships, ensuring that every breast radiologist has the skills to be both an effective mentor and mentee is key to the future of the profession.

Students as game designers and developers: developing cooperative strategy board games to teach team leadership skills

Purpose The purpose of this manuscript is to highlight how gamification is transforming recruitment, retention and training to resolve employee engagement challenges in the ever-changing workplace. In collaborating with game industry experts and designers, the authors taught students team leadership skills by demonstrating how to design and play their own original cooperative strategy games. In doing so, students learn what gamification is and how it can be used to train our multigenerational workforce; how designing board games teaches team leadership skills (e.g. communication, conflict management, power, decision-making); and how to develop cooperative strategy game elements (player characters, roles and actions) that motivate engaging gameplay with successful learning outcomes. Design/methodology/approach In this paper, the authors discuss the practical implications of a three-phase semester-long experiential learning experience, where game design demonstrates to students how employees can work collaboratively together in teams. Students’ developed storylines (i.e. strategic objectives) including motivation challenges, social media communication breakdowns, sabotage, global sustainability and other real-world challenges. In Phase 1, students learn about how companies are using gamification in training high-performing teams. In Phase 2, students play a cooperative strategy game Forbidden Island with their student teams. In Phase 3, students design (and play) their original cooperative strategy game, instructions booklet and build a facilitation guide. Findings Approximately, 400 students developed 48 original cooperative strategy games that can be used to teach team leadership skills. These student teams designed cooperative strategy board games – in which the entire team either wins or loses based on their control of valued resources and player actions as key decision-making points. The data and feedback indicate that the learning experience helped them practically consider team interdependence in making effective decisions, and in creating creative self-efficacy, resilience and self-confidence in their own leadership voice. In this manuscript, the authors focus on providing an overview and implementation plan for our semester-long experiential learning exercise. Originality/value This experiential exercise was implemented from 2019 to 2023 in different learning modalities (face-to-face, hybrid, 100% synchronous online learning) and during challenging times (prepandemic, pandemic and postpandemic learning environments). These varying experiences provided them with a challenge to persevere and learn about their own interpersonal skills and resilience in a creative engaging way with limited resources. Students developed 26 original games during 100% synchronous remote learning due to COVID. To the best of the authors’ knowledge, no other business school is working with gaming industry experts and game designers to teach team leadership to this degree during pre- and postpandemic environments.

Effective Team Leaders and Leadership Skills in Healthcare

Effective Team Leaders and Leadership Skills in Healthcare

Qualitative Study of Emergency Medicine Residents' Perspectives of Trauma Leadership Development.

Trauma team leadership is a core skill for the practice of emergency medicine (EM). In this study our goal was to explore EM residents' perception of their trauma leadership skill development through formal and informal processes and to understand factors that may impact the development and implementation of trauma leadership skills. Using qualitative semi-structured interviews, we explored the leadership experiences of 10 EM residents ranging from second to fourth postgraduate year. Interviews were conducted between July 26-October 31, 2019 and were audio-recorded, transcribed, and de-identified. We analyzed data using qualitative content analysis. Residents discussed three main themes: 1)sources of leadership development; 2)challenges with simultaneously assuming a dual leader-learner role; and 3)contextual factors that impact their ability to assume the leadership role, including the professional hierarchy in the clinical environment, limitations in the physical environment, and gender bias. This study describes the complex factors and experiences that contribute to the development and implementation of trauma team leadership skills in EM residents. This includes three primary sources of leadership development, the dual role of leader and learner, and various contextual factors. Research is needed to understand how these factors and experiences can be leveraged or mitigated to improve resident leadership training outcomes.

No size fits all - a qualitative study of factors that enable adaptive capacity in diverse hospital teams.

