Medical Team Training Research Articles

TEAMs go VR—validating the TEAM in a virtual reality (VR) medical team training

BackgroundInadequate collaboration in healthcare can lead to medical errors, highlighting the importance of interdisciplinary teamwork training. Virtual reality (VR) simulation-based training presents a promising, cost-effective approach. This study evaluates the effectiveness of the Team Emergency Assessment Measure (TEAM) for assessing healthcare student teams in VR environments to improve training methodologies.MethodsForty-two medical and nursing students participated in a VR-based neurological emergency scenario as part of an interprofessional team training program. Their performances were assessed using a modified TEAM tool by two trained coders. Reliability, internal consistency, and concurrent validity of the tool were evaluated using intraclass correlation coefficients (ICC) and Cronbach’s alpha.ResultsRater agreement on TEAM’s leadership, teamwork, and task management domains was high, with ICC values between 0.75 and 0.90. Leadership demonstrated strong internal consistency (Cronbach’s alpha = 0.90), while teamwork and task management showed moderate to acceptable consistency (alpha = 0.78 and 0.72, respectively). Overall, the TEAM tool exhibited high internal consistency (alpha = 0.89) and strong concurrent validity with significant correlations to global performance ratings.ConclusionThe TEAM tool proved to be a reliable and valid instrument for evaluating team dynamics in VR-based training scenarios. This study highlights VR’s potential in enhancing medical education, especially in remote or distanced learning contexts. It demonstrates a dependable approach for team performance assessment, adding value to VR-based medical training. These findings pave the way for more effective, accessible interdisciplinary team assessments, contributing significantly to the advancement of medical education.

Addressing Differences in Knowledge and Experience in Trauma Care Capabilities Among an International Team of Military Medical Care Providers in a Deployed Setting.

Military medical personnel are crucial in providing life-saving care at the point of injury (POI) in challenging environments such as combat zones and disaster areas. This article examines the specialized training US Military medical personnel undergo before deployment and the increasing trend of deploying as part of multinational forces in operations like those in Afghanistan with NATO and non-NATO countries. Integrating medical teams from diverse backgrounds poses significant challenges in maintaining a cohesive and efficient team due to varying trauma management training standards and medical practices among the allied forces. Tactical Combat Casualty Care (TCCC) training and the development of clinical practice guidelines (CPG) by the US Joint Trauma Service have been key strategies by the US Military to standardize care. However, the variation in trauma management training among NATO allies and the differences in medical subspecialties and approaches can lead to inefficiencies and reduced effectiveness in a multinational trauma center setting. For instance, the approach to trauma care can significantly differ between the US and European countries, impacting the interoperability and teamwork in multinational medical teams. To address these challenges, the article highlights the importance of standardized medical training programs that include cultural awareness to enhance the effectiveness of multidisciplinary, multinational medical teams. It also underscores the necessity for standardized international trauma training in the face of increasing global conflicts and the potential for large-scale combat operations. The article discusses the "Trauma Tuesday" program implemented in Kabul, Afghanistan, as an example of how intensive training and simulation exercises can improve team dynamics, knowledge, and skills in trauma management among a diverse team from various nations. The need for ongoing education and developing a standard for managing trauma patients in international teams is emphasized to ensure effective communication and coordination. The article suggests that multinational trauma training can significantly improve team cohesion and critical life-saving skills, essential for future battlefields where access to definitive care may be delayed. Further research is recommended to explore the best methods for achieving effective multinational medical team integration and training standardization.

