Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical ...clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.
Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioural and technical performance measures. Analysis using Generalisability and Decision studies were completed for the two scenarios with two raters.
The behavioural score was not more reliable than the technical score. With two raters > 20 scenarios would be required to achieve a reliability estimate of 0.7. Increasing the number of raters for a given scenario would have little effect on reliability.
The performance of practicing physicians on simulated critical events may be highly context-specific. Realistic simulation-based assessment for practicing physicians is resource-intensive and may be best-suited for individualized formative feedback. More importantly, aggregate data from a population of participants may have an even higher impact if used to identify skill or knowledge gaps to be addressed by training programs and inform continuing education improvements across the profession.
We reviewed the available literature on measuring human performance to evaluate human-system interfaces (HSIs), focused on high-fidelity simulations of industrial process control systems, to identify ...best practices and future directions for research and operations. We searched the available literature and then conducted in-depth review, structured coding, and analysis of 49 articles, which described 42 studies. Human performance measures were classified across six dimensions: task performance, workload, situation awareness, teamwork/collaboration, plant performance, and other cognitive performance indicators. Many studies measured performance in more than one dimension, but few studies addressed more than three dimensions. Only a few measures demonstrated acceptable levels of reliability, validity, and sensitivity in the reviewed studies in this research domain. More research is required to assess the measurement qualities of the commonly used measures. The results can provide guidance to direct future research and practice for human performance measurement in process control HSI design and deployment.
•Human performance measures in process control HSI evaluation were reviewed.•The reviewed measures were categorized into six human performance dimensions.•Many of the measures were not adequately evaluated in the reviewed domain.•We provided recommendations on current practices and future directions.
Burnout can lead to health and psychologic problems and is apparently increasing in physicians and nurses. Previous studies have not evaluated all healthcare workers within a single work unit. This ...study evaluates the risk of burnout in all medical personnel in one perioperative unit.
We developed an online survey that included demographics, a modified version of the Maslach Burnout Inventory-Human Services Survey, and the Social Support and Personal Coping Survey. Survey constructs (e.g., depersonalization and health) and a global score were calculated. Larger construct and global values were associated with higher risk of burnout. These were separately regressed on role, age, and sex. The global score was then regressed on each of the survey constructs.
Of the 145 responses, 46.2% were physicians (22.8% residents), 43.4% were nurses or nurse anesthetists, and 10.3% were other personnel. After adjusting for sex and age, residents scored higher than other physicians on the following (expected change 95% confidence interval): global score (1.12 0.43-1.82), emotional exhaustion (1.54 0.44-2.60), and depersonalization (1.09 0.23-1.95). Compared with nonphysicians, residents were 1 U or more higher on these items (P < 0.05 in all cases). Residents had higher health (1.49 0.48-2.50) and workload (1.23 0.07-2.40) values compared with physicians. Better health, personal support, and work satisfaction scores were related to decreased global scores (P < 0.05).
Physicians (particularly residents) had the largest global burnout scores, implying increased risk of burnout. Improving overall health, increasing personal support, and improving work satisfaction may decrease burnout among perioperative team members.
During routine cases, anesthesia providers may divert their attention away from direct patient care to read clinical (e.g., medical records) and/or nonclinical materials. The authors sought to ...ascertain the incidence of intraoperative reading and measure its effects on clinicians' workload and vigilance.
In 172 selected general anesthetic cases in an academic medical center, a trained observer categorized the anesthesia provider's activities into 37 possible tasks. Vigilance was assessed by the response time to a randomly illuminated alarm light. Observer- and subject-reported workload were scored at random intervals. Data from Reading and Non-Reading Periods of the same cases were compared to each other and to matched cases that contained no observed reading. The cases were matched before data analysis on the basis of case complexity and anesthesia type.
Reading was observed in 35% of cases. In these 60 cases, providers read during 25 +/- 3% of maintenance but not during induction or emergence. While Non-Reading Cases (n = 112) and Non-Reading Periods of Reading Cases did not differ in workload, vigilance, or task distribution, they both had significantly higher workload than Reading Periods. Vigilance was not different among the three groups. When reading, clinicians spent less time performing manual tasks, conversing with others, and recordkeeping.
Anesthesia providers, even when being observed, read during a significant percentage of the maintenance period in many cases. However, reading occurred when workload was low and did not appear to affect a measure of vigilance.
Failures of teamwork and interpersonal communication have been cited as a major patient safety issue. Although healthcare is increasingly being provided in interdisciplinary teams, medical school ...curricula have traditionally not explicitly included the specific knowledge, skills, attitudes, and behaviors required to function effectively as part of such teams.
As part of a new "Foundations" core course for beginning medical students that provided a two-week introduction to the most important themes in modern healthcare, a multidisciplinary team, in collaboration with the Center for Experiential Learning and Assessment, was asked to create an experiential introduction to teamwork and interpersonal communication. We designed and implemented a novel, all-day course to teach second-week medical students basic teamwork and interpersonal principles and skills using immersive simulation methods. Students' anonymous comprehensive course evaluations were collected at the end of the day. Through four years of iterative refinement based on students' course evaluations, faculty reflection, and debriefing, the course changed and matured.
