Doctoral Colloquium

The 2015 iConference Doctoral Colloquium is made possible in part by a generous grant from the National Science Foundation (#1519338). Additional funding was provided by the iSchools.Ope

Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care

Article presents a study conducted at Gold Coast University Hospital that aimed to define and improve relational aspects of trauma care and facilitate co-creation of targeted interventions designed to improve team relationships and performance

Canadian Trauma Training Needs Assessment and Development of a Trauma Laparotomy Operative Assessment Tool

Background: Canadian general surgery trainees are required to achieve competence in multiple domains of trauma care such as the operative and non-operative management of injuries, performance of the role of trauma team leader, trauma-specific knowledge, teamwork, and communication. A gap between clinical exposure and the required operative competencies in trauma education has been identified. Additionally, there are no procedure-specific competency- based operative assessment tools available for general surgery trauma procedures. Objectives: This work aims to: (1) Conduct a national needs assessment for Canadian general surgery trauma training; and (2) develop a novel competency-based formative operative assessment tool for the trauma laparotomy procedure. Methods: A national needs assessment was conducted through a survey of general surgery educators and trainees. The survey encompassed a wide range of components of the trauma training experience and included questions on clinical exposure, completion of formal trauma courses, physical and human resources available for education, perceived deficits in training, and support for curriculum initiatives. A modified Delphi study was then conducted with an international panel of trauma surgeons and educators to identify a set of items to be included in a novel trauma laparotomy operative assessment tool. Strict consensus criteria were applied throughout the three rounds of the study. Items were modified based on Delphi panel comments. Results: Perceived deficiencies in trauma training were identified including operative management for many injury patterns, trauma epidemiology, evidence-based practice, and community advocacy. There was strong support for a wide array of curriculum initiatives to improve trauma education among both educators and trainees. Competency-based curriculum objectives and assessment tools for both technical and non-technical skills were strongly supported by participants. The modified Delphi study was conducted over three rounds. Items were categorized into four sections within the tool: pre-operative, intra-operative, post-operative, and global rating. At the end of the Delphi study, 17 items were included in the operative assessment tool. Conclusions: At this time, both educators and trainees perceive the existing Canadian trauma training curriculum to be insufficient to meet the educational needs of general surgery residents. Competency-based approaches to education and assessment were strongly supported by both educators and trainees in the national needs assessment. A competency-based formative operative assessment tool for the trauma laparotomy procedure has been developed for use in general surgery trauma training. Future work should focus on developing a national competency- based trauma training curriculum and evaluation of the assessment tool for utility, feasibility, and additional supporting validity evidence. Furthermore, the assessment tool development process and validity studies may be replicated to develop a full suite of assessment tools for trauma operations

Interventions to improve team effectiveness within health care

Background: A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. Objectives: To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. Methods: Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. Results: Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. Conclusion: Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research t

CORD Abstracts 2025

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Using Critical Incident Debriefing after Code Blue Events to Support Registered Nurses

Using Critical Incident Debriefing after Code Blue Events to Support Registered Nurses Section I: Abstract Background: During a code blue event (CBE), the environment becomes highly stressful and intense. Nurses rapidly transition from performing life-saving procedures on their patients to carrying out their usual duties. Without proper debriefing, nurses cannot properly process their emotions leading to increased burnout and secondary traumatic stress (Stamm, 2010). Local Problem: In 2021, the nurses at Providence Saint John’s Health Center (2021a) responded to 110 CBEs, a 43% increase from 2020. Without a process for critical incident debriefing (CID), these nurses were exposed to trauma at each event without support for their psychological well-being. Methods: This quality improvement change project occurred at a community hospital in Santa Monica, California (July 2022 through January 2023). It used a pre- and post-implementation design to determine if CID changed nurses’ professional quality of life survey scores. Interventions: Interventions for this project included conducting a survey pre- and post-implementation of education on CID and implementing a formal debriefing process for CBEs. Results: Eight-one nurses participated in this project’s survey. Eighteen nurses completed the pre- and post-implementation survey. No statically significant changes occurred in the nurses’ levels of compassion satisfaction, burnout, or secondary traumatic stress. Conclusions: Implementing debriefing at PSJHC supported nurses involved in CBE. Several limitations exist, but the project overall supports CID. PSJHC should consider the formal adoption of this CID process

Factors affecting interprofessional teamwork in emergency department care of polytrauma patients : results of an exploratory study

Considering that traumatic injuries are the leading cause of death among young adults across the globe, emergency department care of polytrauma patients is a crucial aspect of optimized care and premature death prevention. Unfortunately, many studies have highlighted important gaps in collaboration among different trauma team professionals, posing a major quality of care challenge. Using the conceptual framework for interprofessional teamwork (IPT) of Reeves, Lewin, Espin, and Zwarenstein (2010), the aim of this qualitative descriptive exploratory study was to better understand IPT from the perspective of health professionals in emergency department care of polytrauma patients, specifically by identifying factors that facilitate and impede IPT. Data was collected from a sample of seven health professionals involved in the care of polytrauma patients, through individual interviews and a focus group. In a second phase, two structured observations of polytrauma patient care were conducted. Following a thematic analysis, results show multiple factors affecting IPT, which can be divided into five broad categories: individual, relational, processual, organizational and contextual. Individual factors, a category that is not part of the conceptual framework of Reeves et al. (2010), also emerged as playing a major part in IPT

Context: Much ado about - what, exactly?

