Observational Study About the Impact of Simulation Training of Non-Technical Skills on Teamwork: Towards a Paradigm Shift in Undergraduate Medical Training
DOI:
https://doi.org/10.20344/amp.19021Keywords:
Education, Medical, Undergraduate, Emergency Medicine/education, Simulation Training, Students, MedicalAbstract
Introduction: Recently, simulation as an educational method has gained increasing importance in Medicine. However, medical education has favored the acquisition of individual knowledge and skills, while overlooking the development of teamwork skills. Since most errors in clinical practice are due to human factors, i.e., non-technical skills, the aim of this study was to assess the impact that training in a simulation environment has on teamwork in an undergraduate setting.
Material and Methods: This study took place in a simulation center, with a study population of 23 participants, fifth year undergraduate students, randomly divided into teams of four elements. Twenty simulated scenarios of teamwork in the initial assessment and resuscitation of critically ill trauma patients were recorded. Video recordings were made at three distinct learning moments (before training, end of the semester, and six months after the last training), and a blinded evaluation was performed by two independent observers, who applied the Trauma Team Performance Observation Tool (TPOT). Additionally, the Team STEPPS Teamwork Attitudes Questionnaire (T-TAQ) was applied to the study population before and after the training to assess any change in individual attitudes towards non-technical skills. A 5% (or 0.05) significance level was considered for statistical analysis.
Results: With a moderate level of inter-observer agreement (Kappa = 0.52, p = 0.002), there was a statistically significant improvement in the team's overall approach, evidenced by the TPOT scores (median of 4.23, 4.35 and 4.50, in the three time-points assessed, respectively, p = 0.003). In the T-TAQ, there was an improvement in non-technical skills, that was statistically significant for "Mutual Support” (median from 2.50 to 3.00, p = 0.010).
Conclusion: In this study, incorporating non-technical skills education and training in undergraduate medical education was associated with sustained improvement in team performance in the approach to the simulated trauma patient. Consideration should be given to introducing non-technical skills training and teamwork in the emergency setting during undergraduate training.
Downloads
References
Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RV. Patterns of errors contributing to trauma mortality: lessons learned from 2594 deaths. Ann Surg. 2006;244:371. DOI: https://doi.org/10.1097/01.sla.0000234655.83517.56
Flin R, Winter J, Sarac C, Raduma M. Human factors in patient safety: review of topics and tools. Geneva: World Health Organization: 2009.
Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer Health System. Washington: National Academies Press (US); 2000.
Clarke JR, Spejewski B, Gertner AS, Webber BL, Hayward CZ, Santora TA, et al. An objective analysis of process errors in trauma resuscitations. Acad Emerg Med. 2000;7:1303–10. DOI: https://doi.org/10.1111/j.1553-2712.2000.tb00480.x
Doumouras AG, Keshet I, Nathens AB, Ahmed N, Hicks CM. Trauma Non-Technical Training (TNT-2): the development, piloting and multilevel assessment of a simulation-based, interprofessional curriculum for team-based trauma resuscitation. Can J Surg. 2014;57:354–5. DOI: https://doi.org/10.1503/cjs.000814
Dick WF. The European trauma course. Resuscitation. 2008;77:419. DOI: https://doi.org/10.1016/j.resuscitation.2008.01.006
Kawaguchi AL, Kao LS. Teamwork and surgical team – based training. Surg Clin North Am. 2021;101:15–27. DOI: https://doi.org/10.1016/j.suc.2020.09.001
Alexandrino H, Baptista S, Vale L, Júnior JH, Espada PC, Junior DS, et al. Improving intraoperative communication in trauma: the educational effect of the joint DSTCTM – DATCTM courses. World J Surg. 2020;44:1856–62. DOI: https://doi.org/10.1007/s00268-020-05421-5
Paige JT, Garbee DD, Kozmenko V, Yu Q, Kozmenko L, Yang T, et al. Getting a head start: high-fidelity, simulation-based operating room team training of interprofessional students. J Am Coll Surg. 2014;218:140–9. DOI: https://doi.org/10.1016/j.jamcollsurg.2013.09.006