Resilient healthcare research studies how healthcare systems and stakeholders adapt and cope with challenges and changes to enable high quality care. By examining how performance emerges in everyday work in different healthcare settings, the research seeks to receive knowledge of the enablers for adaptive capacity. Hospitals are defined as complex organizations with a large number of actors collaborating on increasingly complexity tasks. Consequently, most of today's work in hospitals is team based. The study aims to explore and describe what kind of team factors enable adaptive capacity in hospital teams. The article reports from a multiple embedded case study in two Norwegian hospitals. A case was defined as one hospital containing four different types of teams in a hospital setting. Data collection used triangulation of observation (115 h) and interviews (30), followed by a combined deductive and inductive analysis of the material. The study identified four main themes of team related factors for enabling adaptive capacity; (1) technology and tools, (2) roles, procedures, and organization of work, (3) competence, experience, knowledge, and learning, (4) team culture and relations. Investigating adaptive capacity in four different types of teams allowed for consideration of a range of team types within healthcare and how the team factors vary within and across these teams. All of the four identified team factors are of importance in enabling adaptive capacity, the various attributes of the respective team types prompt differences in the significance of the different factors and indicates that different types of teams could need diverse types of training, structural and relational emphasis in team composition, leadership, and non-technical skills in order to optimize everyday functionality and adaptive capacity.

The Emerging Leaders in Public Health Initiative: Leadership Development to Advance Public Health Practice.

Effective leadership is essential for governmental public health agencies to promote and protect the health of their communities. The Emerging Leaders in Public Health Initiative, a program of The Kresge Foundation, was implemented to strengthen leadership in governmental public health. We seek to examine lessons from the initiative to contribute to the field a better understanding of leadership development practices. An external evaluator conducted a retrospective analysis of participant responses postinitiative to assess the overall impact of the initiative and explore which components were most valuable. United States. Directors and other staff from governmental public health agencies were recruited in 2-person teams to participate in 3 successive cohorts. Drawn from adaptive leadership principles, a framework was developed to guide the selection and implementation of educational and experiential activities. Participants were challenged to develop a new role for their public health agency, which provided a learning laboratory to practice individual and team leadership skills. The Kresge Foundation provided participants with a resource grant and a National Program Office offered convenings, webinars, coaching, and technical assistance over the 18 months of the developmental experience. Satisfaction, perceived value of components, and future intentions were assessed from participants in cohorts II and III (n = 70). The overall response rate was 93%. One hundred four diverse leaders from 52 agencies, representing 30 states participated in the initiative. Participants were extremely satisfied with the program (94%) and indicated a strong likelihood of recommending it to a colleague (96%). Unrestricted grant funding, peer learning, and in-person learning sessions were the program components rated most highly valuable. This initiative offers insights into principles and processes to be considered for future public health leadership development.

Succeeding in a Virtual World – Best Practices for Teaching Teamwork Skills

Effective teamwork has grown to be one of the most important aspects of any organization to enhance its performance and success in today’s highly competitive global business environment. As a result, business programs are including teamwork as part of their curricula; and higher business education accrediting agencies have identified teamwork as one of key student learning outcomes. This paper identifies strategies for incorporating teamwork as part of developing effective teamwork pedagogy in online graduate business courses. Building on the work by Tuckman (1965) and Matthews and McLees (2015), this paper discusses a pedagogical approach to teamwork that is organized around the four steps of successful group process, namely forming, storming, norming, and performing, and how to develop team leadership skills for each of these in a virtual learning environment. Empirical data from a case study provides statistical evidence that supports our recommendations

Low-Cost "Telesimulation" Training Improves Real Patient Pediatric Shock Outcomes in India.

