Objective: To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum.
Setting: Level 1 trauma center and academic emergency medicine training program.
Participants: Emergency department (ED) staff including nurses, technicians, emergency medicine residents, and attending physicians.
Intervention: : ED staff who had recently received didactic training in the Emergency Team Coordination Course (ETCC®) also received an 8 hour intensive experience in an ED simulator in which three scenarios of graduated difficulty were encountered. A comparison group, also ETCC trained, was assigned to work together in the ED for one 8 hour shift. Experimental and comparison teams were observed in the ED before and after the intervention.
Design: Single, crossover, prospective, blinded and controlled observational study. Teamwork ratings using previously validated behaviorally anchored rating scales (BARS) were completed by outside trained observers in the ED. Observers were blinded to the identification of the teams.
Results: There were no significant differences between experimental and comparison groups at baseline. The experimental team showed a trend towards improvement in the quality of team behavior (p = 0.07); the comparison group showed no change in team behavior during the two observation periods (p = 0.55). Members of the experimental team rated simulation based training as a useful educational method.
Conclusion: High fidelity medical simulation appears to be a promising method for enhancing didactic teamwork training. This approach, using a number of patients, is more representative of clinical care and is therefore the proper paradigm in which to perform teamwork training. It is, however, unclear how much simulator based training must augment didactic teamwork training for clinically meaningful differences to become apparent.
- high fidelity medical simulation
- patient safety
- error prevention
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See editorial commentary, p 413
Research for this study was supported by the Army Research Laboratory contract #DAAL01-96-C-0091. The views, opinions, or findings expressed are those of the authors and should not be construed as an official position of the US Department of Defense or its agencies. Steve Small was supported by AHRQ grants P20 HS11553 and U18 HS 11905 in the revision/rewriting of this paper. Marc Shapiro was supported by AHRQ grant P20 HS 11592 in the revision of this paper.