Transcript Slide 1

TeamSTEPPS
Interprofessional Education
and TeamSTEPPS
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TEAMSTEPPS 05.2
The Imperative for Team
Training in (Medical)
Education
Karyn Baum, MD, MSEd
University of Minnesota
TeamSTEPPS
 “Once in practice, health
professionals are asked to
work in interdisciplinary
teams…yet they are not
educated together or trained
in team-based skills”
 --IOM, Health Professions
Education: A Bridge to
Quality
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TEAMSTEPPS 05.2
TeamSTEPPS
 “Effective teamwork in health-care delivery can
have an immediate and positive impact on patient
safety”
 World Health Organization, Topic 4, Patient Safety
Curriculum
 “Our challenge…is not whether we will deliver
care in teams but rather how well we will deliver
care in teams”
 Paul Schyce, SVP Joint Commission
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TEAMSTEPPS 05.2
TeamSTEPPS
Core Competencies for
Interprofessional Collaborative
Practice
 Competency Domain 4:
Teams and Teamwork
 “Understanding how
team developmental
processes can affect
team members, overall
team functioning, and
outcomes…is an
important part of being
an effective team
member.”
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TEAMSTEPPS 05.2
TeamSTEPPS
ACGME New “Common” Program
Requirements
 Residents must care for patients in an
environment the maximizes effective
communication. This must include the
opportunity to work as a member of effective
interprofessional teams
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TEAMSTEPPS 05.2
TeamSTEPPS in Medical Student Education
N. Kevin Krane, M.D.
Vice Dean for Academic Affairs
Tulane University School of Medicine
TeamSTEPPS
REVIEW
A Systematic Review of Teamwork
Training Interventions in
Medical Student and Resident Education
Chakraborti, et al., J Gen Intern Med 23:846–53, 2008.
 Thirteen studies met inclusion criteria. All
curricula employed active learning methods ;the
majority (77%) included multidisciplinary training.
 Conclusions:
 Appear to be modestly effective in the short term.
 Curricula may be more effective when they
address more of the teamwork principles
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TEAMSTEPPS 05.2
TeamSTEPPS
Team Training of Medical Students in the 21st
Century: Would Flexner Approve?
Morrison et al. Acad Med. 2010; 85:254–259.
 Penn: 2-day retreat during orientation, students
in same teams of 6-7 for all four years, and
embeds team learning activities for student
teams throughout the four-year curriculum.
 Team training must be embedded in medical
school education.
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TeamSTEPPS
The use of simulation and a modified TeamSTEPPS
curriculum for medical and nursing student team training.
Emory: Robertson, et al., Simul Healthc 2010;5:332-7.
 METHODS: 213 students, 4-hour team training with lecture and
small group exercises. Knowledge and attitudes assessed
before/after. Recognition of team skills was assessed using
videos.
 CONCLUSIONS: Students improved their knowledge of vital team
and communication skills, attitudes toward working as teams, and
were able to identify effective team skills.
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TEAMSTEPPS 05.2
TeamSTEPPS
Atallah H, Kaplan B, Ander D, Robertson B. (Emory)
Interprofessional Team Training Scenario. MedEdPORTAL; 2009.
Available from: http://www.mededportal.org/publication/1713
Simulation Exercise: Educational Objectives
 To be able to understand the impact of communication and
coordination on efficiency and effectiveness of care
implementation.
 To be able to identify the performance of team skills in the
area of leadership, communication, mutual support and
situational monitoring.
 To be able to perform team skills in the area of leadership,
communication, mutual support and situational monitoring.
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TEAMSTEPPS 05.2
TeamSTEPPS
Interprofessional TeamSTEPPS training: Comparing
Peer Assessment to Expert Ratings.
Brock et al., U of Washington, Seattle, Wa
 Piloted an iP training program with simulators using
mixed teams of medical, nursing, pharmacy and physician assist
students to learn and practice TeamSTEPPS communications
skills and Global assessments of I-P team performance
 Methods: 49 students, assigned to 6 Teams,were trained
on TeamSTEPPS skills.
 3 sims (asthma, CHF and SVT).
 Assessed Team Performance with experienced Observers
for: Team Structure, Leadership, Situation
Monitoring, Mutual Support and Communication.
 Results:55% of peer assessments indicated team success with
the Communication dimension but only 26% reported success for
Mutual Support. Peer assessments weren’t comparable to
expert ratings.
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TEAMSTEPPS 05.2
TeamSTEPPS
UNC and Duke
 UNCHCS, UNC School of Medicine, UNC School
of Nursing and Duke University Medical Center
awarded GlaxoSmithKline funding for development
of a collaborative patient safety educational
program using TeamSTEPPS
 The 2 year project focused on interdisciplinary team training for students in the SON &
SOM at each institution
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TeamSTEPPS
University of North Dakota School
of Medicine and Health Sciences
 IPHC is required for MD, RN, PT, OT, and
communication sciences and disorders students
who have a clinical focus. Uses TeamSTEPPS
concepts as a framework for application of team
communication skills in small groups.
 The course objectives include:
 Demonstrate patient/client-centered approach in
decision-making as an interdisciplinary team.
 Demonstrate ability to reflect about team
experiences and feedback.
 Identify sources of potential error and
consequences to health care delivery.
