Working in ad hoc teams in a health care environment is frequent but a challenging and complex undertaking. One way for teams to refine their teamwork could be through post-resuscitation reflection ...and debriefing. However, this would require that teams have insight into the quality of their teamwork. This study investigates (1) the accuracy of the self-monitoring of ad hoc resuscitation teams and their leaders relative to external observations of their teamwork and (2) the relationship of team self-monitoring and external observations to objective performance measures.
We conducted a quantitative observational study of real-world ad hoc interprofessional teams responding to a simulated cardiac arrest in an emergency room. Teams consisting of residents, consultants, and nurses were confronted with an unexpected, simulated, standardized cardiac arrest situation. Their teamwork was videotaped to allow for subsequent external evaluation on the team emergency assessment measure (TEAM) checklist. In addition, objective performance measures such as time to defibrillation were collected. All participants completed a demographic questionnaire prior to the simulation and a questionnaire tapping their perceptions of teamwork directly after it.
22 teams consisting of 115 health care professionals showed highly variable performance. All performance measures intercorrelated significantly, with the exception of team leaders' evaluations of teamwork, which were not related to any other measures. Neither team size nor cumulative experience were correlated with any measures, but teams led by younger leaders performed better than those led by older ones.
Team members seem to have better insight into their team's teamwork than team leaders. As a practical consequence, the decision to debrief and the debriefing itself after a resuscitation should be informed by team members, not just leaders.
In Arthur Schnitzlers Traumnovelle und in Stanley Kubricks filmischer Adaption Eyes Wide Shut ist die Maske zentrales Darstellungsmittel von Schaulust, Blick und Scham. So, wie die Maske das Gesicht ...verhüllt, so versucht der Beschämte, sich vor dem enthüllenden Blick des Anderen zu verbergen.Ausgehend von der aktuellen psychoanalytischen Scham-Theorie wird hier erstmals gezeigt, wie die spezifische Medialität von Scham und Maske nicht nur die Figuren, sondern auch die ästhetischen Strategien in Text und Film maßgeblich prägt und reflektiert. Dies betrifft u.a. die Wahrnehmung des Zuschauers/Lesers, die filmische und literarische Inszenierung des Blicks, die Visualität und die Frage der Darstellbarkeit.
The objective of this article is a description of the longitudinal communication curriculum in the Model Medicine Curriculum (MSM) at Charité - Universitätsmedizin Berlin. The authors describe the ...planning and integration of the curriculum into the study program, outline how communicative competence is taught and evaluated in the MSM, and identify which challenges need to be mastered in the process.
Starting with the introduction of the MSM in 2010, students have been spending 102 class hours, spread out over seven semesters, practicing social and communicative competences in the interactive small group format "Communication, Interaction & Teamwork (KIT)". The course contents are closely linked to the topics covered each semester and increase in complexity over the course of their studies. The contents are selected by the KIT planning group whose members continually check the curriculum's timeliness and determine any changes. Students as well as instructors have opportunities for evaluating KIT throughout, and their evaluations are taken into consideration as KIT continues to be updated. Instructors from different disciplines teach KIT courses. They participate in mandatory didactic trainings that prepare them to teach KIT. During their 4
and 9
semesters, respectively, students take summative exams that test their communicative competence.
According to the semester evaluations by students and instructors, students participating in KIT improved their conversation management skills (students: M=2.2, SD=1.1, instructors: M=1.9, SD=0.7, on a scale of 1-5). In addition, students and graduates rate KIT to be (very) relevant, consider the degree to which it is taught in the MSM to be (very) high, and consider KIT to be a meaningful part of the curriculum. Students taking the summative exams in their 4
and 9
semesters achieve a mean score of 75.9%, respectively 76.9%, in the purely communicative stations and 82.6%, respectively 83.3%, in the global evaluation of communicative competence in clinical-practical stations.
Survey and exam results alike indicate that the communication training is well accepted by students and instructors and that the training led to an improvement in general and specific communicative skills. Due to a lack of control groups or a pre-post design, it has thus far not been possible to unequivocally demonstrate a causal relationship between communicative competence trainings and good test results. Quality control measures, such as trainings for instructors and regular course evaluations, have been designed to address any challenges in the implementation of the communication curriculum at the faculty level.
Building on the experience with the Charité's Reformed Medical Curriculum, a longitudinal, competence-based communication curriculum was integrated into the MSM's overall curriculum. This measure remedied a gap in the medical training that many graduates of regular study programs had previously bemoaned (Jansen 2010 1).
IntroductionMedical errors have an incidence of 9% and may lead to worse patient outcome. Teamwork training has the capacity to significantly reduce medical errors and therefore improve patient ...outcome. One common framework for teamwork training is crisis resource management, adapted from aviation and usually trained in simulation settings. Debriefing after simulation is thought to be crucial to learning teamwork-related concepts and behaviours but it remains unclear how best to debrief these aspects. Furthermore, teamwork-training sessions and studies examining education effects on undergraduates are rare. The study aims to evaluate the effects of two teamwork-focused debriefings on team performance after an extensive medical student teamwork training.Methods and analysesA prospective experimental study has been designed to compare a well-established three-phase debriefing method (gather–analyse–summarise; the GAS method) to a newly developed and more structured debriefing approach that extends the GAS method with TeamTAG (teamwork techniques analysis grid). TeamTAG is a cognitive aid listing preselected teamwork principles and descriptions of behavioural anchors that serve as observable patterns of teamwork and is supposed to help structure teamwork-focused debriefing. Both debriefing methods will be tested during an emergency room teamwork-training simulation comprising six emergency medicine cases faced by 35 final-year medical students in teams of five. Teams will be randomised into the two debriefing conditions. Team performance during simulation and the number of principles discussed during debriefing will be evaluated. Learning opportunities, helpfulness and feasibility will be rated by participants and instructors. Analyses will include descriptive, inferential and explorative statistics.Ethics and disseminationThe study protocol was approved by the institutional office for data protection and the ethics committee of Charité Medical School Berlin and registered under EA2/172/16. All students will participate voluntarily and will sign an informed consent after receiving written and oral information about the study. Results will be published.
