Garcia Popov Andrei, Hall Andrew K, Chaplin Timothy
Department of Emergency Medicine Lennox and Addington County General Hospital Napanee Ontario Canada.
and the Department of Emergency Medicine Queen's University Kingston Ontario Canada.
AEM Educ Train. 2020 Oct 13;5(3):e10533. doi: 10.1002/aet2.10533. eCollection 2021 Jul.
Trauma resuscitations require competence in both clinical and nonclinical skills but these can be difficult to observe and assess. Multisource feedback (MSF) is workplace-based, involves the direct observation of learners, and can provide feedback on nonclinical skills. We sought to compare and contrast the priorities of multidisciplinary trauma team members when assessing resident trauma team captain (TTC) performance. Additionally, we aimed to describe the nature of the assessment and perceived the utility of incorporating MSF into the trauma context.
A convenience sample of 10 trauma team activations were observed. Following each activation, the attending physician trauma team leader (TTL), TTC, and a registered nurse (RN) participated in a semistructured interview. MSF was not provided to the TTC for the purpose of this study because MSF was not part of the assessment process of TTCs at the time of this study and maintaining anonymity may have encouraged more honest interview responses. Transcripts from each assessor group (TTL, TTC, RN) were coded and assigned to one of the five crisis resource management skills: leadership, communication, situational awareness, resource utilization, and problem-solving. Comments were also coded as positive, negative, or neutral as interpreted by the coder.
All assessor groups mentioned communication skills most frequently. After communication, the RN and TTC groups commented on situational awareness most frequently, comprising 15 and 29% of their total responses, respectively, whereas 31% of the TTL comments focused on leadership skills. The RN and TTL groups provided positive assessments, with 51 and 42% of their respective comments coded as positive. Forty-five percent of self-assessment comments in the TTC group were negative. All (100%) of the TTC and TTL respondents felt that incorporating MSF would add to the quality of feedback, only 66% of the RN group felt that way.
We found that each assessor group brings a unique focus and perspective to the assessment of resident TTC performance. The future inclusion of MSF in the trauma team context has the potential to enhance the learning environment in a clinical arena that is difficult to directly observe and assess.
创伤复苏需要具备临床技能和非临床技能，但这些技能可能难以观察和评估。多源反馈（MSF）基于工作场所，涉及对学习者的直接观察，并且可以提供有关非临床技能的反馈。我们试图比较和对比多学科创伤团队成员在评估住院医师创伤团队队长（TTC）表现时的优先事项。此外，我们旨在描述评估的性质，并了解将多源反馈纳入创伤情境中的效用。
观察了10次创伤团队启动的便利样本。每次启动后，主治医师创伤团队负责人（TTL）、TTC和注册护士（RN）参与了半结构化访谈。在本研究中，未向TTC提供多源反馈，因为在本研究时多源反馈不是TTC评估过程的一部分，保持匿名可能会鼓励更诚实的访谈回答。每个评估者组（TTL、TTC、RN）的访谈记录进行编码，并分配到五个危机资源管理技能之一：领导能力、沟通能力、态势感知、资源利用和解决问题能力。评论也被编码为主观积极、消极或中性。
所有评估者组最常提到沟通技能。在沟通之后，RN组和TTC组最常评论态势感知，分别占其总回复的15%和29%，而TTL组31%的评论集中在领导能力上。RN组和TTL组给出了积极评价，分别有51%和42%的评论被编码为积极。TTC组自我评估评论中有45%为消极。所有（100%）的TTC和TTL受访者认为纳入多源反馈会提高反馈质量，只有66%的RN组有此看法。
我们发现每个评估者组在评估住院医师TTC表现时都有独特的关注点和视角。未来在创伤团队环境中纳入多源反馈有可能改善这个难以直接观察和评估的临床领域的学习环境。
