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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

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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)

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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

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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

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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

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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!)

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QUESTIONS?

THANK YOU

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