Ju Mindy, Bochatay Naike, Werne Alexander, Essakow Jenna, Tsang Lisa, Nottingham Mary, Franzon Deborah, Lyndon Audrey, van Schaik Sandrijn
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th St., Floor 5, San Francisco, CA, 94143, USA.
Karger Publishers, Basel, Switzerland.
Adv Simul (Lond). 2024 Oct 12;9(1):43. doi: 10.1186/s41077-024-00313-3.
Interprofessional simulation-based team training (ISBTT) is commonly used to optimize interprofessional teamwork in healthcare. The literature documents the benefits of ISBTT, yet effective interprofessional collaboration continues to be challenged by complex hierarchies and power dynamics. Explicitly addressing these issues during ISBTT may help participants acquire skills to navigate such challenges, but guidelines on how to do this are limited.
We applied an educational design research approach to develop and pilot structured facilitator guidelines that explicitly address power and hierarchy with interprofessional teams. We conducted this work in a previously established ISBTT program at our institution, between September 2020 and December 2021. We first reviewed the literature to identify relevant educational theories and developed design principles. We subsequently designed, revised, and tested guidelines. We used qualitative thematic and content analysis of facilitator interviews and video-recording of IBSTT sessions to evaluate the effects of the guidelines on the pre- and debriefs.
Qualitative content analysis showed that structured guidelines shifted debriefing participation and content. Debriefings changed from physician-led discussions with a strong focus on medical content to conversations with more equal participation by nurses and physicians and more emphasis on teamwork and communication. The thematic analysis further showed how the conversation during debriefing changed and how interprofessional learning improved after the implementation of the guidelines. While power and hierarchy were more frequently discussed, for many facilitators these topics remained challenging to address.
We successfully created and implemented guidelines for ISBTT facilitators to explicitly address hierarchy and power. Future work will explore how this approach to ISBTT impacts interprofessional collaboration in clinical practice.
基于模拟的跨专业团队培训（ISBTT）常用于优化医疗保健中的跨专业团队合作。文献记载了ISBTT的益处，但有效的跨专业协作仍受到复杂的等级制度和权力动态的挑战。在ISBTT期间明确解决这些问题可能有助于参与者获得应对此类挑战的技能，但关于如何做到这一点的指导方针有限。
我们采用教育设计研究方法，为跨专业团队制定并试点结构化的促进者指导方针，明确解决权力和等级制度问题。我们于2020年9月至2021年12月在我们机构先前设立的ISBTT项目中开展了这项工作。我们首先查阅文献以确定相关教育理论并制定设计原则。随后我们设计、修订并测试了指导方针。我们对促进者访谈以及ISBTT课程视频记录进行定性主题和内容分析，以评估指导方针对预讨论和总结讨论的影响。
定性内容分析表明，结构化指导方针改变了总结讨论的参与情况和内容。总结讨论从以医生为主导、高度关注医学内容的讨论转变为护士和医生参与度更平等、更强调团队合作和沟通的对话。主题分析进一步表明了总结讨论期间的对话是如何变化的，以及指导方针实施后跨专业学习是如何改进的。虽然权力和等级制度的讨论更为频繁，但对许多促进者来说，这些话题仍然难以解决。
我们成功地为ISBTT促进者创建并实施了明确解决等级制度和权力问题的指导方针。未来的工作将探索这种ISBTT方法如何影响临床实践中的跨专业协作。