IntroductionPediatric shock, especially septic shock, is a significant healthcare burden in low-income countries. Early recognition and management of shock in children improves patient outcome. Simulation-based education (SBE) for shock recognition and prompt management prepares interdisciplinary pediatric emergency teams in crisis management. COVID-19 pandemic restrictions on in-person simulation led us to the development of telesimulation for shock. We hypothesized that telesimulation training would improve pediatric shock recognition, process of care, and patient outcomes in both simulated and real patient settings.Materials and MethodsWe conducted a prospective quasi-experimental interrupted time series cohort study over 9 months. We conducted 40 telesimulation sessions for 76 participants in teams of 3 or 4, utilizing the video telecommunication platform (Zoom©). Trained observers recorded time-critical interventions on real patients for the pediatric emergency teams composed of residents, fellows, and nurses. Data were collected on 332 pediatric patients in shock (72% of whom were in septic shock) before, during, and after the intervention. The data included the first hour time-critical intervention checklist, patient hemodynamic status at the end of the first hour, time for the resolution of shock, and team leadership skills in the emergency room.ResultsThere was a significant improvement in the percent completion of tasks by the pediatric emergency team in simulated scenarios (69% in scenario 1 vs. 93% in scenario 2; p < 0.001). In real patients, completion of tasks as per time-critical steps reached 100% during and after intervention compared to the pre-intervention phase (87.5%), p < 0.05. There was a significant improvement in the first hour hemodynamic parameters of shock patients: pre (71%), during (79%), and post (87%) intervention (p < 0.007 pre vs. post). Shock reversal time reduced from 24 h pre-intervention to 6 h intervention and to 4.5 h post intervention (p < 0.002). There was also a significant improvement in leadership performance assessed by modified Concise Assessment of Leader Management (CALM) instrument during the simulated (p < 0.001) and real patient care in post intervention (p < 0.05).ConclusionTelesimulation training is feasible and improved the process of care, time-critical interventions, leadership in both simulated and real patients and resolution of shock in real patients. To the best of our knowledge, this is one of the first studies where telesimulation has shown improvement in real patient outcomes.

Elements of Teamwork in Resuscitation: An Integrative Review.

Objective:To identify the elements of teamwork in resuscitation, an integrative review and synthesize current primary studies conducted. Methods:PubMed, Scopus, Web of Science, and Embase, as well as Google Scholar search engine were searched from November 2015 to March 2020 to review previously published peer‐reviewed studies. Out of the 5495 articles, 16 were finally included in the study. Search strategy implemented with these keywords (in the title/abstract) were (team* AND CPR) or (team* AND resuscitation). Six descriptive criteria was performed by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to analyze the articles and a modified version of Cooper’s five‐stage method.Results:Sixteen studies were included in this research. Twenty elements related to teamwork in resuscitation were identified by using data synthesis, then classified into four categories includes team interaction elements, leadership skills, individual elements and environmental elements. Communication, leadership, situation awareness and scene organization had the highest frequency of reviewed articles 10, 5, 4, 4, respectively. Conclusion:The interactions between resuscitation team members and the skills of the leader and team members along with environmental elements had attracted the most attention of researchers by focusing on teamwork in resuscitation. Due to the limited number of articles related to this subject, more research is needed to reveal all the key elements of teamwork in resuscitation.

STUDENTS’ APPLICATION OF TEAM LEADERSHIP SKILLS IN AN UNDERGRADUATE AGRICULTURAL LEADERSHIP COURSE WHEN LEARNING EXPERIENTIALLY

Undergraduate agricultural leadership education opportunities are prevalent and growing. However, additional attention should be placed on the quality of educational leadership experiences. The purpose of this study was to explore how the context of a learning experience impacts student application of team leadership skills. The findings and implications of this study are reported in three themes: (a) contextual dimensions of educational experiences, (b) agricultural disconnect, and (c) team leadership skill application. Recommendations for practitioners include providing students with real-life leadership skill application experiences, regulating assignments to have agricultural connections, and integrating opportunities for student reflection. Future research should consider questions such as: (a) what other educational leadership experiences may have considerable learning impacts? and (b) what other pedagogical methodologies are useful in teaching agricultural and team leadership education?

