Multidisciplinary teams performing simulated trauma resuscitation have improved teamwork scores based on level of experience __________________________ M. Crozier, H. Ting, M. Hogan, D. Boone, A. Furey, N. O’Regan, N. Bandrauk, J. Hapgood Department of Medicine, Memorial University of Newfoundland Author: Michael Crozier Date: 23 September 2011
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Multidisciplinary teams performing simulated trauma resuscitation have improved
teamwork scores based on level of experience
__________________________ M. Crozier, H. Ting, M. Hogan, D. Boone, A. Furey, N. O’Regan, N.
Bandrauk, J. Hapgood Department of Medicine, Memorial University of Newfoundland
Author: Michael Crozier
Date: 23 September 2011
Background:
• Michael Crozier
• MD University of Ottawa
• PGY-IV General Surgery Memorial University
• Certificate, Diploma in Medical Education, University of Dundee CME
• Interests in multidisciplinary training and assessment, human patient simulation
• Poster Presentation ICRE 2010, Ottawa
M. Crozier¹, H. Ting², D. Boone¹, N. O’Regan², N. Bandrauk³, A. Furey¹, C. Brown, J. Hapgood and M. Hogan¹
Disciplines of Surgery¹, Anesthesia², Medicine³
Memorial University of Newfoundland
St. John's, Newfoundland, Canada
International Finalist, Committee on Trauma Resident Paper Competition in Washington, DC American College of Surgery Committee on Trauma
Conclusion – Team Situation Awareness Global Assessment Technique
TSAGAT provides valid and reliable assessment of TEAM CLINICAL PERFORMANCE.
But what about actual TEAMWORK skills?
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Teamwork is important
• The provision of safe, effective medical care is a team effort that requires the coordinated skill, collaboration, and communication of each team member (Joint Commission 2006).
• Communication errors have been cited as one the most frequent causes of erroneous medical events in the U.S. and Canada (Kohn et al, 2000)
• Teamwork skills impact clinical performance, and ultimately patient outcomes…teamwork skills can be taught (Wright 2009)
• Properly functioning trauma teams, as part of a trauma system, are vital to improved outcomes in trauma resuscitation, and have shown to significantly reduce the rate of preventable trauma deaths (West JG, et al. Archives of Surgery 1979)
5
Teamwork assessment using human patient simulation
• Due to decreases in work hours for residents, shortening of training programs, ethical implications to protect patients from harm, the expectation that trainees will acquire all necessary skills in a purely clinical environment is no longer realistic (Palter CMAJ 2010).
• Simulation provides a safe, reliable and reproducible tool for teaching and assessment in medicine
Teamwork can be assessed…Objectively
• Behaviourly Anchored Team Skill Rating Scale (BARS)
• Individual assessment • Wright, et al 2009
• Team Performance Observation Tool (TPOT) • Team assessment • TeamSTEPPS teamwork system
• Observational Teamwork Assessment for Surgery (OTAS)
• Sevdalis, 2009
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Research Question
Can multidisciplinary teams rate their teamwork skills subjectively?
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METHODS
• Four teams of varying experience participated in two simulated trauma resuscitation scenarios using human patient simulation
• Student team • Junior resident team • Senior resident team • Staff/attending team
• Each team was composed of a TTL (trauma team
leader), an airway manager, and a nurse
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Assessment methods
• Individual teamwork skills were assessed objectively using the BARS assessment tool
• Assessed by two independent raters via video review
• Team teamwork skills were assessed objectively using the TPOT assessment tool
• Assessed by two independent raters via video review
• Subjective teamwork skills were assessed using a modified OTAS assessment tool.
• Administered to participants after completion of both scenarios
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Student Team
2 Trauma Scenarios using HPS
Assessment 3: Self-
Assessment
Assessment 2: TPOT
Assessment 1: BARS Junior
Resident Team
Senior Resident
Team
Staff Team
12
13
TPOT – 17 point scale
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Teamwork Self and Peer-Assessment Questionnaire You are invited to participate in a self and peer-assessment exercise regarding your team’s performance and teamwork skills in the simulated trauma scenario. There are 20 questions in total that ask questions based on 5 salient skills that constitute effective teamwork skills.