Four hundred twenty evaluations were collected. Course evaluations were positive with almost all questions having means and medians greater than 5 out of 7 across all 4 years. Sequential year comparisons were of greatest interest for examining the effects of year-to-year curricular improvements. Differences were not detected among any of the course evaluation questions between 2007 and 2008 except that more students in 2008 felt that the course further developed their "Decision Making Abilities" (OR 1.69, 95% CI 1.07-2.67). With extensive changes to the syllabus and debriefer selection/assignment, concomitant improvements were observed in these aspects between 2008 and 2009 (OR = 2.11, 95% CI: 1.28-3.50). Substantive improvements in specific exercises also yielded significant improvements in the evaluations of those exercises.
This curriculum could be valuable to other medical schools seeking to inculcate teamwork foundations in their medical school's preclinical curricula. Moreover, this curriculum can be used to facilitate teamwork principles important to inter-disciplinary, as well as uni-disciplinary, collaboration.
Nonroutine events (NREs, i.e., deviations from optimal care) can identify care process deficiencies and safety risks. Nonroutine events reported by clinicians have been shown to identify systems ...failures, but this methodology fails to capture the patient perspective. The objective of this prospective observational study is to understand the incidence and nature of patient- and clinician-reported NREs in ambulatory surgery.
We interviewed patients about NREs that occurred during their perioperative care using a structured interview tool before discharge and in a 7-day follow-up call. Concurrently, we interviewed the clinicians caring for these patients immediately postoperatively to collect NREs. We trained 2 experienced clinicians and 2 patients to assess and code each reported NRE for type, theme, severity, and likelihood of reoccurrence (i.e., likelihood that the same event would occur for another patient).
One hundred one of 145 ambulatory surgery cases (70%) contained at least one NRE. Overall, 214 NREs were reported-88 by patients and 126 by clinicians. Cases containing clinician-reported NREs were associated with increased patient body mass index ( P = 0.023) and lower postcase patient ratings of being treated with respect ( P = 0.032). Cases containing patient-reported NREs were associated with longer case duration ( P = 0.040), higher postcase clinician frustration ratings ( P < 0.001), higher ratings of patient stress ( P = 0.019), and lower patient ratings of their quality of life ( P = 0.010), of the quality of clinician teamwork ( P = 0.010), being treated with respect ( P = 0.003), and being listened to carefully ( P = 0.012). Trained patient raters evaluated NRE severity significantly higher than did clinician raters ( P < 0.001), while clinicians rated recurrence likelihood significantly higher than patients for both clinician ( P = 0.032) and patient-reported NREs ( P = 0.001).
Both patients and clinicians readily report events during clinical care that they believe deviate from optimal care expectations. These 2 primary stakeholders in safe, high-quality surgical care have different experiences and perspectives regarding NREs. The combination of patient- and clinician-reported NREs seems to be a promising patient-centered method of identifying healthcare system deficiencies and opportunities for improvement.
Describe prevalence of burnout in perianesthesia nurses, explore risks, mitigating factors.
Cross-sectional descriptive.
Survey containing Maslach Burnout Inventory, Short Form-12, and Social Support ...and Personal Coping was emailed to American Society of PeriAnesthesia Nurses. Regression analysis examined relationships between burnout and health, social support, personal coping, substance use, and demographics.
Of 2,837 respondents, 18% were currently and 35% were formerly burned out, with lower incidence in those >40 years. Currently burned out nurses had worse health and also perceived a lack of advancement opportunities and organizational investment in the individual. Lower burnout was associated with regular participation in physical (P < .001), creative (P = .004), or mindfulness hobbies (P < .001) and ease in discussing work problems with spouse or partner (P = .001).
Despite burnout nurses' empathy for their patients is maintained. Interests outside of work, personal and work support, healthy work environment, and regular physical activities can improve burnout.
Objective:
This study adapted ecological momentary assessment methods to: (a) examine differences in work stress between nurses and physicians, and (b) to study relationships between work stress, ...work activity patterns, and sleep.
Design:
A total of 185 physicians and 119 nurses (206 women, 98 men) working in four teaching hospitals participated in an observational study of work stress.
Main Outcome Measures:
Participants carried handheld computers that randomly prompted them for work activity, patient load, and work stress information.
Results:
Participants completed more than 9,500 random interval surveys during the study (an average of 30.8 surveys per person-week). Approximately 85% of all surveys were completed in full (73.3%) or partially (11.6%). Emotional stress scores among physicians were nearly 50% higher (26.919.0) than those of nurses (18.114.9,
r
302 = .37,
p
< .001). Direct and indirect care activities were associated with higher stress reports by both clinician groups (
r
s159 = .14-.26,
p
s < .01). Sleep quality and quantity were predictors of work stress scores (
p
s < .05). Finally, higher work stress and lower sleep quality were also associated with poorer memory performance (
r
302 = −.12, .17,
p
s < 05).
Conclusions:
The findings identify patterns of work stress in relationship to work activities, sleep habits, and provider differences that may be used to assist ongoing hospital work reform efforts.
Full text
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
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