Teamwork training using patient simulation

Teamwork is an important factor in safe healthcare. Simulation based team training (SBTT) is a method to gain the non-technical skills important for proficient teamwork. This thesis evaluated SBTT using different modalities and evaluation levels, looking at whole teams of either medical students or full professionals. In study I 15 medical students participated in a target-focused scenario-based teamwork practice during a one-day course. Their team behaviour skills were video-recorded and their attitudes towards safe teamwork assessed in this observational cohort study. Team behaviour skills showed improvement after five scenarios in a full-scale patient simulator environment, while no change in attitudes toward safe teamwork were detected. In study II 54 medical students participated in three video-recorded scenarios (n=36). Clinical performance improved in one variable; the frequency of sum-ups. Changes in individual experiences could be detected early during SBTT; self-efficacy improved after training. Individual teamwork behaviours did not change after this half-day course. Participants communicated to a greater extent and experienced higher mental strain and concentration in the role of leader than in the role of follower. Study III investigated whether training with high-fidelity simulators (HFS) could increase trainees’ experience of realism in task performance and facilitate the trainers’ task, resulting in different behaviour and individual experiences than training with low-fidelity models (LFM). A case control study was conducted with 34 teams using either a LFM (n=17) or a HFS (n=17). Professionals involved in paediatric emergencies performed one video-recorded emergency scenario in situ in an authentic emergency room. The trainees’ time to deliver oxygen was significantly longer (p=0.014) when using a HFS, which was interpreted as more realistic timing of task performance. Leaders experienced a higher level of mental strain during training with a HFS. There was a reduction in the trainers’ frequency of interventions in the scenarios as well as their mental strain, signifying potential for the trainers to focus more on trainees’ behaviours and performance during training using a HFS. In study IV all staff members (n=152) in an intensive care unit (ICU) were trained during one day. An observational cohort study (case control design on sick leave and staff turnover) was conducted. The training was performed in situ at the ICU and preceded by an interactive lecture concerning human factors. Before training, the medical professions’ perceptions of safety differed. After the training period, nurses’ and physicians’ mean self-efficacy scores improved, and nurse assistants’ perceived that the quality of collaboration and communication with physician specialists improved. In addition, nurse assistants’ perception of the Safety Attitude Questionnaire (SAQ) factors teamwork climate, safety climate and working conditions were more positive after the project and in concert with nurses’ perception of safety climate. In comparison to a control ICU during the study period, the number of nurses quitting their job and nurse assistants’ time on sick leave was reduced. In conclusion, the SBTT protocols applied in these studies are promising. A one-day course seems to benefit medical students’ teamwork behaviour. During a half-day course, i.e. early phase of training, aspects of clinical performance were improved as well as self-efficacy. Equipment fidelity influenced trainees’ clinical performance to some extent, but the trainers’ performance and experience to a larger extent. Leaders, followers and the different medical professions reported different experiences and attitudes. This finding accords with earlier studies on professions but has not been well studied earlier in the context of leaders and followers. All professions benefited from one day of SBTT in an ICU, but it was expressed in different ways

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

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

L’opinion européenne en 2008 : le rôle de l’Union dans la mondialisation conditionnera le soutien des Européens

Background: High-fidelity patient simulators in team training are becoming popular, though research showing benefits of the training process compared to low-fidelity models is rare. We explored in situ training for paediatric teams in an emergency department using a low-fidelity model (plastic doll) and a high-fidelity paediatric simulator, keeping other contextual factors constant. The goal was to study differences in trainees' and trainers' performance along with their individual experiences, during in situ training, using either a low-fidelity model or a high-fidelity paediatric simulator. Methods: During a two-year period, teams involved in paediatric emergency care were trained in groups of five to nine. Each team performed one video-recorded paediatric emergency scenario. A case control study was undertaken in which 34 teams used either a low-fidelity model (n = 17) or a high-fidelity paediatric simulator (n = 17). The teams' clinical performances during the scenarios were measured as the time elapsed to prescribe as well as deliver oxygen. The trainers were monitored regarding frequency of their interventions. We also registered trainees' and trainers' mental strain and flow experience. Results: Of 225 trainees' occasions during 34 sessions, 34 trainer questionnaires, 163 trainee questionnaires, and 28 videos, could be analyzed. Time to deliver oxygen was significantly longer (p = 0.014) when a high-fidelity simulator was used. The trainees' mental strain and flow did not differ between the two types of training. The frequency of trainers interventions was lower (p < 0.001) when trainees used a high-fidelity simulator; trainers' perceived mental strain was lower (< 0.001) and their flow experience higher (p = 0.004) when using high-fidelity simulator. Conclusions: Levels of equipment fidelity affect measurable performance variables in simulation-based team training, but trainee s' individual experiences are similar. We also note a reduction in the frequency of trainers' interventions in the scenarios as well as their mental strain, when trainees used a high-fidelity simulator

