Identifying Nontechnical Skill Deficits in Trainees Through Interdisciplinary Trauma Simulation

Abstract

Interprofessional team simulation in trauma resuscitation scenarios followed by debriefing differently affected individual nontechnical skills domains. Additional facilitation strategies, such as focused facilitation and encouraging learner self-assessment, may target other nontechnical skills in different ways.

Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts

“…2. Leader performing technical interventions resulting in task fixation/loss of situational awareness [ 4 – 6 , 10 , 20 , 24 , 28 , 32 , 34 , 41 , 44 , 45 , 51 , 58 , 65 , 66 ] Communication Verbal and non-verbal exchange of information. May occur within the team and between team and environment (e.g., patient, bystanders).…”

“…2. Vertical integration and hierarchy have oppressive impact on follower performance [ 4 – 6 , 29 , 32 , 34 , 35 , 42 , 58 , 65 , 66 ] Briefing/Planning Briefing: A targeted communication prior to commencing team resuscitation in which salient details of the impending resuscitation are delivered and a team plan of action and role assignment is determined via collaborative decision-making Planning: Updates occur throughout team activity via regular situation reports [10/16%] Briefing is attributed to enhanced team mental models, decreased role ambiguity, and is associated with error reduction A four-step model is proposed to facilitate rapid prebriefing, these roles include: 1) what do we know? ; 2) what do we expect?…”

“…(plan B); 4) role assignment Planning behaviours include updating of the initial briefing through regular “pauses” or “situation reports” and facilitates improved situational awareness and adaptive behaviours Threats: 1. Ad hoc resuscitation teams often assemble while the event is ongoing, eliminating the opportunity for prebriefing [ 6 , 28 , 29 , 36 , 44 , 56 , 65 ] Resource Management The assignment of team members and equipment to tasks in a way that is responsive to variable supply and demand of these assets. Requires the assessment of provider capacity/skill level and utilizing team members in such a way that optimizes their contribution.…”

“…The construct applied to this circumstance is that of a multi-team system. In a multi-team system, team composition is highly reactive to fluctuating demands of broader incident priorities [ 6 , 20 , 29 , 31 , 32 , 51 , 62 , 65 ] Stress/Fatigue Management Individual and team-based approaches to maintaining team performance by mitigating the adverse effects associated with stress and fatigue [11/18%] Maladaptive stress response is associated with dysfunctions including degraded shared mental models, decreased performance in decision making, altered situational awareness, and impaired team function Fatigue is associated with deficits in resource management, teamwork, situational awareness, and decision making Leadership, mutual performance monitoring, backup behaviour, communication, are suggested as mechanisms to foster optimal team orientation, which can combat the detrimental effects of acute stress and fatigue [ 6 , 20 , 41 , 45 , 51 , 61 ] Followership Who follows whom, the traits and characteristics exhibited by those in a following position, the process by which team members occupy a following role, and the influence that followers hold within the team [3/5%] Refers to traits of resuscitation team members not assigned or fulfilling a leadership position. The corollary to leadership, an acknowledgement that most team members are not leaders but nevertheless exhibit characteristics that have the capacity to significantly impact team performance Followership research in resuscitation is limited, but there is increasing recognition that the earlier focus on hierarchical teams – with the resulting focus on leader behaviour – contrasts with recognition for the role of follower behaviours [ 66 , 87 ] Debriefing A facilitated reflective process performed upon conclusion of team resuscitation efforts for the purpose of examining elements of optimal and suboptimal performance.…”

“…Attaining optimal arousal state during moments when demand nears or exceeds resources [3/5%] Behaviours associated with the maintenance of an ideal performance state of arousal include: controlled or “tactical” breathing, self-talk, mental rehearsal, and activities that foster optimal team orientation such as prebriefings and maintaining mutual trust Stress inoculation training, mental practice, and overlearning are three training techniques that are associated with enhanced psychological skills for optimizing performance in acute stress environments An important foundational component of stress management [ 6 , 45 , 53 ] Adaptive Behaviours A team’s ability to anticipate and modify their structure and behaviours in response to dynamic changes in their patient’s clinical presentation and the environment. These behaviours are highly integrated with other NTS constructs including shared mental models, situational awareness, decision making, and debriefing [6/10%] Based upon 4 adaptation phases: (1) situation assessment; (2) plan formulation; (3) plan execution; (4) team learning By virtue of understanding each team member’s role in relation to one another, teams with a strong team mental model have the greatest capacity for adaptive behaviour Optimizing team situational awareness through regular situation reports allows teams to more accurately and proactively predict dynamic changes resulting in more effective adaptive behaviours [ 6 , 20 , 29 , 51 , 65 ] Shared Mental Model Mental models reflect team members’ understanding of the team objectives, structures, and members’ roles within the team. Sharedness reflects the extent that members’ models are similar across the group [13/23%] Shared mental models enable members to coordinate and anticipate one-another’s actions, even with limited discussion Other constructs from this review are known to support the strength of shared mental models, including orienting members as a team, backup behaviour between members, situational awareness, and effective leadership Associated with higher frequency of communicating and updating situational awareness Threats: Ad hoc and intersectoral teams may have a limited shared understanding of their team and tasks [ 5 , 6 , 35 , 45 , 57 , 58 , 75 , 79 , 82 ] …”