A systematic review of behavioural marker systems in healthcare: what do we know about their attributes, validity and application?

Dietz, Aimee; Pronovost, Peter J.; Benson, Kari N; Mendez-Tellez, Pedro A.; Dwyer, Cynthia; Wyskiel, Rhonda; Rosen, Michael A.

doi:10.1136/bmjqs-2013-002457

Cited by 51 publications

(61 citation statements)

References 72 publications

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“…For this constructivist study, we conducted simulation scenarios followed by a debrief focusing on NTS in clinical practice. The debriefs were augmented by use of a behavioural marker system, an observational measurement tool used to facilitate the recognition and assessment of NTS through observed behaviours . Immediately following the sessions, we conducted semi‐structured focus groups based on the transformative learning framework .…”

Section: Methodsmentioning

confidence: 99%

Exploring transformative learning when developing medical students' non‐technical skills

et al. 2020

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Context Non‐technical skills (NTS) training should be incorporated into medical students' education and simulation‐based approaches are often utilised to facilitate this. Such experiences have the potential to foster transformative learning by facilitating a reassessment of one's prior assumptions and a significant shift in one's outlook, referred to as the process of perspective transformation. The aim of this research was to explore how NTS training might facilitate transformative learning in final‐year medical students. Methods Following ethical approval, medical student volunteers from four medical schools (Aberdeen, Dundee, Edinburgh and Glasgow) participated in simulation sessions, were debriefed with an emphasis on NTS using a behavioural marker system and then took part in focus groups. Focus group discussions were semi‐structured and questions were based on the phases of perspective transformation identified by Jack Mezirow. Focus group discussions were audiorecorded, transcribed verbatim, anonymised and analysed using template analysis. Results A total of 33 medical students took part in five focus groups. There was evidence of the following stages of perspective transformation: Phase 2 (self‐examination with emotional disturbance, including fear, anxiety, guilt, shame and frustration); Phase 3 (critical assessment of assumptions, including the undervaluing of NTS, recognising that technical skills alone are insufficient, and recognising that it is possible to improve one’s NTS); Phase 5 (exploring options for new roles, relationships and actions), and Phase 6 (planning a course of action for future simulations, as a medical student and as a doctor). Conclusions This study deepens our understanding of how exposure to NTS training in simulation‐based education influences the learning of medical students and shows that such exposure can result in the cognitive phases of transformative learning. It provides us with valuable insights into medical students' perspectives on their learning of NTS at a pivotal stage in training and represents an interesting way of assessing the educational impact of such sessions.

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Section: Methodsmentioning

confidence: 99%

Exploring transformative learning when developing medical students' non‐technical skills

et al. 2020

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“…17,18 More recent reviews indicate improvements in the quality of tools, 19,20 with some notable exemplars. 16,[21][22][23] Continued progress in this area is needed, but the burdens of administration will probably constrain routine use.…”

Section: Teamwork and Measurement In Healthcarementioning

confidence: 99%

An integrative framework for sensor-based measurement of teamwork in healthcare

Rosen

Dietz

Yang

et al. 2014

Journal of the American Medical Informatics Association

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There is a strong link between teamwork and patient safety. Emerging evidence supports the efficacy of teamwork improvement interventions. However, the availability of reliable, valid, and practical measurement tools and strategies is commonly cited as a barrier to long-term sustainment and spread of these teamwork interventions. This article describes the potential value of sensor-based technology as a methodology to measure and evaluate teamwork in healthcare. The article summarizes the teamwork literature within healthcare, including team improvement interventions and measurement. Current applications of sensor-based measurement of teamwork are reviewed to assess the feasibility of employing this approach in healthcare. The article concludes with a discussion highlighting current application needs and gaps and relevant analytical techniques to overcome the challenges to implementation. Compelling studies exist documenting the feasibility of capturing a broad array of team input, process, and output variables with sensor-based methods. Implications of this research are summarized in a framework for development of multi-method team performance measurement systems. Sensor-based measurement within healthcare can unobtrusively capture information related to social networks, conversational patterns, physical activity, and an array of other meaningful information without having to directly observe or periodically survey clinicians. However, trust and privacy concerns present challenges that need to be overcome through engagement of end users in healthcare. Initial evidence exists to support the feasibility of sensor-based measurement to drive feedback and learning across individual, team, unit, and organizational levels. Future research is needed to refine methods, technologies, theory, and analytical strategies.

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“…This has obvious resource implications since assessors need to be recruited, trained and available. Another issue is that different teamwork behaviour may occur at any point or simultaneously during an assessed episode, which demands the question of which behaviours to score and which to not score when there are over 79 different behaviour domains described [27]. Clearly, this may make cognitive overload of raters problematic.…”

Section: What Methods Of Assessment Are Currently Usedmentioning

confidence: 99%

“…A simulated environment creates opportunities to direct performance so that particular behaviours can be tested rather than relying on opportunistic learning. The majority of assessment tools are developed for specific clinical situations such as surgery or anaesthetics, or other acute healthcare settings [27]. When using these tools outside their validated contexts it is important to customise them so that they map accurately to the attributes being assessed [28].…”

Section: When We Should Assessmentioning

confidence: 99%

Assessing team performance – Markers and methods

Marriage

Kinnear

2016

Trends in Anaesthesia and Critical Care

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Optimal team performance in healthcare is vital to avoid error. Assessing teams improves their performance by providing accurate feedback to team members. To construct an assessment tool that is both valid and reliable, it is necessary to understand what should be measured, when it should be measured and the context of the team performance. Current assessment methods include observation of behavioural markers, self-assessment by team members, event-based coding, and narrative field notes. Future assessment tools should incorporate best practice elements such as having a theoretical or empirical basis for teamwork competencies, measuring process rather than outcomes, analysing rather than describing performance, capturing non-observable cognitions, distinguishing individual from collective team behaviours, using trained raters, and linking assessment to learning objectives.

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A systematic review of behavioural marker systems in healthcare: what do we know about their attributes, validity and application?

Cited by 51 publications

References 72 publications

Exploring transformative learning when developing medical students' non‐technical skills

Exploring transformative learning when developing medical students' non‐technical skills

An integrative framework for sensor-based measurement of teamwork in healthcare

Assessing team performance – Markers and methods

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