A simulation-based curriculum to introduce key teamwork principles to entering medical students

Banerjee et al. BMC Medical Education (2016) 16:295 DOI 10.1186/s12909-016-0808-9 RESEARCH ARTICLE Open Access A simulation-based curriculum to introduce key teamwork principles to entering medical students Arna Banerjee1,2*, Jason M. Slagle3,4, Nathaniel D. Mercaldo5, Ray Booker2, Anne Miller3,6,7, Daniel J. France3,4, Lisa Rawn2,8 and Matthew B. Weinger2,3,4,9 Abstract Background: Failures of teamwork and interpersonal communication have been cited as a major patient safety issue. Although healthcare is increasingly being provided in interdisciplinary teams, medical school curricula have traditionally not explicitly included the specific knowledge, skills, attitudes, and behaviors required to function effectively as part of such teams. Methods: As part of a new “Foundations” core course for beginning medical students that provided a two-week introduction to the most important themes in modern healthcare, a multidisciplinary team, in collaboration with the Center for Experiential Learning and Assessment, was asked to create an experiential introduction to teamwork and interpersonal communication. We designed and implemented a novel, all-day course to teach second-week medical students basic teamwork and interpersonal principles and skills using immersive simulation methods. Students’ anonymous comprehensive course evaluations were collected at the end of the day. Through four years of iterative refinement based on students’ course evaluations, faculty reflection, and debriefing, the course changed and matured. Results: Four hundred twenty evaluations were collected. Course evaluations were positive with almost all questions having means and medians greater than 5 out of 7 across all 4 years. Sequential year comparisons were of greatest interest for examining the effects of year-to-year curricular improvements. Differences were not detected among any of the course evaluation questions between 2007 and 2008 except that more students in 2008 felt that the course further developed their “Decision Making Abilities” (OR 1.69, 95% CI 1.07–2.67). With extensive changes to the syllabus and debriefer selection/assignment, concomitant improvements were observed in these aspects between 2008 and 2009 (OR = 2.11, 95% CI: 1.28–3.50). Substantive improvements in specific exercises also yielded significant improvements in the evaluations of those exercises. Conclusions: This curriculum could be valuable to other medical schools seeking to inculcate teamwork foundations in their medical school’s preclinical curricula. Moreover, this curriculum can be used to facilitate teamwork principles important to inter-disciplinary, as well as uni-disciplinary, collaboration. Keywords: Teamwork, Communication, Simulation, Interpersonal skills, Curriculum development, Iterative curriculum design, Course evaluation, Standardized patients, Undergraduate medical education, Geriatrics education * Correspondence: 1 Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue S, 526 MAB, Nashville, TN 37212, USA 2 Department of Medical Education, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center, Nashville, TN, USA Full list of author information is available at the end of the article © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Banerjee et al. BMC Medical Education (2016) 16:295 Background Failures of teamwork and interpersonal communication have been cited as a major patient safety issue [1–6]. The 1999 Institute of Medicine (IOM) report, To Err is Human [7], reported a very high rate of preventable medical errors associated with dysfunctional teamwork or failed communication. Such failures may be especially high in patients with multiple complex conditions, in emergencies, and during care transitions. The Joint Commission identified communication as a critical factor in more than 65% of reported sentinel events [8]. For example, Mazzocco and colleagues demonstrated that surgical teams that exhibited fewer team behaviors had worse patient outcomes [6]. In 2002, another IOM report dealing with healthcare curricula highlighted the importance of teamwork and communication as a core competency for healthcare professionals [9]. Yet, formal teamwork training is still uncommon in healthcare [10–12]. Increasingly, patients are cared for by distributed multidisciplinary teams of specialized healthcare professionals. Yet, the training of new physicians tends to be unidisciplinary, with few formal interactions with other healthcare providers until post-graduate training [13, 14]. To be effective team members, individuals must learn teamwork competencies. A team consists of a small number of people with complementary skills who are committed to a common purpose and perform goals for which they are mutually accountable [15]. A successful healthcare team must also maintain a common understanding of what is to be done and what constitutes success; make a commitment to achieving the team goals, technical competence (i.e., the collective knowledge and tools necessary to do the job), effective team communication (which requires shared information, trust, and respect), and effective coordination and collaboration; and develop an effective team culture [16]. The notion that communication and teamwork are essential to medical education is not new. Crisis Resource Management (CRM) techniques borrowed from aviation have been widely used to teach teamwork skills to healthcare providers, for example, in anesthesia [17] and emergency medicine [18]. The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense have collaboratively developed the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) tool intended to improve patient safety by training healthcare providers in interpersonal communication and other teamwork skills [19]. Traditionally, medical school curricula have not included instruction in the specific knowledge, skills, attitudes, and behaviors required to function as part of interdisciplinary care teams. The current literature on teamwork curricula for physicians is sparse and, despite Page 2 of 12 high face validity, there is as yet no high quality evidence that teamwork training of medical students has long-term or patient care quality impact [20–23]. Charkraborti, et al. [24], in a 2008 systematic review, identified only 13 studies of tea (...truncated)