Universitätsmedizin Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Charité, Berlin, Germany.
Universitätsmedizin Berlin, Medical Skills Lab, Charité, Berlin, Germany.
West J Emerg Med. 2018 Jan;19(1):185-192. doi: 10.5811/westjem.2017.11.35275. Epub 2017 Dec 14.
Preventable mistakes occur frequently and can lead to patient harm and death. The emergency department (ED) is notoriously prone to such errors, and evidence suggests that improving teamwork is a key aspect to reduce the rate of error in acute care settings. Only a few strategies are in place to train team skills and communication in interprofessional situations. Our goal was to conceptualize, implement, and evaluate a training module for students of three professions involved in emergency care. The objective was to sensitize participants to barriers for their team skills and communication across professional borders.
We developed a longitudinal simulation-enhanced training format for interprofessional teams, consisting of final-year medical students, advanced trainees of emergency nursing and student paramedics. The training format consisted of several one-day training modules, which took place twice in 2016 and 2017. Each training module started with an introduction to share one's roles, professional self-concepts, common misconceptions, and communication barriers. Next, we conducted different simulated cases. Each case consisted of a prehospital section (for paramedics and medical students), a handover (everyone), and an ED section (medical students and emergency nurses). After each training module, we assessed participants' "Commitment to Change." In this questionnaire, students were anonymously asked to state up to three changes that they wished to implement as a result of the course, as well as the strength of their commitment to these changes.
In total, 64 of 80 participants (80.0%) made at least one commitment to change after participating in the training modules. The total of 123 commitments was evenly distributed over four emerging categories: , , and . Roughly one third of behavior- and attitude-related commitments were directly related to interprofessional topics (e.g., "acknowledge other professions' work"), and these were equally distributed among professions. At the two-month follow-up, 32 participants (50%) provided written feedback on their original commitments: 57 of 62 (91.9%) commitments were at least partly realized at the follow-up, and only five (8.1%) commitments lacked realization entirely.
A structured simulation-enhanced intervention was successful in promoting change to the practice of emergency care, while training teamwork and communication skills jointly.
可预防的错误经常发生，并可能导致患者受到伤害和死亡。急诊科（ED）特别容易出现此类错误，有证据表明，改善团队合作是降低急性护理环境中错误率的关键方面。只有少数策略用于培训团队技能和跨专业环境中的沟通。我们的目标是为参与急救护理的三个专业的学生构思、实施和评估一个培训模块。目的是使参与者认识到跨专业团队技能和沟通方面的障碍。
我们为跨专业团队开发了一种纵向模拟增强培训格式，由医学专业的最后一年学生、急诊护理高级学员和学生护理人员组成。培训格式包括几个为期一天的培训模块，这些模块在 2016 年和 2017 年分两次进行。每个培训模块都从介绍开始，介绍每个人的角色、专业自我概念、常见误解和沟通障碍。接下来，我们进行了不同的模拟案例。每个案例都包括一个院前部分（护理人员和医学生）、一个交接部分（所有人）和一个 ED 部分（医学生和急诊护士）。每个培训模块结束后，我们评估参与者的“改变承诺”。在这个问卷中，学生被要求匿名说出他们希望因课程而实施的三个改变，以及他们对这些改变的承诺程度。
共有 80 名参与者中的 64 名（80.0%）在参加培训模块后做出了至少一项改变承诺。总共 123 项承诺均匀分布在四个新兴类别中：态度、知识、技能和组织。大约三分之一的与行为和态度相关的承诺直接与跨专业主题相关（例如，“承认其他专业的工作”），并且在专业之间分布均匀。在两个月的随访中，32 名参与者（50%）对他们的原始承诺提供了书面反馈：62 项承诺中的 57 项（91.9%）在随访中至少部分实现，只有 5 项（8.1%）承诺完全没有实现。
结构化的模拟增强干预成功地促进了急救护理实践的改变，同时共同培训团队合作和沟通技巧。
