Are We on the Same Page? Shared Mental Models to Support Clinical Teamwork Among Health Professions Learners: A Scoping Review

Bringing team science to the ambulatory diagnostic process: how do patients and clinicians develop shared mental models?

The ambulatory diagnostic process is potentially complex, resulting in faulty communication, lost information, and a lack of team coordination. Patients and families have a unique position in the ambulatory diagnostic team, holding privileged information about their clinical conditions and serving as the connecting thread across multiple healthcare encounters. While experts advocate for engaging patients as diagnostic team members, operationalizing patient engagement has been challenging. The team science literature links improved team performance with shared mental models, a concept reflecting the team's commonly held knowledge about the tasks to be done and the expertise of each team member. Despite their proven potential to improve team performance and outcomes in other settings, shared mental models remain underexplored in healthcare. In this manuscript, we review the literature on shared mental models, applying that knowledge to the ambulatory diagnostic process. We consider the role of patients in the diagnostic team and adapt the five-factor model of shared mental models to develop a framework for patient-clinician diagnostic shared mental models. We conclude with research priorities. Development, maintenance, and use of shared mental models of the diagnostic process amongst patients, families, and clinicians may increase patient/family engagement, improve diagnostic team performance, and promote diagnostic safety.

Team member familiarity and team effectiveness in the operating room: The mediating effect of mutual trust and shared mental models

BACKGROUND

Teamwork in the operating room is of paramount importance to provide high-quality patient care. It has been shown that increased team member familiarity predicts improved teamwork. A complicating factor is the often-changing composition of the operating room teams. Team member familiarity is associated with shared mental models and mutual trust, which are in turn important factors for team effectiveness. However, it remains unclear how this interplay takes place and can be influenced (eg, through team training). Our aim was to investigate the relationship between team member familiarity and perceived team effectiveness in operating room teams. We hypothesized that shared mental models and mutual trust mediate this relationship.

METHODS

We performed a prospective, correlational study in 2 hospitals in the Netherlands. A questionnaire was used to assess team member familiarity, mutual trust, shared mental models (perceived and content-related), and perceived team effectiveness. Data were analyzed using a random intercept multilevel model.

RESULTS

Team member familiarity significantly predicted perceived team effectiveness, both through a direct effect, as well as mediated by perceived shared mental models. Mutual trust also significantly predicted team effectiveness. Variance is determined mostly at an individual level, but also partly (12%) at the operating room level.

CONCLUSION

Greater team member familiarity predicts greater team effectiveness, and this relationship is mediated by shared mental models. Training should be aimed at these aspects of team functioning to optimize team performance in the operating room.

Team functioning in Neurorehabilitation: a mixed methods study

The objective of this study was to enhance understanding of team functioning in a neurorehabilitation team by identifying the factors that impede and facilitate effective interprofessional team collaboration. We focused on team identification, psychological safety, and team learning, and conducted the research at a neurorehabilitation center treating young patients with severe acquired brain injury in the Netherlands. A mixed-methods approach was employed, integrating quantitative data from questionnaires (N = 40) with qualitative insights from a focus group (n = 6) and in-depth interviews (n = 5) to provide a comprehensive perspective on team dynamics. Findings revealed strong team identification among participants, denoting a shared sense of belonging and commitment. However, limited psychological safety was observed, which negatively affected constructive conflict and team learning. Qualitative analysis further identified deficiencies in shared mental models, especially in shared decision-making and integrated care. These results highlight the crucial role of psychological safety in team learning and the development of shared mental models in neurorehabilitation settings. Although specific to neurorehabilitation, the insights gained may be applicable to enhancing team collaboration in various healthcare environments. The study forms a basis for future research to investigate the impact of improvements in team functioning on patient outcomes in similar settings.