Comparison of high- and low equipment fidelity during paediatric simulation team training : a case control study

Background: High-fidelity patient simulators in team training are becoming popular, though research showing benefits of the training process compared to low-fidelity models is rare. We explored in situ training for paediatric teams in an emergency department using a low-fidelity model (plastic doll) and a high-fidelity paediatric simulator, keeping other contextual factors constant. The goal was to study differences in trainees' and trainers' performance along with their individual experiences, during in situ training, using either a low-fidelity model or a high-fidelity paediatric simulator. Methods: During a two-year period, teams involved in paediatric emergency care were trained in groups of five to nine. Each team performed one video-recorded paediatric emergency scenario. A case control study was undertaken in which 34 teams used either a low-fidelity model (n = 17) or a high-fidelity paediatric simulator (n = 17). The teams' clinical performances during the scenarios were measured as the time elapsed to prescribe as well as deliver oxygen. The trainers were monitored regarding frequency of their interventions. We also registered trainees' and trainers' mental strain and flow experience. Results: Of 225 trainees' occasions during 34 sessions, 34 trainer questionnaires, 163 trainee questionnaires, and 28 videos, could be analyzed. Time to deliver oxygen was significantly longer (p = 0.014) when a high-fidelity simulator was used. The trainees' mental strain and flow did not differ between the two types of training. The frequency of trainers interventions was lower (p < 0.001) when trainees used a high-fidelity simulator; trainers' perceived mental strain was lower (< 0.001) and their flow experience higher (p = 0.004) when using high-fidelity simulator. Conclusions: Levels of equipment fidelity affect measurable performance variables in simulation-based team training, but trainee s' individual experiences are similar. We also note a reduction in the frequency of trainers' interventions in the scenarios as well as their mental strain, when trainees used a high-fidelity simulator

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

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

Fear of making a mistake: a prominent cause of stress for COVID-19 ICU staff—a mixed-methods study

Introduction The COVID-19 pandemic has had a profound effect on many domains of healthcare. Even in high-income countries such as Sweden, the number of patients has vastly outnumbered the resources in affected areas, in particular during the first wave. Staff caring for patients with COVID-19 in intensive care units (ICUs) faced a very challenging situation that continued for months. This study aimed to describe burnout, safety climate and causes of stress among staff working in COVID-19 ICUs.Method A survey was distributed to all staff working in ICUs treating patients with COVID-19 in five Swedish hospitals during 2020 and 2021. The numbers of respondents were 104 and 603, respectively. Prepandemic data including 172 respondents from 2018 served as baseline.Results Staff exhaustion increased during the pandemic, but disengagement decreased compared with prepandemic levels (p<0.001). Background factors such as profession and work experience had no significant impact, but women scored higher in exhaustion. Total workload and working during both the first and second waves correlated positively to exhaustion, as did being regular ICU staff compared with temporary staff. Teamwork and safety climate remained unchanged compared with prepandemic levels.Respondents reported ‘making a mistake’ as the most stressful of the predefined stressors. Qualitative analysis of open-ended questions identified ‘lack of knowledge and large responsibility’, ‘workload and work environment’, ‘uncertainty’, ‘ethical stress’ and ‘organization and teamwork’ as major causes of stress.Conclusion Despite large workloads, disengagement at work was low in our sample, even compared with prepandemic levels. High levels of exhaustion were reported by the ICU staff who carried the largest workload. Multiple significant causes of stress were identified, with fear of making a mistake the most significant stressor

Additional file 1 of All professions can benefit — a mixed-methods study on simulation-based teamwork training for operating room teams

Additional file 1. Dataset

Additional file 2 of All professions can benefit — a mixed-methods study on simulation-based teamwork training for operating room teams

Additional file 2. Scenario 1: Wrong patient ID and hypotension during laparoscopic cholecystectomy. Scenario 2: Pneumothorax during laparoscopic cholecystectomy