Cross-border simulation training for German and Polish emergency medical teams is feasible: conception and evaluation of a bilingual simulation training

BackgroundCross-border cooperation of emergency medical services, institutions and hospitals helps to reduce negative impact of national borders and consecutive discrimination of persons living and working in border regions. This study aims to explore the feasibility and effectiveness of a cross-border bilingual simulation training for emergency medical services within an INTERREG-VA-funded project.MethodsFive days of simulation training for German and Polish paramedics in mixed groups were planned. Effectiveness of training and main learning objectives were evaluated as pre-post-comparisons and self-assessment by participants.ResultsDue to COVID-19 pandemic, only three of nine training modules with n = 16 participants could be realised. Cross-border-simulation training was ranked more positively and was perceived as more useful after the training compared to pretraining. Primary survey has been performed using ABCDE scheme in 18 of 21 scenarios, whereas schemes to obtain medical history have been applied incompletely. However, participants stated to be able to communicate with patients and relatives in 10 of 21 scenarios.ConclusionThis study demonstrates feasibility of a bilingual cross-border simulation training for German and Polish rescue teams. Further research is highly needed to evaluate communication processes and intra-team interaction during bilingual simulation training and in cross-border emergency medical services rescue operations.

Medical Evacuation of Seriously Injured in Emergency Situations: Experience of EMERCOM of Russia and Directions of Development

Introduction:The steady increase in the number of natural and man-made disasters causes the need for urgent ambulance aircraft evacuation of seriously injured to the specialized federal medical institutions with appropriate equipment, advanced technologies and highly qualified personnel to provide specialized high-tech assistance to victims. The medical institutions can be located at a considerable distance from the place of emergency.Method:EMERCOM of Russia, staffed by highly qualified medical personnel, equipped with resuscitating medical modules in airplanes and helicopters (MMA and MMH), has been successfully carrying out medical evacuation of seriously injured in emergency situations to specialized medical institutions for many years (since 2008).Results:Based on the results of the use of the medical modules, it was proved that their use in mass ambulance aircraft evacuation is fully justified. During the flights, sparing transportation of the injured is provided, complete monitoring and compliance with the continuity of the treatment process. With the use of MMA and MMH, the quality of mass ambulance aircraft evacuation of seriously injured has significantly improved and the delivery time from the lesion to specialized hospitals has been reduced, as well as the lethality of victims.The analysis of the effectiveness of the use of medical modules showed that the use of modules during the ambulance aircraft evacuation of seriously injured reduces mortality at the pre-hospital stage by 3.3 times, at the hospital stage–by two times (p<0.05).Conclusion:EMERCOM of Russia introduced into the practice of aviation medical evacuation the medical technology using extracorporeal membrane oxygenation (ECMO) for the rescue of seriously injured.On the basis of NRCERM, a simulation center has been founded and equipped for the training of aviation medical teams, a training program has been developed for the medical personnel of EMERCOM of Russia participating in ambulance aircraft evacuation of victims in emergency situations.

Tailoring a national emergency medical team training package for Pacific island countries and areas.

Tailoring a national emergency medical team training package for Pacific island countries and areas.

Impacts of COVID-19 Pandemic on Dermatology Outpatient Department at a Tertiary Hospital in Eastern China: A Pre-Post Study.

The COVID-19 pandemic has considerable impact on health care system in the world directly. Although the pandemic has been effectively controlled, people's lifestyle, stress of job, economic status and health conditions have all changed. Therefore, it is unclear whether the COVID-19 pandemic has affected the distribution of diseases in dermatology outpatient department, especially in the post-pandemic era and how we should respond to these changes. We aimed to assess the impact of the COVID-19 pandemic on diagnosis of dermatology outpatient department in eastern China. A pre-post study design was a retrospective study to assess the changes of diseases diagnoses from the outpatient department of Dermatology, Taicang first people's hospital, Suzhou University, Suzhou, China in the 2021 (Post-COVID-19 pandemic) compared to the 2019 (Pre-COVID-19 pandemic). Statistical analysis was performed using the SPSS 23.0 and Excel 2010. The data were analysed by methods independent t-test and Pearson's chi-square test. A two-sided p-value of <0.05 was considered statistically significant. A total of 67,994 patients in 2019 and 67,288 patients in 2021 were included in the study.During the pre-pandemic year, the most common diagnoses in the outpatient department were urticaria, fungal dermatitis, acne, herpeszoster, seborrheic dermatitis. Urticaria, acne, allergic dermatitis, fungal dermatitis, herpeszoster, were statistically more common in the post-pandemic period. Acne, animal-related diseases, allergic dermatitis, insect dermatitis, alopecia, and verruca vulgaris diagnoses were found to increase statistically during the post-pandemic period when compared with the pre-pandemic period. The COVID-19 pandemic had a minimal effect on the average yearly dermatology outpatients department visits, but the distribution of dermatology diagnoses was affected. As a result, governments and health departments may introduce innovative ways and training of medical teams according to the impact of the pandemic to ensure normal medical care.

