Exploring transformative learning when developing medical students' non-technical skills.

CONTEXT: Non-technical skills (NTS) training should be incorporated into medical students' education and simulation-based approaches are often utilised to facilitate this. Such experiences have the potential to foster transformative learning by facilitating a reassessment of one's prior assumptions and a significant shift in one's outlook, referred to as the process of perspective transformation. The aim of this research was to explore how NTS training might facilitate transformative learning in final-year medical students. METHODS: Following ethical approval, medical student volunteers from four medical schools (Aberdeen, Dundee, Edinburgh and Glasgow) participated in simulation sessions, were debriefed with an emphasis on NTS using a behavioural marker system and then took part in focus groups. Focus group discussions were semi-structured and questions were based on the phases of perspective transformation identified by Jack Mezirow. Focus group discussions were audiorecorded, transcribed verbatim, anonymised and analysed using template analysis. RESULTS: A total of 33 medical students took part in five focus groups. There was evidence of the following stages of perspective transformation: Phase 2 (self-examination with emotional disturbance, including fear, anxiety, guilt, shame and frustration); Phase 3 (critical assessment of assumptions, including the undervaluing of NTS, recognising that technical skills alone are insufficient, and recognising that it is possible to improve one's NTS); Phase 5 (exploring options for new roles, relationships and actions), and Phase 6 (planning a course of action for future simulations, as a medical student and as a doctor). CONCLUSIONS: This study deepens our understanding of how exposure to NTS training in simulation-based education influences the learning of medical students and shows that such exposure can result in the cognitive phases of transformative learning. It provides us with valuable insights into medical students' perspectives on their learning of NTS at a pivotal stage in training and represents an interesting way of assessing the educational impact of such sessions.

Definition, Measurement, Precursors, and Outcomes of Trust Within Health Care Teams: A Scoping Review.

PURPOSE: This scoping review aims to map the breadth of the literature examining how trust is defined in health care teams, describe what measurements of trust are used, and investigate the precursors and outcomes of trust. METHOD: Five electronic databases (Ovid MEDLINE, CINAHL, PsycInfo, Embase, and ASSIA [Applied Social Sciences Index and Abstracts]) were searched alongside sources of gray literature in February 2021. To be included, studies needed to discuss a health care team directly involved in managing patient care and one aspect of trust as a relational concept. A content count of the definitions of trust and tools used to measure trust and a deductive thematic analysis of the precursors and outcomes of trust in health care teams were conducted. RESULTS: Ultimately, 157 studies were included after full-text review. Trust was the main focus of 18 (11%) studies and was not routinely defined (38, 24%). Ability appeared to be key to the definition. Trust was measured in 34 (22%) studies, often using a bespoke measure (8/34, 24%). The precursors of trust within health care teams occur at the individual, team, and organizational levels. The outcomes of trust occur at the individual, team, and patient levels. Communication was a broad overarching theme that was present at all levels, both as a precursor and outcome of trust. Respect, as a precursor, influenced trust at the individual, team, and organizational levels, while trust influenced learning, an outcome, across the patient, individual, and team levels. CONCLUSIONS: Trust is a complex, multilevel construct. This scoping review has highlighted gaps in the literature, including exploration of the swift trust model, which may be applicable to health care teams. Furthermore, knowledge from this review may be integrated into future training and health care practices to optimize team processes and teamworking.

Online non-technical skills faculty training.

BACKGROUND: The Medical Students Non-Technical Skills (Medi-StuNTS) system is a behavioural marker system (BMS) designed to identify and debrief non-technical skills (NTS) for medical students during immersive simulation. Educators must be adequately trained in using the BMS. This study aimed to design and implement an online platform to deliver a faculty development course on using Medi-StuNTS and evaluate the feasibility of this platform in training faculty to identify and debrief NTS. APPROACH: The online platform was developed by faculty with expertise in NTS, based on guidance for faculty training programme requirements and the multimodal model for online education. Content was arranged in modules, using presentations, videos of simulation scenarios and interactive discussion boards. EVALUATION: Fifteen participants completed the course and feedback over a two-month period. A feedback form was completed to assess feasibility, based on a feasibility framework. The areas of focus were acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited efficacy. Feedback indicated that the course shows promise in improving the ability of faculty to identify and debrief NTS. IMPLICATIONS: The platform was successfully developed and implemented and was able to reach a national audience due to its online nature. Specific strengths include increased flexibility and accessibility compared to in-person training. Feasibility assessment suggests that this newly developed online platform can work as an effective method for faculty development in order to increase skills in identifying and debriefing NTS using Medi-StuNTS. Future work will focus on expansion of the online platform and dissemination to an international audience.