A) Communication – Please rate your team’s use of communication in the trauma scenar io: 1) Team communication was highly effective in enhancing teamwork:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
2) The team exchanged information proactively and politely:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
3) Case specific communication was clearly audible and well articulated:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
4) The team made a concerted and consistent effort to maintain open communication in order to fulfill the scenario:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
B) Co-operation – Please rate your team’s degree of co-operation in the trauma scenar io: 5) Team members acknowledged and acted upon suggestions and requests from each other immediately and fully:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
6) Members offered and gave assistance and support to each other, compensating for weaknesses and difficulties experienced by others:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
7) They made a concerted and consistent effort to cooperate with each other:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
8) Co-operation enhanced team function:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
C) Coordination – Please rate your team’s coordination in the trauma scenar io: 9) The team coordinated among individual tasks and within shared tasks:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
10) Team members were present when required at each stage to coordinate activities:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
11) Team members made a concerted and consistent effort to ensure team tasks coordinated:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
15
D) Leadership – Please rate the degree of leadership exhibited by your team members in the trauma scenar io. 12) Team members provided direction, instruction and explanation to the team:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly
Agree
13) Team members fully asserted themselves in drawing attention to team process and changing events:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly
Agree
14) Team members were proactive in their effort to direct the team to relevant events and process:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly
Agree
E) Monitor ing – Please rate your team’s use of monitor ing dur ing the trauma scenar io: 15) The team showed clear evidence of monitoring and awareness of their individual tasks and those of other members:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly
Agree
16) Team members were attentive, vigilant to process and changing events:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly
Agree
17) The team made a concerted and consistent effort in monitoring:
1
Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
18) Monitoring was highly effective in enhancing teamwork:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
F) Global assessment – Please give a global assessment of you and your team’s use of teamwork in the trauma scenar io. 19) Overall, I feel that I PERSONALLY displayed good teamwork skills which contributed positively to the team’s performance:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
20) Overall, I feel that MY TEAM displayed good teamwork skills that contributed positively to overall team performance:
1 Strongly Disagree
2 Somewhat Disagree
3 Disagree
4 Neutral
5 Somewhat
Agree
6 Agree
7 Strongly Agree
RESULTS
16
0
20
40
60
80
100
120
Students Juniors Seniors Staff
Mea
n S
core
Mean BARS score by level of experience
0
20
40
60
80
100
120
140
160
Students Juniors Seniors Staff
Mea
n S
core
Mean TPOT scores by level of experience
200
220
240
260
280
300
320
340
360
380
400
STUDENTS JUNIORS SENIORS STAFF
Tota
l Tea
m S
core
Total Team Subjective Scores
300
310
320
330
340
350
360
370
380
390
Students and Juniors Seniors and Staff
Mea
n S
core
Grouped Subjective Teamwork Scores
RESULTS
• Mean BARS scores improved significantly with increasing levels of team experience (p<0.05).
• Mean TPOT scores improved significantly with increasing levels of team experience (p<0.05).
• Inter-rater reliability was high for the BARS (r=0.91) and the TPOT (r=0.89) tool.
• There was a significant improvement in mean subjective teamwork questionnaire scores between less experienced (student and junior) teams and more experienced (senior and staff) teams (p<0.05).
Conclusion
• Multidisciplinary trauma teams with different levels of experience performing simulated trauma resuscitation display improved teamwork scores based on individual, global and subjective teamwork assessment scales.
• These findings further support the validity of the BARS and TPOT tools
• These findings also suggest that participants reliably self-assess their own teamwork skills
Discussion
• The results of our study suggest that subjective teamwork scales are effective methods of assessment
• These results have implications for training and assessment in teamwork skills
• Limitation: Small sample size (n=12)
• The next step is to use the same assessment tool in both objective and subjective form (analysis in progress; using the TPOT assessment tool with 16 teams of medical students performing simulated trauma resuscitation…see you next year!)