Jumpstarting Team Cohesion with Team Activity Debriefings

Non-technical skills and teamwork in trauma: from the emergency department to the operating room

Management of a trauma patient is a challenging process. Swift and accurate clinical assessment is required and time-sensitive decisions and life-saving procedures must be performed in an unstable patient. This requires a coordinated response by both the emergency room (ER) and operating room (OR) teams. However, a team of experts does not necessarily make an expert team. Root cause analysis of adverse events in surgery has shown that failures in coordination, planning, task management and particularly communication are the main causes for medical errors. While most research is focused on the ER trauma team, the trauma OR team also deserves attention. In fact, OR team dynamics may resemble more the ER team than the elective OR team. ER and OR trauma teams assemble on short notice, and their members, who are from different specialties and backgrounds, may not train regularly together or even know each other beforehand. And yet, they have to perform high-risk procedures and make high stake decisions, in a time-sensitive manner. The airline industry has long recognized the role of team training and non-technical skills (NTS) in reducing hazards. The implementation of the so called crew resource management or crisis resource management (CRM) has significantly made airline travel safer and the transposition to the medical context, with specific training in non-technical skills, has also brought great benefits. In fact, it is clear that adoption of non-technical skills (NTS) in healthcare has led to an increase in patient safety. In this narrative review we recapitulate some of the key non-technical skills and their relevance in trauma, with a focus on both the emergency department (ER) and the operating room (OR) teams, as well as on the transition of care from one to the other. Also, we explore the use of debriefing the team, as well as the roles of NTS training in both undergraduate and postgraduate settings. We review some of the existing trauma training courses and their roles in developing NTS. Finally, we briefly address the challenges posed by the development of trauma hybrid operating rooms.

Using the design-thinking method to develop and validate a peer evaluation scale for team-based learning (PES-TBL) for nursing students

BACKGROUND

Peer evaluation in team-based learning provides meaningful information about the learning process and dynamics. Despite the importance of peer evaluation in learner-centred learning, there is a lack of valid and reliable scales that reflect students' experiences in the classroom.

OBJECTIVES

To develop and validate a peer evaluation scale for team-based learning.

DESIGN

A cross-sectional methodological study.

SETTING

Four universities located in Gwangju, Republic of Korea.

PARTICIPANTS

Eight nursing students exposed to team-based learning voluntarily participated in a design-thinking project, and eight nursing professors were selected for content validity. For the validation of the Scale, 722 nursing students were randomly selected.

METHODS

The design-thinking method was implemented to develop the Scale, and a questionnaire was used to assess the Scale's construct validity and reliability. The construct validity was examined in a split-half analysis with exploratory and confirmatory factor analyses. Cronbach's alpha, McDonald's omega, and composite reliability were investigated for the peer evaluation scale for team-based learning.

RESULTS

A 12-item tool, with each item using a 5-point scale for peer evaluation, was developed through the empathise, define, ideate, prototype, and test stages of the design-thinking method. Exploratory factor analysis identified three factors from the 12 items: responsibility, initiative, and collaboration. Confirmatory factor analysis demonstrated that the tool had acceptable convergent and discriminant validity, thus confirming good construct validity. All values for reliability were >0.70.

CONCLUSIONS

This study was noteworthy in that it employed the design-thinking method to reflect learners' opinions in developing a peer evaluation instrument. Moreover, the study demonstrated adequate evidence of reliability and validity. Consequently, the developed Scale can be effectively applied to team-based learning assessments for nursing students.