Brydges Ryan, Nemoy Lori, Ng Stella, Khodadoust Nazanin, Léger Christine, Sampson Kristen, Campbell Douglas M
Allan Waters Family Simulation Centre, St. Michael's Hospital, Unity Health Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
Department of Medicine, University of Toronto, Toronto, Canada.
Adv Simul (Lond). 2021 Nov 3;6(1):39. doi: 10.1186/s41077-021-00191-z.
In this methodological intersection article, we describe how we developed a new variation of the established tabletop simulation modality, inspired by institutional ethnography (IE)-informed principles. We aimed to design and conduct pilot implementations of this innovative tabletop simulation modality, which focused uniquely on everyday and everynight work, along with the factors that govern that work. In so doing, we aimed to develop a modality and preliminary findings that researchers and educators can use to simulate healthcare practices across longer episodes of care (i.e., time scales of hours or an entire day) and to detect the 'latent social threats' that can emerge during interprofessional clinical care.An interprofessional team designed tabletop simulation scenarios of interprofessional challenges during transfers of care on a labour and delivery (L&D) unit. Within each scenario, participants provided real-time explanations for their work and associated drivers, both independently and as a team. Thus, we combined 'think-aloud' and simulation principles to design tabletop simulation scenarios to elicit healthcare professionals' descriptions of how they collaborate in their work on the L&D unit. We completed a total of five tabletop simulations with eight participants (obstetricians, N = 2; midwives, N = 2; nurses, N = 5).The conversations stimulated by the tabletop simulation scenarios and debriefs allowed us to generate a preliminary understanding of the texts that govern and organize clinicians' everyday work processes. We generated data about longitudinal, multi-hour work processes in a condensed timeline, with opportunities to pause and probe, and with reduced focus on individual practitioner's competence.We believe our innovative tabletop simulation approach allowed us to examine clinical work in ways no other simulation permits. Participants described how the scenarios opened a productive dialogue between professional groups and suggested this simulation-based approach might contribute to enhanced interprofessional understanding and cultural change. We suggest that others can adapt our low-resource approach to understand clinicians' everyday work and to map how this work is governed by documents, like policies, with the end goal of facilitating system change and managing latent social threats.
在这篇方法交叉性文章中，我们描述了受制度民族志（IE）启发的原则影响，如何开发一种既定桌面模拟模式的新变体。我们旨在设计并开展这种创新桌面模拟模式的试点实施，该模式独特地聚焦于日常和夜间工作以及支配该项工作的因素。通过这样做，我们旨在开发一种模式和初步研究结果，供研究人员和教育工作者用于模拟较长护理时段（即数小时或一整天的时间尺度）内的医疗保健实践，并检测跨专业临床护理期间可能出现的“潜在社会威胁”。一个跨专业团队设计了关于分娩和接生（L&D）科室护理交接期间跨专业挑战的桌面模拟场景。在每个场景中，参与者独立并作为团队为其工作及相关驱动因素提供实时解释。因此，我们将“边想边说”和模拟原则相结合，设计桌面模拟场景，以引出医疗保健专业人员对他们在L&D科室工作中如何协作的描述。我们总共对八名参与者（产科医生，N = 2；助产士，N = 2；护士，N = 5）进行了五次桌面模拟。桌面模拟场景和汇报引发的对话使我们能够对支配和组织临床医生日常工作流程的文本产生初步理解。我们在紧凑的时间线内生成了关于纵向、数小时工作流程的数据，有机会暂停和探究，并且减少了对个体从业者能力的关注。我们相信，我们创新的桌面模拟方法使我们能够以其他模拟无法实现的方式审视临床工作。参与者描述了这些场景如何开启了专业群体之间富有成效的对话，并表示这种基于模拟的方法可能有助于增进跨专业理解和文化变革。我们建议其他人可以采用我们这种资源需求少的方法来理解临床医生的日常工作，并描绘这项工作如何受政策等文件的支配，最终目标是促进系统变革和管理潜在社会威胁。