Gerardo CJ, Glickman SW, Vaslef SN, Chandra A, Pietrobon R, Cairns CB. The rapid impact on mortality rates of a dedicated care team including trauma and emergency physicians at an academic medical center. J Emerg Med. 2011;40:586–91. DOI: https://doi.org/10.1016/j.jemermed.2009.08.056
Gillman LM, Brindley PG, Blaivas M, Widder S, Karakitsos D. Trauma team dynamics. J Crit Care. 2016;32:218–21. DOI: https://doi.org/10.1016/j.jcrc.2015.12.009
Bento A, Ferreira L, Yánez Benitez C, Koleda P, Fraga GP, Kozera P, et al. Worldwide snapshot of trauma team structure and training: an international survey. Eur J Trauma Emerg Surg. 2022 (in press). doi: 10.1007/s00068-022-02166-9. DOI: https://doi.org/10.1007/s00068-022-02166-9
Sá-Couto C, Rodrigues D, Gouveia M. Debriefing or feedback: exploring the impact of two post-scenario discussion methods in the acquisition and retention of non-technical skills. Acta Med Port. 2023;36:34–41. DOI: https://doi.org/10.20344/amp.16898
Maguire MB, Bremner MN, Yanosky DJ. Reliability and validity testing of pilot data from the TeamSTEPPS® performance observation tool. Qual Saf Heal Care. 2014;22:5-8. DOI: https://doi.org/10.4172/2167-1168.1000202
Baker DP, Amodeo AM, Krokos KJ, Slonim A, Herrera H. Assessing teamwork attitudes in healthcare: development of the TeamSTEPPS teamwork attitudes questionnaire. Qual Saf Heal Care. 2010;19:1–4. DOI: https://doi.org/10.1037/t78124-000
Burke CS, Salas E, Wilson-Donnelly K, Priest H. How to turn a team of experts into an expert medical team: guidance from the aviation and military communities. BMJ Qual Saf. 2004;13:Si96–104. DOI: https://doi.org/10.1136/qshc.2004.009829
Baker DP, Salas E, King H, Battles J, Barach P. The role of teamwork in the professional education of physicians: current status and assessment recommendations. Jt Comm J Qual Patient Saf. 2005;31:185–202. DOI: https://doi.org/10.1016/S1553-7250(05)31025-7
Steinemann S, Berg B, Skinner A, DiTulio A, Anzelon K, Terada K, et al. In situ, multidisciplinary, simulation-based teamwork training improves early trauma care. J Surg Educ. 2011;68:472–7. DOI: https://doi.org/10.1016/j.jsurg.2011.05.009
Reagans R, Argote L, Brooks D. Individual experience and experience working together: predicting learning rates from knowing who knows what and knowing how to work together. Manage Sci. 2005;51:869–81. DOI: https://doi.org/10.1287/mnsc.1050.0366
Wolf FA, Way LW, Stewart L. The efficacy of medical team training: improved team performance and decreased operating room delays: a detailed analysis of 4863 cases. Ann Surg. 2010;252:477–83. DOI: https://doi.org/10.1097/SLA.0b013e3181f1c091
Gjeraa K, MØller TP, Østergaard D. Efficacy of simulation-based trauma team training of non-technical skills. A systematic review. Acta Anaesthesiol Scand. 2014;58:775–87. DOI: https://doi.org/10.1111/aas.12336
Motola I, Devine LA, Chung HS, Sullivan JE, Issenberg SB. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Med Teach. 2013;35:142–59. DOI: https://doi.org/10.3109/0142159X.2013.818632
Herrmann-Werner A, Nikendei C, Keifenheim K, Bosse HM, Lund F, Wagner R, et al. “Best practice” skills lab training vs. a “see one, do one” approach in undergraduate medical education: an RCT on students’ long-term ability to perform procedural clinical skills. PLoS One. 2013;8:1–13. DOI: https://doi.org/10.1371/journal.pone.0076354
Baker VO, Cuzzola R, Knox C, Liotta C, Cornfield CS, Tarkowski RD, et al. Teamwork education improves trauma team performance in undergraduate health professional students. J Educ Eval Health Prof. 2015;12:36. DOI: https://doi.org/10.3352/jeehp.2015.12.36
Direção-Geral do Ensino Superior. Acesso ao Ensino Superior 2021 - Índices de Cursos (por curso e instituição). [cited 2022 Jan 18]. Available from: https://www.dges.gov.pt/guias/indcurso.asp?curso=9813.
Rosen MA, Salas E, Wilson KA, King HB, Salisbury M, Augenstein JS, et al. Measuring team performance in simulation-based training: adopting best practices for healthcare. Simul Healthc. 2008;3:33–41. DOI: https://doi.org/10.1097/SIH.0b013e3181626276
van Maarseveen OE, Ham WH, van Cruchten S, Duhoky R, Leenen LP. Evaluation of validity and reliability of video analysis and live observations to assess trauma team performance. Eur J Trauma Emerg Surg. 2022;48:4797–803. DOI: https://doi.org/10.1007/s00068-022-02004-y
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.