Team based learning in pathology: Lessons learned from a pilot study

Background: Team based learning (TBL) is an approach where students are organised in groups where they learn from each other. TBL is a student centric approach, which ensures active participation of each member and also promotes teamwork and learning ability. Looking at the teacher centric approach of the conventional teaching learning methods in medical education, where the students are mere passive learners and the sessions can be monotonous, TBL seems to be extremely relevant today as a more student centric teaching learning method. Aim of this study was to compare TBL with conventional teaching learning method (CTL). Methods: This randomised crossover study was conducted in the Department of Pathology, SMS Medical College, on 224 third semester medical students, wherein they were exposed to TBL session and their learning outcome and perception was compared to CTL. The data was analysed using Primer version 6 software. Results: In this study, there was a statistically significant improvement (p &lt; 0.001) in the score of students after exposure to TBL. Also, there was a significant difference in the learning outcome of students of TBL (mean assessment score 7.21) as compared to CTL (mean assessment score 6.09). The student perception trends revealed a positive tilt towards TBL, wherein 70.98 % students agreed that TBL was a better learning strategy as compared to lectures. Conclusion: This pilot study concluded that TBL can be used as a supplement to the conventional lectures for improving the learning as well as team work and leadership skills of students.

Telehealth Training During the COVID-19 Pandemic: A Feasibility Study of Large Group Multiplatform Telesimulation Training.

Background:Video telehealth is an important tool for health care delivery during the COVID-19 pandemic. Given physical distancing recommendations, access to traditional in-person telehealth training for providers has been limited. Telesimulation is an alternative to in-person telehealth training. Telesimulation training with both remote participants and facilitators using telehealth software has not been described.Objective:We investigated the feasibility of a large group telesimulation provider training of telehealth software for remote team leadership skills with common neonatal cases and procedures.Methods:We conducted a 90-min telesimulation session with a combination of InTouch™ provider access software and Zoom™ teleconferencing software. Zoom facilitators activated InTouch software and devices and shared their screen with remote participants. Participants rotated through skill stations and case scenarios through Zoom and directed bedside facilitators to perform simulated tasks using the shared screen and audio connection. Participants engaged in a debrief and a pre- and postsurvey assessing participants' comfort and readiness to use telemedicine. Data were analyzed using descriptive statistics and paired t tests.Results:Twenty (n = 20) participants, five Zoom and eight bedside facilitators participated. Twenty-one (21) pre- and 16 postsurveys were completed. Most participants were attending neonatologists who rarely used telemedicine software. Postsession, participants reported increased comfort with some advanced InTouch features, including taking and sharing pictures with the patient (p < 0.01) and drawing on the shared image (p < 0.05), but less comfort with troubleshooting technical issues, including audio and stethoscope (p < 0.01). Frequently stated concerns were troubleshooting technical issues during a call (75%, n = 16) and personal discomfort with telemedicine applications and technology (56%, n = 16).Conclusion:Large group telesimulation is a feasible way to offer telehealth training for physicians and can increase provider comfort with telehealth software.

Development of an Observation-Based Rating Tool to Assess Trauma Team Leadership Skills

Development of an Observation-Based Rating Tool to Assess Trauma Team Leadership Skills

Effect of simulation training on nurse leadership in a shared leadership model for cardiopulmonary resuscitation in the emergency department.

Empowering a senior nurse in a shared leadership role has been proposed as a more efficient set up for the cardiac arrest team in ED. In this model, a senior nurse leads the cardiac arrest algorithm which allows cognitive off-loading of the lead emergency physician. The emergency physician is then more available to perform tasks such as echocardiography and exclude reversible causes. Simulation provides an opportunity for training and practice of this shared leadership model. We hypothesised that a structured simulation training programme that focused on implementing a nurse and doctor shared leadership model for cardiopulmonary resuscitation (CPR), would improve leadership and teamwork quality in the setting of cardiac arrest as measured by a Trauma Non-technical Skills (T-NOTECHS) teamwork scale. Fifteen senior ED nurses participated in this pre-interventional post-observational study. Training consisted of a didactic course on team leadership and crisis resource management (CRM) followed by 4 × 10-min resuscitation scenarios with a structured debrief focusing on team leadership skills and CRM. The primary outcome was measured on scenarios 1 and 4 using a modified T-NOTECHS teamwork scale. A statistically significant increase in the T-NOTECHS scale was detected for the measures of leadership (P = 0.0028), CRM (P = 0.0001), adherence to New Zealand Resuscitation Council ALS algorithm (P = 0.0088) and situational awareness (P = 0.0002). The present study shows that a short simulation training programme improved nurse leadership and teamwork performance in the setting of a shared leadership model for CPR in the ED which could easily be replicated in other departments.

