Most medical care is delivered by teams but the majority of healthcare education is conducted in settings where students are segregated by discipline. Many medical errors are attributed to system failures which represent a breakdown in medical team function. The Agency for Healthcare Research and Quality (AHRQ) has promoted the TeamSTEPPS® program as a framework for educating healthcare personnel on the important aspects of medical team operations.1–3 We assessed differences in nursing students self-identified use of/intention to use TeamSTEPPS® medical teamwork skills at two points; before and after an interactive didactic presentation and after a series of three interprofessional high-fidelity simulations focusing on medical teamwork operations. Our research hypotheses included: 1) Nursing students will acknowledge a baseline low-to-moderate historical level of medical team skill utilization; 2) The TeamSTEPPS® Essentials presentation will produce a small but significant increase in nursing students intention to utilize medical team operation skills; 3) Nursing students will have a significant increase in their intention to utilize medical team operation skills following a series of three interprofessional high-fidelity simulation experiences and will identify factors which promote or inhibit effective interprofessional teamwork in the simulation experience and in their clinical sites.
A repeated measures design was used to assess past actions and future intentions regarding medical operation teamwork skills. Two cohorts of senior nursing students participating in a final capstone course (total n=177) were asked to anonymously complete the three researcher developed surveys based on the TeamSTEPPS® program. All surveys used the same eight five-point Likert-scale questions. The final survey included two additional Likert-scale questions and two open ended questions to assess student’s perception of potential opportunities to improve support of teamwork during the simulation activity and at their clinical sites. Each cohort completed the first survey via an audience response system prior to a one hour interactive TeamSTEPPS® Essentials session conducted by the PI. The students completed the second survey by audience response system immediately after completion of the TeamSTEPPS® session. Students were then scheduled in groups of 12 students to complete an interprofessional high-fidelity simulation session over the next eight weeks. All students completed a hands-on experience in subgroups of four in one emergency department (ED) scenario with an ED resident as the team leader (n=21 ED residents total) and observed two additional ED scenarios during a four hour simulation session. The debriefing following each scenario focused on teamwork skills, as well as task related skills. Participants completed the third and final survey immediately after the final debriefing. Differences between first and second surveys were compared using the t-test for paired responses from the same subject. Survey three Results were compared to Survey two using the t-test for responses from samples with equal variance. The study was approved by the affiliating university Institutional Review Board.
With the exception of one question in the first cohort, both cohorts demonstrated a significant increase in Likert-scores from pre-presentation to post-presentation (p<0.05). There were no significant differences in scores from post-presentation to post-simulation in either cohort (p>0.05). Students in both cohorts perceived the simulation lab to be a significantly better environment for medical team operations than their clinical sites (p≤0.01). Open-ended questions indicated students appreciated the opportunity to experience a safe environment for teamwork operations and practice TeamSTEPPS® tools with an actual medical provider.
A brief interactive TeamSTEPPS® presentation significantly enhanced student intentions to improve medical team behaviors. We could not demonstrate further enhancements following simulations. This may be due to the high post-presentation scores (>4.8 on a 5-point scale) or potentially because simulation is better suited to practicing teamwork skills than improving the intention to change.
1. Agency for Healthcare Research and Quality (AHRQ). TeamSTEPPS® website. http://teamstepps.ahrq.gov/. Accessed June 28, 2013.
2. Bridges DR, et. al. Interprofessional collaboration: three best practice Models of interprofessional education. 2011 Medical Education Online 2011, 16: 6035 - DOI: 10.3402/meo.v16i0.6035.
3. Stewart M, Kennedy N. Undergraduate interprofession al education using high-fidelity paediatric simulation. 2010. THE CLINICAL TEACHER 2010; 7: 90–96
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