Exploring the impact of the COVID-19 pandemic on doctors' core workplace needs: a qualitative study of internal medicine trainees in Scotland.

OBJECTIVES: This study aimed to explore how the COVID-19 pandemic has impacted the workplace core needs of internal medicine (IM) trainees in Scotland. DESIGN: This qualitative study used an observational approach of interprofessional workshops combined with subsequent individual interviews with IM trainees. Workshops and interviews were audiorecorded, transcribed verbatim and analysed utilising NVivo software. Template analysis was used with the Autonomy/control, Belonging and Competence (ABC) of doctors' core needs outlined in the 2019 General Medical Council report Caring for doctors, caring for patients as a conceptual lens for the study. SETTING: The national IM boot camp in Scotland includes a 2-hour interprofessional workshop which is trainee led and explores current challenges in the workplace, including the impact of the pandemic on such relationships. PARTICIPANTS: Twelve workshops, involving 72 trainees, were included with ten trainees taking part in the subsequent interview process. Trainees representing all four regions in Scotland were involved. RESULTS: Trainees described all core needs having been impacted by the pandemic. They described a loss of autonomy with emergency rotas but also through a pervasive sense of uncertainty. The data revealed that work conditions improved initially with additional resources which have since been removed in some areas, affecting trainees' sense of value. Analysis found that belonging was affected positively in terms of increased camaraderie but also challenged through inability to socialise. There were concerns regarding developing competence due to a lack of teaching opportunities. CONCLUSIONS: Using the ABC of doctor's core needs as a conceptual framework for this study highlighted the impact of the COVID-19 pandemic on all domains for IM trainees in Scotland. It has highlighted an opportunity to foster the renewed sense of camaraderie among healthcare teams, while rebuilding work conditions to support autonomy and competence.

Validity of the Medi-StuNTS behavioural marker system: assessing the non-technical skills of medical students during immersive simulation.

Background: The Medical Students' Non-Technical Skills (Medi-StuNTS) behavioural marker system (BMS) is the first BMS to be developed specifically for medical students to facilitate training in non-technical skills (NTS) within immersive simulated acute care scenarios. In order to begin implementing the tool in practice, validity evidence must be sought. We aimed to assess the validity of the Medi-StuNTS system with reference to Messick's contemporary validity framework. Methods: Two raters marked video-recorded performances of acute care simulation scenarios using the Medi-StuNTS system. Three groups were marked: third-year and fourth-year medical students (novices), final-year medical students (intermediates) and core medical trainees (experts). The scores were used to make assessments of relationships to the variable of clinical experience through expert-novice comparisons, inter-rater reliability, observability, exploratory factor analysis, inter-rater disagreements and differential item functioning. Results: A significant difference was found between the three groups (p<0.005), with experts scoring significantly better than intermediates (p<0.005) and intermediates scoring significantly better than novices (p=0.001). There was a strong positive correlation between the two raters' scores (r=0.79), and an inter-rater disagreement of more than one point in less than one-fifth of cases. Across all scenarios, 99.7% of skill categories and 84% of skill elements were observable. Factor analysis demonstrated appropriate grouping of skill elements. Inconsistencies in test performance across learner groups were shown specifically in the skill categories of situation awareness and decision making and prioritisation. Conclusion: We have demonstrated evidence for several aspects of validity of the Medi-StuNTS system when assessing medical students' NTS during immersive simulation. We can now begin to introduce this system into simulation-based education to maximise NTS training in this group.