Tailoring and Implementing an Emergency Medical Team (EMT) Training Package for Pacific Island Countries and Areas (PICs)

Background/Introduction:Pacific Island Countries and Areas (PICs) represent some of the most remote and logistically challenging locations – with thousands of islands covering vast ocean territory. Since 2017, Pacific Ministries of Health have been developing EMTs, and all have worked to train team members to be deployment-ready.1Objectives:To describe an EMT training package specifically tailored to PIC contexts, including curated content, practical exercises, and “talanoa” discussions to improve EMT readiness, with a focus on logistics in remote and austere PIC contexts.Method/Description:WHO leveraged EMT training materials developed globally and regionally to continuously tailor an in-person EMT training package, emphasizing readiness for the deployment of light, mobile clinical teams for disaster-prone small island/large ocean countries. Emphasis was placed on practical learning exercises focusing on skills and competencies needed to manage complex Pacific deployments, and to care for populations on remote, difficult-to-reach islands with limited resources and referral options.Results/Outcomes:The Pacific EMT training program includes a mix of didactic and practical sessions coupled with a full-scale simulation exercise; it was designed with and for Pacific EMTs. The effectiveness of the training package has been evidenced through many successful national EMT deployments in several PICs, as well as through consistently positive participant feedback.Conclusion:Tailoring training materials to specific country contexts is essential. In the Pacific, core EMT training content with an emphasis on practical activities and simulations and “talanoa” discussions reflecting on previous deployments in remote islands has been viewed by participants as critical to preparing them for real-world deployments.