When routine becomes stressful: A qualitative study into resuscitation team members' perception of stress and performance

Interprofessional teamwork is of high importance during stressful situations such as CPR. Stress can potentially influence team performance. This study explores the perception of stress and its stressors during performance under pressure, to be able to further adjust or develop training. Healthcare professionals, who are part of the resuscitation team in a large Dutch university medical center, discussed their experiences in homogeneous focus groups. Nine focus groups and one individual interview were conducted and analyzed thematically, in order to deepen our understanding of their experiences. Thematic analysis resulted in two scenarios, routine and stress and an analysis of accompanying team processes. Routine refers to a setting perceived as straightforward. Stress develops in the presence of a combination of stressors such as a lack of clarity in roles and a lack of knowledge on fellow team members. Participants reported that stress affects the team, specifically through an altering of communication, a decrease in situational awareness, and formation of subgroups. This may lead to a further increase in stress, and potentially result in a vicious cycle. Team processes in a stressful situation like CPR can be disrupted by different stressors, and might affect the team and their performance. Improved knowledge about the stressors and their effects might be used to design a training environment representative for the performance setting healthcare professionals work in. Further research on the impact of representative training with team-level stressors and the development of a "team brain" might be worthwhile.

On the edge of decision-making in trauma care: A focus group study on radiographers' experiences of interprofessional collaboration

INTRODUCTION

The temporary trauma teams in trauma alerts consist of a diverse group of unique professionals requiring interprofessional collaboration and coordination to achieve efficient, high-quality care. The uncertain situation and complex care environment impose high demands on team dynamics such as individual attitudes and team behaviours. Within interprofessional teams, interaction and coordination reflect the collective success of collaboration and the achievement of goals. Interactions with radiographers have increased in trauma teams given computed tomography's prominent role in providing crucial knowledge for decision-making in trauma care. This study aimed to explore radiographers' experiences of interprofessional collaboration during trauma alerts.

METHOD

The study was designed with focus group methodology, including 17 radiographers participating in five focus groups, analysed with an inductive focus group analysis.

RESULTS

An overarching theme, "On the edge of decision-making", emerged along with three sub-themes: "Feeling included requires acknowledgement", "Exclusion precludes shared knowledge", and "Experience and mutual awareness facilitate team interaction".

CONCLUSIONS

Interprofessional collaboration from the radiographer's perspective within trauma teams requires a sense of inclusion and the ability to interact with the team. Exclusion from vital decision-making obstructs radiographers' comprehension of situations and thereby the interdependence in interprofessional collaboration.

IMPLICATIONS FOR PRACTICE

Common platforms are needed for knowledge sharing and team practices, including radiographers' areas of responsibility and relational coordination to foster interprofessional relationships. Through these means interdependence through awareness and shared knowledge can be facilitated on trauma teams.

Increasing Nurse-Physician Family-Centered Rounds Communication: A Quality Improvement Pilot Project

BACKGROUND

High-quality nurse-physician communication during family-centered rounds (FCRs) can increase patient safety.

LOCAL PROBLEM

In our hospital, interdisciplinary team members perceived that nurse-physician communication during FCRs declined during the COVID-19 pandemic.

METHODS

Using quality improvement methodology, we measured nurses' perceived awareness of components of the shared mental model, nurses' attendance during FCRs, compliance with completing FCR summaries, and average time spent per FCR encounter.

INTERVENTIONS

A structured resident huddle took place prior to an FCR. Residents used a tool to send individualized alerts to bedside nurses to prepare them for an FCR. Residents developed comprehensive summaries after each FCR encounter and sent a summary text to nurses who were unable to attend the FCR.

RESULTS

We assessed 40 FCRs over 16 weeks. Nurses' perceived awareness increased from 70% to 87%. Nurse attendance increased from 53% to 75%.

CONCLUSIONS

We successfully piloted multiple interventions to improve nurse perceived awareness after an FCR.

Palliative care for NICU survivors with chronic critical illness

The sickest of NICU survivors develop chronic critical illness (CCI). Most infants with CCI will leave the NICU using chronic medical technology and will experience repeated rehospitalizations. The unique issues for these NICU graduates- escalating chronic medical technologies, fractured post-NICU healthcare, gaps in home health services, and family strain-are common and predictable. This means that raising family and NICU team awareness of these issues, and putting plans in place to address them, should occur for every NICU infant with CCI. Pediatric palliative care is one resource that can be engaged within the NICU to support the child and family through NICU discharge and beyond. This review examines what is known about the unique needs of infants who leave the NICU with CCI and the role that NICU-initiated palliative care involvement can play for these patients, families, clinicians, and the health care system.

