!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> Streamline Training & Documentation: Teamwork Training for Healthcare Settings

Wednesday, May 07, 2008

Teamwork Training for Healthcare Settings

In March 2006 the Agency for Healthcare Research and Quality of the US Department of Health and Human Services published an exchange concerning the relative merits of classroom training and high-fidelity simulation for teaching teamwork skills to healthcare professionals.

In this "point-counterpoint" pair of articles, Stephen D. Pratt of Harvard Medical School and Benjamin P. Sachs, now dean of the Tulane School of Medicine, take one side, arguing that
classroom-based team training with low-level simulation is the most effective way to implement [teamwork training] programs in today's environment, particularly given the high cost, both in money and manpower, of high-fidelity simulation.
Pratt and Sachs divide teamwork training into two phases, the teaching phase, and the phase of transfer to the clinical setting. They cite three advantages to using classroom training for the teaching phase:
  • No need for an expensive simulation set-up.

  • More staff can be trained at any one time.

  • Class-based training is easy to schedule as part of the staff orientation process.
As for the implementation phase, in which skills are transferred to actual delivery of patient care, Pratt and Sachs argue that
high-fidelity simulation is highly limited in its ability to effectively teach ... CRM [crew resource management]-based unit management, partly because it has overemphasized crisis management. ... In addition, it would simply be cost prohibitive to build simulated environments with multiple patients and many caregivers.
Instead of simulation, Pratt and Sachs advocate intensive coaching for the implementation phase.

The argument in favor of using high-fidelity simulation for healthcare teamwork training is presented by David M. Gaba, a Stanford professor of anesthesia and associate dean of the Stanford School of Medicine's Center for Immersive and Simulation-Based Learning. Gaba notes that
In many settings (such as in the OR, the ICU, or the ED [emergency department]), one has to simultaneously make clinical decisions, perform procedures,and interact with team members. Doing this is not easy, and integrating all these skills optimally takes practice.

I propose that only simulations of various sorts that involve the key dynamic of the environment can provide such practice in any credible fashion. Neither classroom work nor intensive coaching in real settings can fully probe the complexities of real interpersonal and patient care situations ...
The advantages Gaba cites for using simulation for teamwork training are that it:
  • Involves participants in clinically challenging situations that link directly to their previous work experience.

  • Provides scenarios of known and specific challenge to teamwork skills.

  • Provides opportunities for cross-role understanding and even cross-training and practice in the work of different roles.

  • Facilitates reflection on practice by the team through a shared review of what transpired in the simulation scenario.

  • Provides scheduled time for such exercises, with specially trained teaching faculty.
Gaba also argues that "team-oriented simulations do not necessarily require expensive simulation systems," though he also says that "in many settings a fully interactive patient simulator will be needed to provide credible and challenging clinical work for individuals and teams."

(You can see an example of a patient simulator here. An earlier post dealing with modeling healthcare teamwork processes on crew resource management is here.)


Labels: ,