Interprofessional teamwork in healthcare: Observations and the road ahead.

In this effort we draw from the literature on interprofessional teamwork in high reliability organizations from different fields of study, including healthcare, industrial/organizational psychology, and management. We combine this literature with our collective experience to offer five observations on future needs for the field of team science research and practice. These themes include: (1) exploration of nonclinical teams, (2) evaluation of multi-team systems in healthcare, (3) the study of dyad leadership of teams, (4) the proliferation of virtual healthcare teams, and (5) the continuing integration of organizational and team science into the study of interprofessional teams. By presenting these observations, we argue why each is critical to the overall understanding of interprofessional teamwork in healthcare and provide areas for future scholarly advancement that will inform healthcare practice.

Core conditions of team effectiveness: Development of a survey measuring Hackman's framework.

Leaders and team development practitioners working toward increasing interprofessional team effectiveness frequently need to quickly and accurately determine the extent to which a team possesses the most essential and foundational components required for effective teamwork. While there is no shortage of team theories, there are few freely available, practical, short, and well-developed surveys to measure team functioning across a variety of team types. We developed a 9-item team assessment to fill this gap in the literature, measuring the most fundamental criteria for optimising team functioning, based on Hackman's widely used framework of the foundational conditions for team effectiveness. Reliability and validity of the assessment were investigated through multiple methods, including confirmatory factor analysis and bivariate correlations. Initial psychometric work would appear to support the use of this assessment to measure the three core conditions of team effectiveness. This assessment can be completed by interprofessional team members and their responses can be used to help leaders and team development practitioners focus resources on the most relevant conditions to increase the likelihood of team effectiveness.

Task Deconstruction of Colonic Endoscopic Submucosal Dissection (cESD): An Expert Consensus.

BACKGROUND: Slow adoption of colonic ESD (cESD) in the US is multifactorial due to: lack of clinical training construct (e.g., gastric ESD in Japan), complication risks, and technical difficulty. More than 28,000 patients/year undergo colonic resection for benign lesions that could be managed effectively with cESD. Selected patients could avoid surgery if procedural adoption of cESD increased due to more accessible training. Current US cESD training is scarce, and existing programs are piecemeal. There is a need to develop an effective national training program for practicing endoscopists. A prerequisite to training development is a comprehensive task list delineating procedural steps. The aim of this work was to describe an evidence-based method of deconstructing cESD into the essential steps to provide a task list to guide teaching and assessment. METHODS: Subject-matter experts (SMEs) performed a literature review to create an initial procedural step list. Eleven clinical cESD SMEs and four educational SMEs formed a 'cESD Working Group' to develop consensus regarding steps. Through a two-stage modified Delphi process, a consensus on a comprehensive standard cESD deconstructed task list was reached. The aim was to standardize cESD teaching to efficiently bring a novice to safe performance. RESULTS: A literature review identified eight initial cESD steps. First-round Delphi consensus was gained on seven steps. Semi-structured focus group discussions resulted in consensus on a modified version of 7 of the initial steps, with addition of two steps. Consensus on procedural actions needed to perform each step was achieved after the hands-on laboratory. The final result was a ten-step deconstructed task list for standard cESD. CONCLUSION: The development of a standardized cESD procedural task list provides a foundation to safely and efficiently teach cESD to practicing endoscopists. This list can be used to develop a training pathway to increase procedural adoption. Selected patients currently undergoing colonic resections could benefit from increased adoption of cESD.

The Role of Work Environment in Training Sustainment: A Meta-Analysis.

