Medical Team Training Research Articles

A Qualification in Medical Education - A Luxury or a Necessity?

As doctors, in all spheres of medical practice, we have a responsibility to contribute to the education and training of other doctors, medical students and non-medical healthcare professionals. This is particularly pertinent in the Royal Naval Medical Service where effective education and training of medical teams is extremely important, particularly when preparing for the operational environment. However, it is not unusual to reach a fairly senior stage of a medical career without ever receiving any formal instruction in methods of teaching. So, it is not surprising that most people can recall being on the receiving end of a bad teaching experience; few doctors have escaped the familiar scenario of being taught by humiliation on a ward round. Accepting that good teaching abilities are not innate, I would suggest that we all have a professional obligation to develop and maintain our skills in the field of medical education. The Royal College of Anaesthetists have formalised this obligation by including the subject of medical education in the curriculum for Specialist Registrar training. There is a wealth of courses, which are easily accessed and which offer a broad introduction to generic teaching methods. In addition, many universities now offer part-time and distance-learning courses that lead to a qualification in education, specific to medical practice. Hopefully, this account has given an overview of the available resources and has provided food for thought for anyone wishing to develop an interest in medical education.

Bridging the communication gap in the operating room with medical team training

Background In the operating room (OR), poor communication among the surgeons, anesthesiologists, and nurses may lead to adverse events that can compromise patient safety. A survey performed at our institution showed low communication ratings from surgeons, anesthesiologists, and OR nursing staff. Our objective was to determine if communication in the operating room could be improved through medical team training (MTT). Methods A dedicated training session (didactic instruction, interactive participation, role-play, training films, and clinical vignettes) was offered to the entire surgical service using crew resource management principles. Attendees also were instructed in the principles of change management. A change team was formed to drive the implementation of the principles reviewed through a preoperative briefing conducted among the surgeon, anesthesiologist, and OR nurse. A validated Likert scale survey with questions specific to effective communication was administered to the nurses, anesthesiologists, and surgeons 2 months after the MTT to determine the impact on communication. Data are presented as mean ± SEM. Results There was a significant increase in the anesthesiologist and surgeon communication composite score after medical team training (anesthesia pre-MTT = 2.0 ± .3, anesthesia post-MTT = 4.5 ± .6, P <.0008; surgeons pre-MTT = 5.2 ± .2, surgeons post-MTT = 6.6±.3, P <.0004; nurses pre-MTT = 4.3 ± .3, nurses post-MTT = 4.2 ± .4, P = .7). Conclusions Medical team training using crew resource management principles can improve communication in the OR, ensuring a safer environment that leads to decreased adverse events.

OP or Not OP: The Medical Challenge at the Chemical Terrorism Scene

Since the 1995 Tokyo subway sarin attack, terrorist attacks involving weapons of mass destruction or other industrial chemicals present worldwide security and health concerns. On-scene medical triage and treatment in such events is crucial to save as many lives as possible and minimize the deleterious effects of the toxic agent involved. Since there are many chemicals that can be used as potential terrorist weapons, the medical challenge for the emergency medical services (EMS) is a combination of: (1) recognizing that a chemical terrorist attack (non-conventional) has occurred; and (2) identifying the toxic agent followed by proper antidotal treatment. The latter must be done as quickly as possible, preferably on-scene. The most valuable decision at this stage should be whether the agent is organophosphate (OP) or not OP, based on clinical findings observed by pre-trained, first responders. This decision is crucial, since only OP intoxication has readily available, rapidly acting, onscene, specific agents such as atropine and one of the oximes, preferably administered using autoinjectors. Due to the lack of a specific antidote, exposure to other agents (such as industrial chemicals, e.g., chlorine, bromide, or ammonia) should be treated on-scene symptomatically with non-specific measures, such as decontamination and supportive treatment. This paper proposes an algorithm as a cognitive framework for the medical teams on-scene. This algorithm should be part of the medical team's training for preparedness for chemical terrorist attacks, and the team should be trained to use it in drills. Implementing this path of thinking should improve the medical outcome of such an event.

Objective measures of situation awareness in a simulated medical environment.

One major limitation in the use of human patient simulators is a lack of objective, validated measures of human performance. Objective measures are necessary if simulators are to be used to evaluate the skills and training of medical practitioners and teams or to evaluate the impact of new processes or equipment design on overall system performance. Situation awareness (SA) refers to a person's perception and understanding of their dynamic environment. This awareness and comprehension is critical in making correct decisions that ultimately lead to correct actions in medical care settings. An objective measure of SA may be more sensitive and diagnostic than traditional performance measures. This paper reviews a theory of SA and discusses the methods required for developing an objective measure of SA within the context of a simulated medical environment. Analysis and interpretation of SA data for both individual and team performance in health care are also presented.