Introduction Simulation-based learning is an example of learning in context in which clinical contexts are recreated in controlled settings to facilitate deliberate practice. While widely regarded as effective, unanswered questions exist about what elements of the clinical context must be recreated in simulated settings to promote authenticity. Moreover, the degree of authenticity (or fidelity) required for optimal learning is not known, with current thinking often deemphasizing the importance of physical realism. We therefore sought to explore contextual influences on performance in a ‘context-rich’ clinical setting: paramedicine. Methods We followed constructivist grounded theory principles and recruited currently practicing paramedics to participate in one-on-one, semi-structured interviews. We asked the participants to describe a recent experience in which they attempted to resuscitate a victim of sudden cardiac arrest and asked them how to recreate their experiences in simulated settings. Results Fourteen paramedics provided a total of seventeen interviews, each describing a distinct cardiac arrest event, yielding over ten hours of audio data for analysis. We iteratively identified three major interrelated themes describing contextual influences: the event – its physical characteristics, circumstances and people present; the conceptual response – the cognitive processes and challenges encountered; and the emotional response – the degree of emotional engagement in the management of the resuscitation. We also identified a major theme related to how to simulate these events. Collectively, our results suggest a complex and dynamic interplay between the physical, conceptual and emotional domains of context. Conclusion In contrast to other conceptualizations of context and fidelity, our results suggest that conceptual and emotional responses occur as a result of physical features in the practice environment, arguing in favour of physical authenticity in simulation.ThesisMaster of Science (MSc)Educators in the health professions have the important task of preparing their students – future physicians, nurses, paramedics, etc. – to perform effectively in clinical practice. This transition from healthcare student to healthcare professional is challenging, in part because classrooms and clinical contexts are different entities: the environment, the people within it, the way knowledge is generated, recalled and applied are all different. To narrow the gap between classroom and clinical practice, educators often promote learning in context, using various strategies to make the classroom more like the clinic (or any other setting in which health care is delivered). The challenge, however, is that exactly what features of the practice setting (context) should be recreated to promote learning is not known. We undertook this study, viewing the clinical context through a paramedic lens, to better understand what features present in real world conditions might influence learning and performance

Designing Information Displays to Support Awareness in Ad Hoc, Interdisciplinary Emergency Medical Teamwork

This research focuses on designing an information display to support awareness during ad hoc, collocated, interdisciplinary, and emergency medical teamwork in the trauma resuscitation domain. Our approach is grounded in participatory design (PD), emphasizing the importance of eliciting and addressing clinician needs while gaining long-term commitment from clinicians throughout system development. Engagement in iterative participatory and user-centered design activities with clinicians over the course of two years involved a series of PD workshops, heuristic evaluations, simulated resuscitation sessions, video observations, video review sessions, and a focus group. Sixteen iterations of an information display design were created. A perspective is offered on what awareness means within the context of an ad hoc, collocated, interdisciplinary, and emergency setting by examining teams treating severely ill patients with urgent needs. Major findings include descriptions of: (1) the aspects of trauma teamwork that require support; (2) the main information features to include on an information display; (3) the individual role-based differences in information needs; (4) the role of temporal awareness in trauma teamwork; and (5) clinicians’ concerns about using the information display in real events. Based on these findings, we contribute rich descriptions of four facets of awareness that trauma teams manage—team member awareness, teamwork-oriented and patient-driven task awareness, overall progress awareness, and elapsed and estimated time awareness. Two major design tensions that researchers must manage when developing information displays for teamwork—process-based versus state-based design structures and teamwork-oriented versus patient-driven information—are also illustrated through iterations of the display design. We found balance in a shared information display that featured patient-driven information presented through a state-based design. The outcomes of this study have potential uses for researchers interested in using participatory design strategies to develop information technologies for ad hoc, collocated, interdisciplinary teams working in time- and safety-critical settings. We show how the display designs as well as design techniques were customized to reconcile the role-based differences in information needs that emerged due to the nature of teamwork in the trauma resuscitation setting. This research provides a rich case study demonstrating the value of taking an iterative participatory and user-centered approach to design.Ph.D., Information Studies -- Drexel University, 201