OBJECTIVE: The purpose of this meta-analytic review is to examine the role of three work environment support variables (i.e., peer, supervisor, and organizational support) in training transfer and sustainment or long-term use of learned knowledge, skills, and attitudes (KSAs). BACKGROUND: Estimates demonstrate that little training is transferred to the job, wasting billions in organizational spending each year and resulting in significant loss to safety and individual and team performance. Prior research shows the importance of a supportive work environment to facilitating transfer; however, we know little of the relative importance of specific support variables. This study seeks to examine the unique roles of distinct support variables in training transfer. METHOD: A meta-analysis was conducted with multiple regressions to answer three primary research questions. RESULTS: All work environment support variables demonstrate moderate and positive correlations with transfer of training. Furthermore, multiple regressions demonstrate that each factor of the work environment explains unique variance as a predictor, with the model accounting for 32% of transfer and peer support accounting for most of R2. Motivation to transfer mediates the relationship between all three work environment support variables and transfer. Furthermore, three support variables are positively related to sustainment, with peer and supervisor support showing the strongest relationships. CONCLUSION: Findings illuminate the relative contribution of peer, supervisor, and organizational support to transfer and sustainment of training. As transfer continues to be an important yet understudied measure of the effectiveness of workplace training, these findings hold implications for both research and practice.

Enhancing the effectiveness of team debriefings in medical simulation: more best practices.

BACKGROUND: Teamwork is a vital component of optimal patient care. In both clinical settings and medical education, a variety of approaches are used for the development of teamwork skills. Yet, for team members to receive the full educational benefit of these experiential learning opportunities, postsimulation feedback regarding the team's performance must be incorporated. Debriefings are among the most widely used form of feedback regarding team performance. A team debriefing is a facilitated or guided dialogue that takes place between team members following an action period to review and reflect on team performance. Team members discuss their perceptions of what occurred, why it occurred, and how they can enhance their performance. Simulation debriefing allows for greater control and planning than are logistically feasible for on-the-job performance. It is also unique in that facilitators of simulation-based training are generally individuals external to the team, whereas debriefing on the job is commonly led by an internal team member or conducted without a specified facilitator. Consequently, there is greater opportunity for selecting and training facilitators for team simulation events. Thirteen Best Practices: The 13 best practices, extracted from existing training and debriefing research, are organized under three general categories: (1) preparing for debriefing, (2) facilitator responsibilities during debriefing, and (3) considerations for debriefing content. For each best practice, considerations and practical implications are provided to facilitate the implementation of the recommended practices. CONCLUSION: The 13 best practices presented in this article should help health care organizations by guiding team simulation administrators, self-directed medical teams, and debriefing facilitators in the optimization of debriefing to support learning for all team members.

Institution-specific utilization of the American College of Surgeons/Association of Program Directors operative skills curriculum: From needs assessment to implementation.

BACKGROUND: The American College of Surgeons/Association of Program Directors in Surgery operative skills curriculum standardizes training. However, simulation resources are variable with curriculum implementation institution dependent. Our aim was to use Kern's six steps of curricular development to demonstrate how to tailor the American College of Surgeons/Association of Program Directors in Surgery Phase 2 curriculum to program specific needs. METHODS: Problem identification and general needs assessment was performed. Targeted needs assessment of general surgery residents and attendings was conducted to determine perceived importance of operative skills and residents' confidence with these skills and attendings perceptions of deficiencies in technical skills using the Objective Structured Assessment of Technical Skills criteria. Educational strategies were developed dependent on program resources. The program was piloted between 2018 to 2019 and implemented in the 2019 to 2020 academic year. Assessment of resident technical skills and resident or faculty teaching skills was performed for each session. Resident confidence with procedures was assessed using the Zwisch scale before and after modules. Curricular evaluations were completed by residents after each module. RESULTS: The previous curriculum did not comprehensively cover Phase 2 modules and was not tailored to the needs of residents. Targeted needs assessment revealed differences in prioritization of learning for techniques by seniority (most important operation for faculty: laparoscopic cholecystectomy, postgraduate year 4 and 5: laparoscopic partial colectomy, interns: open inguinal/femoral hernia repair). Faculty identified technical skills on which to focus (ie, interns' knowledge of a specific procedure, postgraduate year 4 and 5 flow of the operation and forward planning). Educational strategies employed included wet and dry lab simulations and online materials. Residents reported increased procedural confidence after curriculum completion. CONCLUSION: This comprehensive implementation of the American College of Surgeons/Association of Program Directors in Surgery Phase 2 skills curriculum effectively used resources and expertise of an institution and focused on the knowledge and technical deficiencies of the target learners. Improvement in learner confidence was demonstrated by this approach.