Santé mentale et Santé bucco-dentaire : de l’intérêt de faire tomber le masque

The mouth is at the heart of our daily life. However, oral health is often overlooked, especially in people with mental illness. The objectives of this review were to identify the factors that can increase their vulnerability toward oral diseases, to describe the consequences in terms of health and quality of life, and to explore solutions for preventing and managing oral diseases in this population. Why are patients with mental illnesses more at risk of poor oral health?The mental illnesses themselves, which can alter one's self-image and perception of the body, may decrease motor skills or disorganize daily life, contribute to a decrease in the practice of daily oral hygiene or in seeking healthcare services. The presence of vomit or gastroesophageal reflux stimulates the demineralization of dental surfaces. Addictive substances, the consumption of which is frequent in this population, particularly tobacco, have a direct impact on the oral mucosa and contribute to poor oral health as well as to a reduction of the effects of pharmacological treatments used to treat psychiatric pathologies. By stimulating the appetite, they promote snacking. By inhibiting the production of saliva, they prevent it from playing its role as a natural oral lubricant. It has a negative effect on self-cleaning dental surfaces, the neutralization of oral acidity and defensive power but also on food pre-digestion, chewing, swallowing and speaking. Finally, by inducing abnormal movements of the lips, tongue or jaw, problems of lip incompetence, breathing through the mouth or bruxism may develop. Difficulties in accessing oral care can also contribute to patients’ poor oral health. They may be related to mental pathology: the failure to keep appointments, refusal of care, anxiety, to the lack of information and understanding of their rights for health insurance and transportation to a dental office. They can also be linked to a stigmatizing or critical attitude or a rush to provide care from some dentists that can discourage the patient from continuing his/her oral follow-up. What are the consequences?Xerostomia has several consequences: difficulty in chewing, swallowing, speaking, wearing removable dentures and altered taste, bad breath, cracked lips, and burning mouth. The patient will then modify his/her diet and increase their consumption of soft drinks and soft foods, which adhere more to dental surfaces. Patients have an increased risk of carious lesions, erosion of the teeth, and periodontal lesions accentuated by smoking. People with substance addiction are roughly three times more likely to have periodontal pockets than control groups. People with eating disorders are five times more likely to have dental erosion, responsible for sensitive teeth than control groups due to vomiting or gastroesophageal reflux. Finally, the problem of dental caries is more severe in people suffering from mental illness: People with schizophrenia seem to be the most affected with 7.7 more tooth decay, missing and filled teeth on average than do control participants. Oral afflictions are responsible for acute and chronic pain and infection. Patients with severe mental illness are 2.8 times more likely to lose all their teeth than those in control groups. Edentulism has many repercussions for the patient's health and quality of life, (eating disorders, speech impediments, and deformed smiles, all of which can lead to low self-esteem and social isolation). What are the solutions?A set of measures can be proposed against xerostomia: frequent intake of unsweetened, non-acidic drinks, chewing sugar-free chewing gum with xylitol, salivary substitutes or salivary stimulants. Support measures to encourage patients to quit smoking, when possible and compatible with the patient's clinical condition, should be offered during psychiatric follow-up. Patients could be encouraged, as soon as their mental pathology has stabilized, to select a dentist and to consult him/her at least once a year for dental care and preventative measures and to become accustomed to receiving dental care. The continuum between psychiatric care and oral care is important, as is the training of medical teams. The number of dental treatments and/or the mental pathology of some patients can cause them to be uncooperative and may necessitate the use of a general anaesthesia during oral care, but this procedure has many limitations. For long-term health improvement and to avoid the accumulation of comorbidities, therapeutic patient education seems to be an appropriate complementary approach. Integrating oral health with psychiatric care would make it possible to encourage patients to develop habits of healthy eating and good oral hygiene, to seek dental care, and to acquire improved social behaviours.

Evaluation of an immersive simulation programme for mental health clinicians to address aggression, violence, and clinical deterioration.

This study investigated the effectiveness of high-fidelity immersive simulation education to support inter-professional hospital clinical staff in recognizing and responding to aggression, violence, and clinical deterioration of patients admitted with mental health issues. Increased incidents of aggression and violence have been reported in many clinical hospital settings, especially in mental health wards. Patients experiencing severe psychological distress/agitation can result in the escalation of physiological symptoms such as chest pain, difficulty breathing, traumatic injury, etc. Mental health staff do receive aggression prevention training and medical emergency team training. However, there is added complexity when dealing with a mental health patient who is exhibiting aggressive, violent behaviour while also experiencing a medical or psychological emergency. Therefore, mental health staff needed a combined training programme that enhanced their delivery of recovery focussed care, de-escalation, and medical emergency crisis resource management skills. This study used a prospective quasi experimental research design with repeated measures. Hospital clinical staff were immersed in two mental health emergency response and clinical deterioration scenarios and debriefing sessions. Self-efficacy was evaluated using a 10-item validated tool which addressed non-technical skills of Leadership, Management, Communication, and Teamwork. The sample consisted of 122 clinical staff, with the majority from mental health wards (52%; n = 63) who were nurses (68%; n = 83). Mean self-efficacy scores increased significantly across the three time points (F = 11.555; df = 2; P = 0.000). Post hoc pairwise comparisons showed that self-efficacy scores increased between pretest (mean 62.9; n = 122) and posttest 1 (mean 83.2; n = 122) and follow up, 3 months later (posttest 2; mean 81.9; n = 24). Between pre- and posttest 1, significant improvements in self-efficacy were observed for both the Leadership/Management domain (t = 8.2; df 119; P < 0.000; 95% CI 13.3-21.7) and the Communication/Teamwork domain (t = 8.0; df 119; P < 0.000; 95% CI 11.1-18.4). Immersive simulation with high fidelity education was found to be effective in improving hospital nursing and medical staffs' confidence, when responding to incidents of aggression/violence and clinical deterioration of a mental health patient.