In Arthur Schnitzlers Traumnovelle und in Stanley Kubricks filmischer Adaption Eyes Wide Shut ist die Maske zentrales Darstellungsmittel von Schaulust, Blick und Scham. So, wie die Maske das Gesicht ...verhüllt, so versucht der Beschämte, sich vor dem enthüllenden Blick des Anderen zu verbergen. Ausgehend von der aktuellen psychoanalytischen Scham-Theorie wird hier erstmals gezeigt, wie die spezifische Medialität von Scham und Maske nicht nur die Figuren, sondern auch die ästhetischen Strategien in Text und Film maßgeblich prägt und reflektiert. Dies betrifft u.a. die Wahrnehmung des Zuschauers/Lesers, die filmische und literarische Inszenierung des Blicks, die Visualität und die Frage der Darstellbarkeit.
The introduction of innovative teaching formats and methods in medical education requires a specific didactic training for teachers to use complicated formats effectively. This paper describes ...preliminary considerations, design, implementation and evaluation of a skills-based workshop (7,5 hours long) for teaching with simulated patients. The aim is to describe the essential components for a lasting effect of the workshop so that the concept can be adapted to other contexts.
We present the theoretical framework, the objectives, the didactic methodology and the implementation of the workshop. The evaluation of the workshop was carried out using questionnaires. First the participants (teachers of the faculty of medicine, clinical and science subjects) were asked to estimate how well they felt prepared for small group teaching immediately after workshop. Later, after some teaching experience of their own, they gave feedback again as a part of the general evaluation of the semester.
In the course of three years 27 trainings were conducted and evaluated with a total of 275 participants. In the context of semester evaluation 452 questionnaires were evaluated on the quality of training.
The evaluation shows that participants appreciate the concept of the workshop and also feel sufficiently well prepared. As a limitation it must be said that this is so far only the lecturers' self-assessment. Nevertheless, it can be stated that even a one-day workshop with a stringent teaching concept shows long term results regarding innovative teaching methods.
Adverse events in patient care are often caused by failures in teamwork. Simulation training and its debriefing can contribute to improving teamwork and thus patient care. When conducting ...debriefings, there are several design factors that can potentially influence learning outcomes. This study examines the use of a cognitive aid to help structure the content of debriefings and compares it with debriefings that are merely roughly structured. In addition, the feasibility of the debriefing, the satisfaction of the participants and their teamwork during the training are investigated.
In a simulated night shift, seven teams of four to five medical students (n=32) took part in six cases that simulated common situations in an emergency medicine environment and received a debriefing on their teamwork after each case, either in the intervention condition with the help of the TeamTAG tool - a cognitive aid focusing on selected teamwork principles from Crisis Resource Management (CRM) - or in the control condition without it. The facilitators noted the topics of the debriefings and rated their experience of conducting them; the participants indicated their satisfaction with the debriefings, as well as their assessment of the importance of CRM principles. In addition, the quality of teamwork was assessed using the Team Emergency Assessment Measure (TEAM).
The analysis showed no difference in the number of teamwork principles discussed between the control and intervention conditions, but topics were repeated more frequently in the control group. The TeamTAG guideline was focused on and implemented by the tutors, who discussed the CRM principles included in the TeamTAG more consistently than in the control condition. The tutors in both conditions were satisfied with the implementation, and the use of TeamTAG facilitated time management. There were no differences in participants' satisfaction, their assessment of the importance of the teamwork principles, or the quality of teamwork between conditions.
The use of a cognitive aid can help to direct the focus on certain topics or learning objectives and facilitate time management through pre-structuring; however, a difference in learning outcomes (in terms of the quality of teamwork) could not be identified. Besides the influence of a certain structure or script, a strong influence from the individual guiding the debriefing is likely.
Nowadays, faculty development programs to improve teaching quality are considered to be very important by medical educators from all over the world. However, the assessment of the impact of such ...programs rarely exceeds tests of participants' knowledge gain or self-assessments of their teaching behavior. It remains unclear what exactly is expected of the attending faculty and how the transfer to practice may be measured more comprehensively and accurately.
This study evaluates how specific teaching standards were applied after a workshop (10 teaching units) focusing on teaching communication skills with simulated patients. Trained observers used a validated checklist to observe 60 teaching sessions (held by 60 different teachers) of a communication skills course integrating simulated patients. Additionally, we assessed the amount of time that had passed since their participation in the workshop and asked them to rate the importance of communication and social skills in medical education.
The observations showed that more than two thirds of teaching standards were met by at least 75% of teachers. Fulfillment of standards was significantly connected to teachers' rating of the importance of communication and social skills (
=-.21,
=.03). In addition, the results suggest a slight decrease in the amount of fulfilled standards over time (
=-.14,
=.15).
Teachers' adherence to basic teaching standards was already satisfying after a one-day workshop. More complex issues need to be re-addressed in further faculty development courses with a special focus on teachers' attitude towards teaching. In future, continuing evaluations of the transfer of knowledge and skills from faculty development courses into practice, preferably including pre-tests or control groups, are needed.
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