Building R&amp;D Team Leaders: Evidence from Change in Conscription Law

Over the years, teamwork innovations have increased in frequency, importance, and complexity. While supporting the development of innovations, the integration of a large number of specialized competences has produced coordination frictions among team members, which has increased the demand for team leaders. This study investigates the origins of team leadership skills in innovation by studying whether leadership-enhancing programs add to innate abilities. We combine inventor-level data with a policy change in the US that abandoned the compulsory draft in 1972 and find that, with the elimination of conscription, the probability of male inventors assuming managerial responsibilities reduces, whereas, at the same time, the probability of women inventors take up leadership positions increases. In addition, and consistent with the type of policy change, we observe less autocratic leadership styles and less hierarchical, more creative, inventive projects. We discuss the implications of our results for the management of innovative projects.

Experiential Learning Platforms that Advance Students to their Careers

&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; The graduate school experience is an expensive proposition in terms of finances, time, and commitment to study.&nbsp; Students make the investment to enhance their career opportunities, to engage in life-long learning, and to build professional networks.&nbsp; The Commission on Accreditation of Health Management Education advises graduate programs to adopt a competency model that serves as the basis of curriculum, course content, learning objectives, and teaching and assessment methods.&nbsp; One such competency model is the National Center for Healthcare Leadership with its original 26 competencies in the domains of transformation, execution, and people. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The authors found the case competition experience advanced student learning the most and provided the opportunity for the student to enhance their skills in 15-competency areas.&nbsp; The case competition experience enhanced the confidence, professionalism, and team leadership skills that prospective employers found attractive for recruitment. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Academic institutions invest resources in providing students with experiential learning activities through guest lectures, site visits, internships, and a host of other events to introduce the student to employment and networking opportunities.&nbsp; In examining the host of activities to which students participate, the authors find the case competition experience the one that provides the best and intensive introduction to competencies.

109. IF YOU CALL IT, WILL THEY COME?: USING QUALITY IMPROVEMENT METHODOLOGY TO IMPROVE RESIDENT CODE TEAM LEADERSHIP SKILLS

Background Management of an acutely ill or decompensating child is pivotal to a pediatric resident's training. Pediatric physicians should be prepared to recognize and respond to pediatric emergencies. Starting in 2014, senior residents in our program were designated as the code team leader on even days. Subsequent data demonstrate that residents rarely led codes on even days. We therefore developed a quality improvement initiative to improve resident code team leadership skills. Aim Statement Our primary aim was to increase the percent of even day codes led by a resident to 50% by May 2018. Interventions A needs assessment survey was conducted to identify barriers to resident code team leadership. A fishbone diagram developed to categorize barriers to target. Plan Do Study Act cycles were conducted to implement and test various interventions including a simulation-based workshop on code team leadership, data sharing about code events, and just-in-time resources addressing common questions. Measures Outcome measures included the percentage of even day codes led by resident. Process measures included resident self-confidence in their code team leaders. Balancing Measures included the percent of even day codes with subsequent negative events. Results Baseline data demonstrated no even day codes led by residents. Special cause variation was seen following interventions of simulation-based education and just-in-time training with 40% of codes led by senior residents. Improvements were sustained throughout the academic year. Conclusions and Next Steps Using quality improvement methodology we were able to successfully increase the number of codes led by senior residents without increased negative outcomes. Future interventions will aim at sustaining improvement into a new academic year.