In-hospital emergency care in the Federal Republic of Germany. Asite survey of hospitals in the German Resuscitation Registry

In contrast to prehospital care there is alack of specifications for the organization and equipment of medical emergency teams for in-hospital emergency care. Evaluation of the organization, team composition, training, equipment and tasks of medical emergency teams in the Federal Republic of Germany. Evaluation of aweb-based survey of all hospitals participating in the German Resuscitation Register between February and March2020. The participants were asked about team composition; emergency equipment; type, content and scope of special training or further training as well as other additional tasks in the everyday clinical routine when participating in the medical emergency team. Hospitals with ≤ or >600beds were compared. Atotal of21 (>600beds: 10, 48%; ≤600beds: 11, 52%) hospitals participated in the survey. Team composition requirements were present at 76% (n = 16; ≤600beds: 8, 72% vs. >600beds: 8, 80%), training requirements for medical emergency teams at 38% (n = 16; ≤600beds: 4, 36% vs. >600beds: 4, 40%) of hospitals, with afocus on cardiac life support (n = 6, 28%; ≤600beds: 3, 27% vs. >600beds: 3, 30%) and airway management (n = 4, 19%; ≤600beds: 3, 27% vs. >600beds: 1, 10%). A12-lead electrocardiogram (n = 7, 33%; ≤600beds: 1, 9% vs. >600beds: 6, 60%; p = 0.02), video laryngoscope (n = 7, 33%; ≤600beds: 2, 18% vs. >600beds: 5, 50%), ventilator without (n = 7, 33%; ≤600beds: 2, 18% vs. >600beds: 5, 50%) or with the possibility of non-invasive ventilation was part of the standard equipment in n = 4, 19% (≤600beds: 1, 9% vs. >600beds: 3, 30%). A total of 85% (n = 18; ≤600beds: 10, 100% vs. >600beds 8, 72%), had additional tasks in the daily clinical routine. While clinics with >600beds staffed medical emergency teams 100% of the time from the intensive care units, in clinics ≤600beds medical emergency teams were deployed significantly more often in the emergency department (n = 5, 45%) and in the normal wards (n = 5, 45%, p = 0.03). Training and equipment of medical emergency teams in the Federal Republic of Germany is heterogeneous. They should at least meet the standards commonly used in prehospital emergency medicine and include the availability of aportable 12-lead electrocardiogram, a ventilator with the possibility of noninvasive ventilation and a video laryngoscope. Regardless of the size of the hospital, continuous availability of all members of the medical emergency teams should be ensured.

A management model for admission and treatment of pediatric trauma cases

BackgroundPediatric trauma, particularly major trauma cases, are often treated in less than optimal facilities by providers who lack training and experience in treating severely injured children. We aimed to develop a management model for admission and treatment of pediatric trauma using the Theory of Constraints (TOC).MethodsWe conducted interviews with 17 highly experienced policy makers, senior nursing managers and medical managers in pediatrics and trauma. The interviews were analyzed by qualitative methods. The TOC was utilized to identify undesirable effects (UDEs) and core challenges, and to design a focused current reality tree (CRT). Subsequently, a management model for optimal admission and treatment of pediatric trauma was constructed.ResultsThe CRT was illustrated according to 4 identified UDEs focusing on lack of: (1) clear definitions of case manager in pediatric trauma; (2) uniform criteria regarding the appropriate site for admitting pediatric trauma, (3) standard guidelines and protocols for treatment of trauma cases and for training of trauma medical teams; and (4) standard guidelines for evacuating pediatric trauma patients. The management model for treatment and admission of pediatric trauma is based on 3 major elements: human resources, hospital policy concerning the appropriate emergency department (ED) for pediatric trauma patients and clear definitions regarding children and trauma levels. Each of the elements contains components that should be clearly defined in order for a medical center to be designated for admitting and treating pediatric trauma patients.ConclusionsOur analysis suggests that the optimal ED for pediatric trauma cases is one with available operating rooms, intensive care beds, an imaging unit, laboratories and equipment suitable for treating children as well as with staff trained to treat children with trauma. To achieve optimal outcomes, medical centers in Israel should be classified according to their trauma treatment capabilities and their ability to treat varied severities of pediatric trauma cases.

