Team Training of Inter-Professional Students Using Simulation

1. Team Training of Inter-Professional Students Using Simulation John T. Paige MD, Deborah D. Garbee PhD, APRN, ACNS-BC, Vadym Rusnak MD, Qingzhao Yu PhD, Richard DiCarlo MD, Alan Marr MD LSU Health New Orleans (NO) Health Sciences Center New Orleans, LA Surgical Education Week Association for Surgical Education Paper Session #1 Orlando, FL April 23, 2013

2. Funding Support / Disclosures Funding support: LSU Academy for the Advancement of Educational Scholarship Educational Enhancement Grant (2011-2012) Disclosures: Co-editor for Simulation in Radiology

3. Goal Promote the adoption of simulation-based training (SBT) of inter-professional teams to enhance collaboration, teamwork, and patient safety

4. Learning Objectives Discuss the current status of teamwork in healthcare and its impact on medical education Describe our simulation-based team training of inter-professional students (TTIPS) program Demonstrate the impact of TTIPS on participants’ attitudes toward inter-professional learning and teamwork Review future directions for TTIPS

5. What do you see? Why show it?

6. background TEAMWORK IN HEALTHCARE

7. Teamwork in Healthcare • What’s this? • What’s the consequence? • Why? • How do we fix it? Bleakley A, J Workplace Learning 2006;18:414-425 Gillespie BM et al, Qual Saf Health Care 2010;19:103-106

8. Good teamwork Negates fatigue Reduces stress Promotes high reliability Poor teamwork Lowers collaboration Increases stress Becomes system liability By Focusing on Teamwork! Firth-Cozens J, Qual Saf Health Care 2001 10(supplI):ii26-ii31 and Baker DP et al, Health Serv Res 2006 41:1576-1598

9. Core Components Team leadership (S)1 Mutual performance monitoring (S) Back-up behavior (S) Adaptability (S) Team orientation (A)2 Coordinating Mechanisms Shared mental model (K)3 Mutual trust (A) Communication (S) The Big Five Model of Teamwork Salas E et al, Small Gr Res 2005 36:555-599; 1S=skill; 2A=Attitude; 3K=Knowledge

10. Consequences POOR TEAMWORK TECHNICAL ERRORS MORBIDITY AND MORTALITY PATIENT SAFETY SENTINEL EVENTS ? Catchpole K et al, Ann Surg 2008 247:699-706; Mazzocco K et al, Am J Surg 2009 197:678-685; Christian CK et al, Surgery 2006 139:159-173; Kwan et al, Arch Surg 2006 141:352-357

11. mETHODS

12. TTIPS Project Funded by the Academy for Advancement of Educational Scholarship at LSU Health NO 2011-2012 Educational Enhancement Grant Outgrowth of prior inter-professional undergraduate team training work Target learners  L3 medical and senior undergraduate nursing students

13. Research Questions What is the impact of inter-professional, scenario based high-fidelity simulation training of undergraduate nursing and medical students on team-based behaviors? How does inter-professional, scenario based high-fidelity simulation training of undergraduate nursing and medical students influence participants’ attitudes toward inter-professional collaboration and learning?

14. Design Quasi-experimental in character Matching of participants pre- and post-intervention using unique, self-generated personal identification number (PIN) Inter-professional education (IPE) with teams of 5 to 8 students Incorporated into general surgery clerkship and senior undergraduate nursing intensive care course

15. Training Setting

16. TTIPS Training Format

17. Training Format ATLS protocols Shared mental model Open communication Anticipatory response Teamwork Attitudes Readiness for Inter-professional Learning High fidelity simulation Two hour sessions Core courses Two scenario format Inter- professional teams Deliberate practice Clinical correlation Virtual Room Four concept Situational awareness Resource management Cross monitoring Role clarity Flattened hierarchy Mental rehearsal LSUHSC-NO Academy for the Advancement of Educational Scholarship Education Enhancement Grant 2011-2012

18. Measurements • Team-based attitudes  TeamSTEPPSTM Teamwork Attitude Questionnaire (TTAQ) • Given to entire class in June 2011 with f/u June 2012 • Five subscales • Inter-professional learning attitudes  Readiness for Interprofessional Learning (RIPL) Questionnaire • Given to participants immediately before and at the end of each simulation session • Nineteen questions

19. RESULTS

20. Training Sessions Breakdown

21. Medical Students – TTAQ scores

22. All Students – RIPL Scores √ √ √ √ √ √ √ √ √ √ aScale: 1-strongly disagree, 2-disagree, 3-neutral, 4-agree, 5-strongly agree bMean (standard deviation) cPaired 2 tail t-test

23. All Students – RIPL Scores Significant change in 10/19 items N ranged from 127 to 129

24. Conclusions Simulation-based IPE improves team-based attitudes related to team structure and mutual support in third year medical students Simulation-based IPE improves both medical and undergraduate nursing students’ attitudes toward inter-professional learning. Future directions include correlating improvement in each measurement with individual learning

25. TTIPS Team Vadym Rusnak, MD Richard DiCarlo MD Alan Marr MD Qingzhao Yu, PhD Megan Bronson Deborah Garbee PhD, APRN John Paige MD

26. What do you see? To improve teamwork, we must target... those in practice, and… those coming up! Why show it?

27. Thank You!