Robertson Bethany, Schumacher Lori, Gosman Gabriella, Kanfer Ruth, Kelley Maureen, DeVita Michael
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA.
Simul Healthc. 2009 Summer;4(2):77-83. doi: 10.1097/SIH.0b013e31819171cd.
The use of team training programs is promising with regards to their ability to impact knowledge, attitudes, and behavior about team skills. The purpose of this study was to evaluate a simulation-based team training program called Obstetric Crisis Team Training Program (OBCTT) (based on the original training program of Crisis Team Training) framed within a multilevel team theoretical model. We hypothesized that participation in OBCTT would positively impact 10 variables: individual's knowledge (about team process and obstetric emergency care); confidence and competence in handling obstetric emergencies; and participant attitudes (toward the utility of a rapid response team, simulation technology as a teaching methodology, the utility of team skills in the workplace, comfort in assuming team roles; and individual and team performance). Improvement of objectively measured team performance in a simulated environment was also assessed.
Twenty-two perinatal health care professionals (attending physicians, nurses, resident, and nurse midwives) volunteered to participate in this pretest-posttest study design. All participants were given an online module to study before attending a 4-hour training session. Training consisted of participation in four standardized, simulated crisis scenarios with a female birthing simulator mannequin. Team simulations were video recorded. Debriefings were conducted after each simulation by having team members review the video and discuss team behaviors and member skills. Self-report measures of perinatal and team knowledge as well as several attitude surveys were given at the beginning and again at the end of the training session. A postsimulation attitude survey was administered immediately after the first and last simulation, and a course reaction survey was administered at the end of the training program. Objective task completion scores were computed after each simulation to assess performance.
There were significant (P<0.004) improvements in three of the outcome variables, after controlling for type I error with Bonferroni's correction; attitudes toward competence in handling obstetric emergencies (t=1.6), as well as individual (t=4.2), and team performance (t=4.1). The remaining 6 variables, attitude toward simulation technology, attitude toward the rapid response team; confidence in handling obstetric emergencies; utility of team skills in the workplace; comfort in assuming various team roles; and knowledge, were not statistically significant. Overall task completion from the first to the last simulation (XF, df=3, n=3, 8.2, P=0.042) substantially improved (P<0.05).
The crisis team training model is applicable to obstetric emergencies. Trainees exhibit a positive change in attitude; perception of individual and team performance, and overall team performance in a simulated environment. The ability of individuals to accurately assess their performance improved as a result of training.
团队培训项目在影响团队技能方面的知识、态度和行为能力方面颇具前景。本研究的目的是评估一个基于模拟的团队培训项目，即产科危机团队培训项目（OBCTT）（基于危机团队培训的原始培训项目），该项目构建于一个多层次团队理论模型之中。我们假设参与OBCTT会对10个变量产生积极影响：个人知识（关于团队流程和产科急救护理）；处理产科紧急情况的信心和能力；以及参与者的态度（对快速反应团队的效用、模拟技术作为一种教学方法的效用、团队技能在工作场所的效用、承担团队角色的舒适度；以及个人和团队绩效）。同时还评估了在模拟环境中客观测量的团队绩效的改善情况。
22名围产期医疗保健专业人员（主治医生、护士、住院医师和助产士）自愿参与这项前测-后测研究设计。所有参与者在参加为期4小时的培训课程之前都要学习一个在线模块。培训包括使用女性分娩模拟人体模型参与四个标准化的模拟危机场景。团队模拟过程进行了录像。每次模拟后，通过让团队成员观看视频并讨论团队行为和成员技能来进行总结汇报。在培训开始和结束时分别进行围产期和团队知识的自我报告测量以及多项态度调查。在第一次和最后一次模拟后立即进行模拟后态度调查，在培训项目结束时进行课程反应调查。每次模拟后计算客观任务完成分数以评估绩效。
在使用Bonferroni校正控制I型错误后，三个结果变量有显著（P<0.004）改善；对处理产科紧急情况能力的态度（t=1.6），以及个人（t=4.2）和团队绩效（t=4.1）。其余6个变量，对模拟技术的态度、对快速反应团队的态度；处理产科紧急情况的信心；团队技能在工作场所的效用；承担各种团队角色的舒适度；以及知识，在统计学上不显著。从第一次模拟到最后一次模拟的总体任务完成情况（XF，自由度=3，n=3，8.2，P=0.042）有显著改善（P<0.05）。
危机团队培训模式适用于产科紧急情况。学员在态度、对个人和团队绩效的认知以及模拟环境中的总体团队绩效方面表现出积极变化。培训使个人准确评估自身绩效的能力得到了提高。