Medical emergency team training: needs assessment, feedback and learning objectives.

There are no published studies assessing learning needs and attitudes prior to attending a medical emergency team (MET) education programme. To conduct a learning needs assessment of MET education programme participants to assess what technical and non-technical skills should be incorporated. All participants in a MET education programme over a 12-month period were invited to complete a self-administered electronic survey. Participants were ICU team members (intensive care registrars and nurses) and medical registrars. Responses were captured through a 5-point Likert scale. There were 62 responses out of 112 participants (55% response rate). Most participants either agreed or strongly agreed that MET training was valuable (59 respondents) and should be multidisciplinary (61 respondents). ICU team members were more likely to select 'Management of End-of-Life Care' (72% compared with only 16% of medical registrars, P < 0.05) as an important learning objective. Non-technical skills such as 'Task Management' (67% compared with 37%, P < 0.05) and 'Team Communication' (79% compared with 32%, P < 0.05) were also more likely to be selected by ICU team members. Nursing team members were more likely to select 'Approach to Common MET Calls' (100% compared with 50% of medical team members, P < 0.05). MET education programme participants overwhelmingly feel that training should be multidisciplinary. However, there are disparities between the perceived learning needs of medical and nursing personnel, and between intensive care team members and medical registrars, which may impact on the design and implementation of a multidisciplinary education programme.

Crew Resource Management Training for Surgical Teams, A Fragmented Landscape

Medical Crew Resource Management (CRM) training courses are designed to increase patient safety by reducing the effects of human errors. These training courses are most popular in surgery and a wide range of medical CRM training courses for surgical teams is now available. However, the effects of these CRM training courses on patient outcomes are inconclusive. Although surgical teams feel the need to be trained in team collaboration skills, they are often puzzled about what criteria to apply when choosing a medical CRM training course. This study aimed to compare CRM training courses on didactic components and simulation-exercises to explore if these courses are interchangeable. In this qualitative study, semi-structured interviews were conducted among 10 main CRM training providers of surgical teams in the Netherlands. Although a large variety was found in the content of CRM training courses, the most substantial differences were found in the simulation-exercises. Nine out of 10 trainers stated that standard simulation-exercises would be a step forward to ensure quality in CRM trainings. According to the trainers, the implementation of medical CRM can reduce human errors and as a result, preventable patient complications. They suggested a quality standard for CRM trainers in the medical field to ensure the quality of medical team training as a way to reach this. Medical CRM training courses are diverse and noninterchangeable. Trainers expect that if CRM becomes part of surgical training and is embedded in operating theatre culture, it could be of great value for patients and professionals.

Understanding team dynamics to promote team building in a radiotherapy department

AbstractBackground:Teamwork is a central framework in healthcare delivery. Team dynamics can impact the team as a whole and has been identified within the literature as a contributory factor to quality and safety, patient satisfaction, staff satisfaction and overall performance. Within radiation therapy (RT), teamwork is essential in the delivery of high-quality care, yet team building and team development is under-reported.Aim:The focus of this research is to form a better understanding of what plays an impact on teams in a large urban RT cancer centre and how to better engage staff to work together, improve team dynamics and promote team building.Materials and Methods:An electronic search of the literature was conducted to better inform debate and aid in the development of team-building sessions in a busy radiotherapy department. Abstracts were screened and relevant articles selected if they met the search criteria that included relevancy related to team building, contributory factors on team dynamics, team-based learning, team performance and implication of civility.Results:A total of 45 articles were included in the final analysis. The majority were from the disciplines of medicine (45%), business (22%) and nursing (18%). Only 3 of the 45 articles (7%) focused on the profession of RT. Most articles discussed more than 1 theme with team dynamics and team building being the most common themes discussed in 16 articles each (36%). Other common themes included teamwork (31%), respect and civility (20%), leadership and hierarchy (11%), medical errors (11%) and team training (11%). Only 3 of the 45 articles (7%) focused on RT.Conclusion:There is a lack of longitudinal evidence to support the impact of team building sessions to improve team dynamics and promote a positive, cohesive team environment. Specifically within RT, the impact team building has on team dynamics has been under investigation.Highlights:High-quality patient care can be linked to team collaboration and cohesiveness. Changing the culture within a team and engaging in civility and respect in everyday practice has the potential to improve team dynamics, patient safety, staff and patient satisfaction.

