Assessing teamwork in medical education and practice: relating behavioural teamwork ratings and clinical performance.

BACKGROUND: Problems with communication and team coordination are frequently linked to adverse events in medicine. However, there is little experimental evidence to support a relationship between observer ratings of teamwork skills and objective measures of clinical performance. AIM: Our main objective was to test the hypothesis that observer ratings of team skill will correlate with objective measures of clinical performance. METHODS: Nine teams of medical students were videotaped performing two types of teamwork tasks: (1) low fidelity classroom-based patient assessment and (2) high fidelity simulated emergent care. Observers used a behaviourally anchored rating scale to rate each individual on skills representative of assertiveness, decision-making, situation assessment, leadership, and communication. A checklist-based measure was used to assess clinical team performance. RESULTS: Moderate to high inter-observer correlations and moderate correlations between cases established the validity of a behaviourally anchored team skill rating tool for simulated emergent care. There was moderate to high correlation between observer ratings of team skill and checklist-based measures of team performance for the simulated emergent care cases (r = 0.65, p = 0.06 and r = 0.97, p < 0.0001). CONCLUSIONS: These results provide prospective evidence of a positive relationship between observer ratings of team skills and clinical team performance in a simulated dynamic health care task.

The "Simulation Roulette" game.

INTRODUCTION: "Simulation Roulette" is a new method of "on-the-fly" simulation scenario creation that incorporates a game-like approach to critical scenarios and emphasizes prescenario preparation. We designed it to complement our traditional anesthesia simulation curriculum, in which residents are exposed to predefined "critical" scenarios. During typical scenarios, trainees are often given minimum preparatory information; they then start the scenario knowing only that "something bad" is going to happen. As a result, trainees often report anxiety, which can be a barrier to learning. To overcome this barrier and to augment traditional critical incident training, we developed the "Simulation Roulette" game. METHODS: "Simulation Roulette" consists of premade cards that are randomly selected to create a patient, another set of premade cards to assist in selecting "complications," worksheets to guide a thorough "prebrief" discussion before the scenario, and scoresheets to facilitate the "debrief" discussion at the end. Similar to traditional scenarios, it requires coordination by a facilitator to ensure plausible scenarios and evaluation of trainee performance. RESULTS: Although we have not conducted formal testing, we believe that (1) incorporating an element of random chance to scenario selection, (2) using a game-like framework, and (3) emphasizing the "prebrief" portion of simulation all have the potential to decrease trainee anxiety. CONCLUSIONS: We present the rationale for designing such a game; examples of instructions, cards, and scoresheets; and our initial experience with implementing this game within our simulation curriculum.

Evaluation of the System O2 Inc portable nonpressurized oxygen delivery system.

OBJECTIVE: To evaluate the performance of the System O2 portable non-pressurized delivery system (SysO2). This device produces oxygen through chemical reaction and might have utility for emergency/field use. METHODS: Performance was evaluated with 10 unmanned trials conducted under standard laboratory conditions. Measures included oxygen flow (mean and peak), total oxygen yield, and system weight-indexed yield. RESULTS: Oxygen flow peaked at 5.74 +/- 0.28 L x min(-1) (mean +/- SD) at 16.9 +/- 1.5 minutes before rapidly falling to zero. Mean flow was 2.98 +/- 1.52 L x min(-1) with a total yield of 62.9 +/- 6.6 L. Mean oxygen fraction was 0.96 +/- 0.15. The weight per unit of oxygen is substantially higher than for commercially available pressurized cylinders; e.g., 47.7 vs. 10.2 g x L(-1) for the small 246 L M9 cylinder. CONCLUSIONS: Given the limited flow rate and supply duration, we believe the SysO2 system does not offer significant advantage over the available pressurized oxygen systems as a source for emergency oxygen.