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TeamSTEPPS
St. Louis University
 Required IP seminars for all 3rd year students with
7 health professional schools
 Integrating principles
of TeamSTEPPS with
programs at their
major teaching hospitals
 Focus is on
case-based discussions
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TeamSTEPPS
Kirksville College of Ostepathic
Medicine
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TeamSTEPPS required of all students before
clinical rotations
Must take quiz to demonstrate completeness
TeamSTEPPS modules available on-line (through
St. Louis University)
 LIJ-Hofstra: Also using TeamSTEPPS in
curriculum for medical students
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TeamSTEPPS
Tulane: TeamSTEPPS
 Dean gives patient safety overview
 Foundations in Medicine: First year MD and
RN students
 TeamSTEPPS presentation
 Simulation activity
 Interdisciplinary seminars using
TeamSTEPPS: MD, RN, Rx students
 Fall 2012: Team training for first year gross
anatomy dissecting teams (randomized
research protocol) using TeamSTEPPS
teamwork module
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TeamSTEPPS
Tulane: TeamSTEPPS for
Clinical Students
 As part of their third/fourth year, Tulane students must
complete 5 “interdisciplinary” seminars from a menu
of topics, one being Patient Safety using
TeamSTEPPS™.
 6 MD, 6 RN and 6 Rx students from local schools (nonTulane) volunteered to participate in each seminar
which focuses on Patient Safety/TeamSTEPPS™
seminar, all taught by one individual (KK)
 Almost all RN and Rx students had completed some
clinical/ward training
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TeamSTEPPS
Results: Data on 96 Students: TeamSTEPPS
 Significant improvement pre/post student mean
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RIPLS scores (p<.01)
RN and Rx students: greater value on working with other
healthcare professionals than MD students (p<.01).
Rx students felt more strongly than MD students that shared
learning with others would help (p<.05).
Compared to RN’s, MD and Rx students more strongly viewed a
nurse’s role as that of support for physicians (p<.01).
MD students felt they had to acquire more knowledge than
pharmacy and nursing students (p<.01).
Overall rating = 4.69/5.00. Training with other healthcare
professional students was the most valuable part of the seminar.
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TeamSTEPPS
Summary
 Several schools now using TeamSTEPPS in their
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curriculum: Emory, UNC, Duke, St. Louis U, U of
North Dakota, Kirksville COM, U Wash,
LIJ-Hofstra, Tulane,
? Others?
Typically part of Interprofessional Education
More likely to be first/second yr medical students
Variable amounts of simulation
Is there evidence it makes any difference?
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TEAMSTEPPS 05.2
Team STEPPS in GME:
A Challenging Task
Michael E. Barfield, M.D.
General Surgery Resident
Duke University
TeamSTEPPS
ACGME
Common Program Requirements
Effective July 1, 2011
Teamwork
Resident must care for patient in an environment that maximizes effective
communication. This must include the opportunity to work as a member of effective
interprofessional teams that are appropriate to the delivery of care in the specialty
And…
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The Joint Commission
Balanced Scorecard
TEAMSTEPPS 05.2
TeamSTEPPS
Institutional Leadership
 With the changing standards in education and
accreditation agencies, institutional leadership
has recognized the need for and are now seeing
the value of GME trainee involvement.
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TEAMSTEPPS 05.2
TeamSTEPPS
Challenges Particular to Trainees
 Resident Schedule
Duty Hour Restrictions
 Daily Workflow
 Mandatory Conferences
 Off-site Rotations
 Resident Complement
 Perceptions of Just Culture
 What do trainees see modeled?
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TeamSTEPPS
What Has Been Done?
 Literature reports of trainee involvement in Team STEPPS
training
 University of Washington
 Four hours of Team STEPPS training is done with all
incoming residents for 3 years
 Combines didactic and breakouts sessions with trainees
teaching each other the concepts
 Duke University
 Creation of GME Patient Safety & Quality Council
 Patient Safety and Quality Concentration
 GME has 5 Master Trainers
 Team STEPPS Essentials has had 8 attendees
 Resident exposure through unit and Peri-operative programs
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TEAMSTEPPS 05.2
TeamSTEPPS
Content Delivery
 Team STEPPS Essentials
 Webinars
 Team STEPPS Series
 “In-service” teaching models common for nurses
on various clinical service units
 App for iPhones, iPads, Droids, etc.
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TEAMSTEPPS 05.2
TeamSTEPPS
Changing Priorities
 Institutional Initiatives
Prioritize trainee involvement in safety and quality
initiatives
 Introduction to Team STEPPS in UME
 Delivering the tools and the language
 Deliver Concepts Earlier?
 Model the Concepts
 Current providers and leaders
 Behaviors, not decisions
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TEAMSTEPPS 05.2
Team training in
interprofessional
settings
TeamSTEPPS
Interprofessional Education
 "Interprofessional Education occurs when two or
more professions learn with, from and about each
other to improve collaboration and the quality of
care"
 Center for the Advancement of Interprofessional
Education (CAIPE)
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TeamSTEPPS
Why?
 Social Learning Theory (Bandura et al.)
 Situated Learning (Lave)
 Cognitive Apprenticeships (Brandt et al.)
 Learning, Generalizing
Andragogy (Knowles)
 And they go on….
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TeamSTEPPS
Does it work?
 Immediate
Yes and no
 Long-term….who knows?
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TEAMSTEPPS 05.2
TeamSTEPPS
Challenges/answers
 Cultural
We don’t know/trust/value each other!
 Different languages
 History
 Logistical
 Schedules (hardest part)
 Space
 Political
 Regulatory
 Local
 Accreditations---these are not only going way, but forcing issue
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TEAMSTEPPS 05.2
TeamSTEPPS
Some curricular resource sites
 MedEdPortal
 IHI Open School
 QSEN
 Academy for Healthcare Improvement
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TEAMSTEPPS 05.2
TeamSTEPPS
Please contact us!
 Karyn Baum: [email protected]
 Michael Barfield: [email protected]
 Kevin Krane: [email protected]
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TEAMSTEPPS 05.2