Emergencies within hospital wards: An observational study of the non-technical skills of medical emergency teams

BackgroundMedical emergency teams are essential in responding to acute deterioration of patients in hospitals, requiring both clinical and non-technical skills. This study aims to assess the non-technical skills of medical emergency teams during hospital ward emergencies and explore team members perceptions and experiences of the use non-technical skills during medical emergencies. MethodsA multi-methods study was conducted in two phases. During phase one observation and assessment of non-technical skills used in medical emergencies using the Team Emergency Assessment Measure (TEAM™) was conducted; and in the phase two in-depth interviews were undertaken with medical emergency team members. ResultsBased on 20 observations, mean TEAM™ ratings for non-technical skill domains were: ‘leadership’ 5.0 out of 8 (±2.0); ‘teamwork’ 21.6 out of 28 (±3.6); and ‘task management’ 6.5 out of 8 (±1.4). The mean ‘global’ score was 7.5 out of 10 (±1.5). The qualitative findings identified three areas, ‘individual’, ‘team’ and ‘other’ contributing factors, which impacted upon the non-technical skills of medical emergency teams. ConclusionNon-technical skills of hospital medical emergency teams differ, and the impact of the skill mix on resuscitation outcomes was recognised by team members. These findings emphasize the importance non-technical skills in resuscitation training and well-developed processes for medical emergency teams.

Publishing Medical Research in Pakistan; Challenges and the Way Forward

Publishing Medical Research in Pakistan; Challenges and the Way Forward

Experiences and challenges in the health protection of medical teams in the Chinese Ebola treatment center, Liberia: a qualitative study

BackgroundHealth care workers are at the frontline in the fight against infectious disease, and as a result are at a high risk of infection. During the 2014–2015 Ebola outbreak in West Africa, many health care workers contracted Ebola, some fatally. However, no members of the Chinese Anti-Ebola medical team, deployed to provide vital medical care in Liberia were infected. This study aims to understand how this zero infection rate was achieved.MethodsData was collected through 15 in-depth interviews with participants from the People’s Liberation Army of China medical team which operated the Chinese Ebola Treatment Center from October 2014 to January 2015 in Liberia. Data were analysed using systematic framework analysis.ResultsThis study found numerous bio-psycho-socio-behavioural risk factors that directly or indirectly threatened the health of the medical team working in the Chinese Ebola Treatment Center. These factors included social and emotional stress caused by: (1) the disruption of family and social networks; (2) adapting to a different culture; (3) and anxiety over social and political unrest in Liberia. Exposure to Ebola from patients and local co-workers, and the incorrect use of personal protective equipment due to fatigue was another major risk factor. Other risk factors identified were: (1) shortage of supplies; (2) lack of trained health personnel; (3) exposure to contaminated food and water; (4) and long working hours. Comprehensive efforts were taken throughout the mission to mitigate these factors. Every measure was taken to prevent the medical team’s exposure to the Ebola virus, and to provide the medical team with safe, comfortable working and living environments. There were many challenges in maintaining the health safety of the team, such as the limited capability of the emergency command system (the standardized approach to the command, control, and coordination of an emergency response), and the lack of comprehensive international protocols for dealing with emerging infectious disease pandemics.ConclusionsThe comprehensive and multidisciplinary measures employed to protect the health of the medical team proved successful even in Liberia’s resource-limited setting. The global health community can learn valuable lessons from this experience which could improve the safety of health care workers in future emergencies. These lessons include: establishing capable command systems; implementing effective coordination mechanisms; providing adequate equipment; providing training for medical teams; investing in the development of global health professionals; and improving research on ways to protect health care workers.