Three years of "CASMS": the world's busiest medical simulation centre.

Medical simulation is a relatively new teaching modality suitable for medical education at all levels, although its long-term benefits have not yet been validated. Simulation allows the participant to practise diagnosis, medical management and behavioural approaches in the care of acutely ill patients in a controlled environment. Simulators have achieved widespread acceptance in the fields of anaesthesia, intensive care and emergency medicine. More recently, team training for pre-hospital and within-hospital multidisciplinary medical response teams has become popular. The increasing number and diversity of courses at "CASMS" parallels the evolution of simulation centres into regional clinical skills centres elsewhere. Such centres are likely to become a cost-effective means of achieving greater consistency in medical skill acquisition and may improve patient outcomes after medical crises.

Prehospital use of minimally invasive direct cardiac massage (MID–CM): a pilot study

Background: Internal cardiac compressions are more efficient than closed chest compressions (CCC) in cardiac arrest (CA). Aim of the study: To evaluate the prehospital feasibility of performing a new method of minimally invasive direct cardiac massage (MID-CM ® TheraCardia Inc.). Methods: Prospective non-randomized open study, after ethical committee approval. Inclusion of 18–85 years old patients in witnessed CA if BLS>5 min and unsuccessful ACLS>20 min after CA. The MID-CM is an atraumatic manual cardiac pumping system deployed in the thoracic cavity through a small incision. Evaluation of: ease of insertion and performing MID-CM, complications, end-tidal CO 2 (PETCO 2), non invasive arterial blood pressure (NIBP) and return of spontaneous circulation (ROSC). Values are mean±SD (min–max). Results: Twenty-five patients included. Mean age 59±16 years (26–85); BLS started at 8±5 min (0–20), compressions started at 47±10 min (29–74) after CA. Dissection and insertion was fast and easy (<1 min). Deployment of the MID-CM was difficult in two patients because of pericardium adhesions and cardiomegaly. In six patients compressions were more difficult because of a ‘stone heart’ phenomenon. Compressions were possible during ambulance transport of four patients. There was a good palpable carotid pulse in all patients receiving internal compressions. There was a trend in increase of PETCO 2 compared to CCC. NIBP could be measured during MID-CM compressions in 9 patients (systolic>85 mmHg), never during CCC. Seven patients had a ROSC, but only four patients were admitted alive. There was no long term survival. One patient had a serious complication (heart rupture). Discussion: Prehospital use of MID-CM is possible, but it is not comparable to any other resuscitation technique. Training of medical teams is mandatory to obtain good skills and to avoid complications. Further studies are necessary to evaluate efficiency and survival compared to closed chest compressions.

Training of medical teams on-site for individual and coordinated response in emergency management

A system for training of coordination and cooperation of decision makers in emergency management has been under construction for some time. A first prototype of the system was developed in the MUSTER system. The system is being developed modularly with one module for each of the suborganisations involved in the complete preparedness: fire brigade, police, medical team, civil defence, etc. All these modules will in the end be integrated on a common integration platform, either to a fully-fledged system covering all aspects of training for the complete preparedness, or for creating a dedicated system for specific training set-ups for specific groups of trainees. The first module completed as a commercial system, Training of medical teams on site, will be presented.

The Impact of Cross-Training and Workload on Team Functioning: A Replication and Extension of Initial Findings

Although previous research has shown that cross-training team members improves team performance, a number of questions remain concerning the nature of cross-training. The current study provides an extension of previous cross-training research by investigating two theoretical issues: the nature of cross-training and the joint impact of cross-training and workload on team functioning. The study examined 40 three-person teams performing a simulated radar task. Results indicated that positional rotation was an effective cross-training method for highly interdependent tasks, that cross-trained teams developed a greater degree of interpositional knowledge than did teams that were not cross-trained, and that cross-training was important only under high-workload performance conditions. The current study suggests that the type of cross-training necessary to improve team performance may be related to the nature of the task and that cross-training may be effective in allowing teams to coordinate implicitly—that is, without the need to communicate overtly. Taken together with previous work, the results of this study indicate strong support for the efficacy of cross-training as a means to help teams perform well. Potential applications of this research include training for military, medical, and aviation teams