DEVELOPING INTERPROFESSIONAL TEAMWORK COMPETENCIES USING TEAMSTEPPS® AND SIMULATION

Ohio Consortium of Nursing Learning Labs 2016

OUR INTERPROFESSIONAL TEAM

Dr. Rami Ahmed– Medicine Diane Brown – Nursing Diane Christensen – Nursing Dr. Connie Chronister – Nursing Kelli Chronister – Respiratory Therapy Marc Haas – Respiratory Therapy Martha Conrad – Director of IP Simulation

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WHERE OUR JOURNEY BEGAN …..

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FINDING COMMON LEARNING OPPORTUNITIES

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Teamwork

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MAKING A

• Learning objectives

• Simulation design• Critical care

context

• Debriefing• Evaluation

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TEAMWORK

Knowledge, Skills, and Attitudes Focus on

Communication Situation

Monitoring

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PLAN FOR PRE-BRIEF LEARNING

Students from different programs

Asynchronous online delivery TeamSTEPPS® video

recording link on YouTube

Clinical resources: articles, algorithms.

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SIMULATION DESIGN

• High-risk, low-frequency events

• Design using INACSL standards

• Embed cues to trigger student behaviors

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DEBRIEFING PLAN

StructuredFocused

on learning objectives“Good

judgment”

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EVALUATION OF LEARNING OUTCOMES

Satisfaction with learning and facilities

Evaluation of debriefing experience: DASH

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SUPPORTIVE PLANNING DETAILS

Tech support plan Patient charts Observer checklists Certificates Logistics Communicate

details to students

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SIMULATION TECH SUPPORT

Plan a meeting Make it real Keep track of details Review for changes

after an event

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CREATE A HEALTH RECORD

Paper or electronic?

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CREATE AN OBSERVER CHECKLIST

Actively engage observers

Useful during peer-peer debriefing

Learning occurs during observation.

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CERTIFICATE OF PARTICIPATION

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DESIGN A STUDENT ROTATION SCHEDULE

Provide rotation schedules for students.

Assign to teams: Ad hocSeat together during

orientation to facilitate socialization.

Balance teams by profession

May serve as a sign in sheet on event day

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LOGISTICS

Educator assignments

Balance assignments by profession

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STUDENT COMMUNICATION

Email students with details including: Who: will be there What: to bring, wear When: Date and time Where: Address and Parking Why: Learning objectives How: to prepare, resources, pre-

learning

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SIMULATION DAY

Orientation to facility and equipment

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INTERPROFESSIONAL SIMULATION DAY

Pre Pre-brief

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MOCK CODE SIMULATION

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DEBRIEFING

video…

Live

rapid cycle

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EVALUATION OF PROGRAM

Experience Learning Instruction Facility Recommendo Experienceo Facility

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SATISFACTION RESULTS

On a 0-4 point scale, 0= Very poor, 4=Excellent All items were rated very high

Mean score range 3.7-3.9.

The overall rating (all 4 items) Mean score 15 out of 16.

Recommend experience and facility: 100% of students recommend for future learning.

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QUALITATIVE COMMENTS: SATISFACTION

Student comments on evaluations Majority were positive with common themes:

Would like more opportunities Contributed to learning about other professions Good for learning teamwork

Specific to debriefing methods: few reported preference for live debriefing compared to tele-debriefing.

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INTERPRETATION OF SATISFACTION DATA

Interprofessional Learning was valued and recommended for future inclusion in their education.

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DEBRIEFING EVALUATION: DASH

Debriefing is the most important part of any simulation experience

Currently the most validated debriefing evaluation available

Several versions Easy to use Quick

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Should take 1-3 mins to complete-6 questions

-All on a 1-7 scale

DATE: ___________________ CIRCLE: MEDICAL STUDENT NURSING STUDENT RESP. THER. STUDENT FACULTY: ________________ INSTRUCTIONS: PLEASE EVALUATE THE FACULTY’S DEBRIEFING UTILIZING THE DASH ELEMENTS AND DIMENSIONS CRITERIA. DASH ELEMENTS AND DIMENSIONS • THE INSTRUCTOR SET THE STAGE FOR AN ENGAGING LEARNING

EXPERIENCE o The instructor introduced him/herself, described the simulation environment,

what would be expected during the activity, and introduced the learning objectives.

o The instructor explained the strengths and weaknesses of the simulation and what I could do to get the most out of simulated clinical experiences.

o The instructor attended to logistical details as necessary such as toilet location, food availability, schedule.

o The instructor made me feel stimulated to share my thoughts and questions about the upcoming simulation and debriefing and reassured me that I wouldn’t be shamed or humiliated in the process.

• THE INSTRUCTOR MAINTAINED AN ENGAGING CONTEXT FOR LEARNING o The instructor clarified the purpose of the debriefing, what was expected of me,

and the instructor’s role in the debriefing. o The instructor acknowledged concerns about realism and helped me learn even

thought the case(s) were simulated. o I felt that the instructor respected participants. o The focus was on learning and not on making people feel bad about making

mistakes. o Participants could share thoughts and emotions without fear of being shamed or

humiliated. • THE INSTRUCTOR STRUCTURED THE DEBRIEFING IN AN ORGANIZED WAY

1 2 3 4 5 6 7 1 2 3 4 5 6 7

DASH RESULTS

Debrief N Mean SD Sig.Live 55 34.5 4.8 p = .001Tele-remote 24 29.7 5.8

Live debriefing was rated statistically higher than Tele-debriefing

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RESULTS: SINGLE VS. MULTI-PROFESSIONAL

Debrief N Mean SD Sig.

Single profession 175 33.0 5.1 p = .74Multi-profession 62 32.8 5.3

No significant difference between single and multi-professional debriefing.

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LESSONS LEARNED

Schedule time to move students: have timekeepers, cushion, and think ahead.

Observer checklists add purpose Match complexity to student ability and time. Plan for alternative student decisions in the sim Run through simulations in advance Debriefing lessons: Faculty training

allow time & focus on learning objectives, video takes time, tele debrief depends on tech, Consider rapid cycle deliberate practice alternative

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KEY POINTS

Look for opportunities for collaboration Make a good plan: Work out logistics! Plan pre-sim learning Design simulations well and be open to revision Choose debrief structure and evaluation Plan to share your experience and findings

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REFERENCES

Ahmed R, King Gardner A, Atkinson SS, Gable B. (2014) Teledebriefing: connecting learners to faculty members. Clinical Teacher., 11(4):270-3.

Brett-Fleegler M, Rudolph J, Eppich W, Monuteaux M, Fleegler E, Cheng A, Simon R: (2012). Debriefing assessment for simulation in healthcare: Development and psychometric properties. Simulation in Healthcare, 7(5), 288-294.

Dreifuerst KT. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education; 51(6):326-333.

Fernandez, R., Kozlowski, S., Shapiro, M., & Salas, E. (2008). Toward a definition of teamwork in emergency medicine. Society for Academic Emergency Medicine, 15(11), 1104-1112.

Raemer D, Anderson M, Cheng A, Fanning R, Nadkarni V, Savoldelli G. (2011). Research regarding debriefing as part of the learning process. Simulation in Healthcare, S52-57.

TeamSTEPPS Instructor Guide 2.0. (2014). Agency for Healthcare Research and Quality. Retrieved from www.ahrq.gov

World Health Organization (2010). Framework for action on interprofessional education and collaborative practice. Geneva, Switzerland: World Health Organization.

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