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Objectives The authors conducted a randomised controlled trial of four pedagogical methods commonly used to deliver teamwork training and measured the effects of each method on the acquisition of student teamwork knowledge, skills, and attitudes. Methods The authors recruited 203 senior nursing students and 235 fourth-year medical students (total N¼438) from two major universities for a 1-day interdisciplinary teamwork training course. All participants received a didactic lecture and then were randomly assigned to one of four educational methods: didactic (control), audience response didactic, role play and human patient simulation. Student performance was assessed for teamwork attitudes, knowledge and skills using: (a) a 36-item teamwork attitudes instrument (CHIRP), (b) a 12-item teamwork knowledge test, (c) a 10-item standardised patient (SP) evaluation of student teamwork skills performance and (d) a 20-item modification of items from the Mayo High Performance Teamwork Scale (MHPTS The TeamSTEPPS programme is designed to improve care and patient safety through improved teamwork training to enhance provider communication skills. While the 7 h multidisciplinary Team-STEPPS programme has proven very effective, questions remain regarding the most effective and cost-efficient approach to providing this content to learners at all stages of the health-education continuum.Various educational approaches have been used to address training in team coordination skills in healthcare. Methods such as crisis resource management training using high fidelity human patient simulation provide realism and interactivity.1e3 However, this training modality is both costly and time-consuming, with one instructor per five trainees costing as much as $5000 per day. 12Because of this, medical and nursing schools are implementing more traditional didactic approaches to teaching team coordination skills as well as computer-based instruction, small-group sessions, analysis of videotaped team coordination scenarios and workplace practice experiences.10 11 13 Questions remain about the effectiveness of any of these methods to achieve the necessary changes in student attitudes, knowledge and skills, and there is little evidence for selecting particular methods. Therefore, this study was designed and implemented to adapt the TeamSTEPPS content to pre-licensure nursing and medical students, and measure the effectiveness of four educational interventions at teaching this material. METHODS ProtocolWe conducted a full-day teamwork training and assessment exercise for 438 students composed of fourth-year medical students (N¼235) and finalsemester nursing students (N¼203) from four health-professional schools at two major universities: all students convened on the one campus where they were randomised to one of four educational intervention groups. Students were offered the option of not participating in the research project but could not decline the educational experience. Institutional review boards of both universities approved the proj...

Undertreatment of pain resulting in physiological, psychosocial, and economic consequences continues despite targeted improvement approaches. Starck et al. propose a systems framework for study of pain management errors. This secondary analysis examined pain outcomes of hospitalized inpatients to determine factors predicting adequate pain management. Data were collected from 964 hospitalized adult patients in the southwestern United States. The American Pain Society Patient Outcome Questionnaire and a demographic and chart audit form were used to collect data. The Pain Management Index (PMI) was computed for all participants. Results revealed that 30% of patients were undertreated for pain, with 67.5% reporting severe worst pain ratings (7 on a 0-10 scale). Non-whites, the elderly, and women had significantly higher pain ratings and higher proportions of negative PMI scores. Logistic regression predicted adequate pain management based on analgesic rating, ethnicity, age, and educational level with 0.89 accuracy. The study findings support conceptualizing mismanagement of pain as a medical error. An intervention model describes the use of a systems approach to identify high risk patients and ensure effective pain management practices for all.

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