Development of Virtual Simulations for Medical Team Training: An Evaluation of Key Features

Medical team training (MTT) conducted in a virtual environment fosters growth in cognitive, technical, and clinical aptitudes while offering advantages of flexibility, cost, and ease of scheduling over traditional high- fidelity simulations. Growing technology facilitates innovations to improve the ability to emulate roles, rules, resources, and fidelity. Our objective was to evaluate elements of key features that inform technical specifications for virtual simulations. A narrative review included 27 articles as relevant to elaborate on five key features identified as critical to development of virtual environments for MTT: automated assessment, task fidelity, interface modality, virtual teammates, and adaptability. Designers continue to improve the technology of virtual reality to create better and more enhanced training modules. We must better understand how variances in simulation features impacts performance outcomes and learned behavior. Future research can more deeply examine features beyond the five reviewed here to guide development of effective, cost-efficient virtual simulations for MTT.

Duration to Establish an Emergency Vascular Access and How to Accelerate It: A Simulation-Based Study Performed in Real-Life Neonatal Resuscitation Rooms.

To compare the duration to establish an umbilical venous catheter and an intraosseous access in real hospital delivery rooms and as a secondary aim to assess delaying factors during establishment and to provide recommendations to accelerate vascular access in neonatal resuscitation. Retrospective analysis of audio-video recorded neonatal simulation training. Simulation training events in exact replications of actual delivery/resuscitation rooms of 16 hospitals with different levels of care (Austria and Germany). Equipment was prepared the same way as for real clinical events. Medical teams of four to five persons with birth-related background (midwives, nurses, neonatologists, and anesthesiologists) in a realistic team composition. Audio-video recorded mannequin-based simulated resuscitation of an asphyxiated newborn including the establishment of either umbilical venous catheter or intraosseous access. The duration of access establishment (time from decision to first flush/aspiration), preparation (decision to start of procedure), and the procedure itself (start to first flush/aspiration) was significantly longer for umbilical venous catheter than for intraosseous access (overall duration 199 vs 86 s). Delaying factors for umbilical venous catheter establishment were mainly due to the complex approach itself, the multitude of equipment required, and uncertainties about necessary hygiene standards. Challenges in intraosseous access establishment were handling of the unfamiliar material and absence of an intraosseous access kit in the resuscitation room. There was no significant difference between the required duration for access establishment between large centers and small hospitals, but a trend was observed that duration for umbilical venous catheter was longer in small hospitals than in centers. Duration for intraosseous access was similar in both hospital types. Vascular access establishment in neonatal resuscitation could be accelerated by infrastructural improvements and specific training of medical teams. In simulated in situ neonatal resuscitation, intraosseous access is faster to establish than umbilical venous catheter. Future studies are required to assess efficacy and safety of both approaches in real resuscitation settings.

Transforming Health Care One Team at a Time: Ten Observations and the Trail Ahead

The present review synthesizes existing evidence and theory on the science of health care teams and health care team training. Ten observations are presented that capture the current state of the science, with applications to both researchers and practitioners. The observations are drawn from a variety of salient sources, including meta-analytic evidence, reviews of health care team training, primary investigations, and the authors’ collective expertise in developing and implementing medical team training. These observations provide insight into the team (e.g., psychological safety) and organizational-level (e.g., culture for teamwork) factors that drive effective health care teamwork, as well as advancements and best practices for designing and implementing team training initiatives (e.g., multilevel measurement). We highlight areas where new knowledge has emerged, and offer directions for future research that will continue to improve our understanding of health care teams in the future.