A Template for Curriculum Development to Teach Complex Surgical or Endoscopic Techniques With Logistical Challenges.

OBJECTIVE: The current, unprecedented pace of change in medicine challenges healthcare professionals to stay up-to-date. To more effectively disseminate new surgical or endoscopic techniques a modern paradigm of training is required. Our aim was to develop a curricular framework for complex techniques that provide logistical challenges to training in order to increase safe, effective use. We use colonic endoscopic submucosal dissection (cESD) as an example. DESIGN: Curriculum development followed a multistep process representing best practice in training and education. First, a Clinical Needs Assessment established the demand for/sustainability of training. A Training Needs Analysis then identified the knowledge, skills, and attitudes required to perform cESD. A modified Delphi process defined desired learner characteristics, identified indications/contraindications to cESD, and developed a procedural task list. A pilot simulation program gathered feedback from cESD faculty experts and learners. Finally, a Behavioral Observation Scale was developed as a clinical assessment tool to assess procedural performance. SETTING: The Houston Methodist Institute for Technology, Innovation and Education. PARTICIPANTS: The first Curriculum Design Summit engaged 11 clinical SMEs, 4 education and training SMEs, 3 market development SMEs, and 1 medical device research and design engineer. The second Curriculum Design Summit engaged 10 clinical SMEs, 4 education and training SMEs, and 4 market development SMEs. We also engaged 12 Learner SMEs at both hands-on pilot courses who currently are training to perform cESD. RESULTS: Desired learner criteria were defined (e.g., in practice >2 years, available case volume ≥25/year) to ensure ability and motivation of learners. Lesions were classified by (1) suitability for cESD (Clinical T1N0M0, Paris 0-IIa +1s  > 2 cm, 0-IIc + IIa, 0-IIc), and (2) suitability for trainee experience level. A comprehensive cESD task list was constructed and an assessment tool created based on SME review of key characteristics (e.g., comprehensiveness and usability). CONCLUSION: We describe a comprehensive framework to develop educational curricula for complex surgical/endoscopic techniques with logistical challenges. To illustrate the sustainability of this training model and impact on patient outcomes, we plan to further develop and implement this program nationally.

Multiple Patient Casualty Scenarios: A Measurement Tool for Teamwork.

INTRODUCTION: Teamwork is a critical aspect of patient care and is especially salient in response to multiple patient casualties. Effective training and measurement improve team performance. However, the literature currently lacks a scientifically developed measure of team performance within multiple causality scenarios, making training and feedback efforts difficult. The present effort addresses this gap by integrating the input of subject matter experts and the science of multicasualty teams and training to (1) identify overarching teamwork processes and corresponding behaviors necessary for team performance and (2) develop a behavioral observation tool to optimize teamwork in multicasualty training efforts. METHOD: A search of articles including team performance frameworks associated with team training was conducted, leading to the identification of a total of 14 articles. Trained coders extracted teamwork processes and the corresponding team behaviors indicative of effective performance from these articles. Five subject matter experts were interviewed using the critical incident technique to identify additional behaviors. RESULTS: Team situation awareness, team leadership, coordination, and information exchange emerged as the four core team processes required for team performance in scenarios with multiple patient casualties. Relevant behaviors and subbehaviors within these overarching processes were identified to inform a pilot behavioral framework of team performance. CONCLUSIONS: The processes and associated behaviors identified within this effort serve as scientifically grounded behaviors of team performance in the case of multiple patient casualties simulated training scenarios. Future work can use and further refine these results to ensure that measures of team performance are grounded in specific, observable, and scientifically delineated behaviors.