Scholarly practice in healthcare professions: findings from a scoping review

Scholarly practitioners are broadly defined as healthcare professionals that address critical practice problems using theory, scientific evidence, and practice-based knowledge. Though scholarly practice is included in most competency frameworks, it is unclear what scholarly practice is, how it develops and how it is operationalized in clinical practice. The aim of this review was to determine what is known about scholarly practice in healthcare professionals. We conducted a scoping review and searched MEDLINE, EMBASE, CINAHL from inception to May 2020. We included papers that explored, described, or defined scholarly practice, scholar or scholarly practitioner, and/or related concepts in healthcare professionals. We included a total of 90 papers. Thirty percent of papers contained an explicit definition of scholarly practice. Conceptualizations of scholarly practice were organized into three themes: the interdependent relationship between scholarship and practice; advancing the profession's field; and core to being a healthcare practitioner. Attributes of scholarly practitioners clustered around five themes: commitment to excellence in practice; collaborative nature; presence of virtuous characteristics; effective communication skills; and adaptive change ethos. No single unified definition of scholarly practice exists within the literature. The variability in terms used to describe scholarly practice suggests that it is an overarching concept rather than a definable entity. There are similarities between scholarly practitioners and knowledge brokers regarding attributes and how scholarly practice is operationalized. Individuals engaged in the teaching, research and/or assessment of scholarly practice should make explicit their definitions and expectations for healthcare professionals.

Team- and task-related knowledge in shared mental models in operating room teams: A survey study

Objective

The operating room is a highly complex environment, where patient care is delivered by interprofessional teams. Unfortunately, issues with communication and teamwork occur, potentially leading to patient harm. A shared mental model is one prerequisite to function effectively as a team, and consists of task- and team-related knowledge. We aimed to explore potential differences in task- and team-related knowledge between the different professions working in the operating room. The assessed team-related knowledge consisted of knowledge regarding other professions' training and work activities, and of perceived traits of a high-performing and underperforming colleague. Task-related knowledge was assessed by mapping the perceived allocation of responsibilities for certain tasks, using a Likert-type scale.

Design

A single sample cross-sectional study.

Setting

The study was performed in three hospitals in the Netherlands, one academic center and two regional teaching hospitals.

Participants

106 health care professionals participated, of four professions. Most respondents (77%) were certified professionals, the others were still in training.

Results

Participants generally were well informed about each other's training and work activities and nearly everyone mentioned the importance of adequate communication and teamwork. Discrepancies were also observed. The other professions knew on average the least about the profession of anesthesiologists and most about the profession of surgeons. When assessing the responsibilities regarding tasks we found consensus in well-defined and/or protocolized tasks, but variation in less clearly defined tasks.

Conclusions

Team- and task-related knowledge in the operating room team is reasonably well developed, but irregularly, with potentially crucial differences in knowledge related to patient care. Awareness of these discrepancies is the first step in further optimization of team performance.

"Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses

OBJECTIVES

(1) Characterize persistent hazards and inefficiencies in inpatient medication administration; (2) Explore cognitive attributes of medication administration tasks; and (3) Discuss strategies to reduce medication administration technology-related hazards.

MATERIALS AND METHODS

Interviews were conducted with 32 nurses practicing at 2 urban, eastern and western US health systems. Qualitative analysis using inductive and deductive coding included consensus discussion, iterative review, and coding structure revision. We abstracted hazards and inefficiencies through the lens of risks to patient safety and the cognitive perception-action cycle (PAC).

RESULTS

Persistent safety hazards and inefficiencies related to MAT organized around the PAC cycle included: (1) Compatibility constraints create information silos; (2) Missing action cues; (3) Intermittent communication flow between safety monitoring systems and nurses; (4) Occlusion of important alerts by other, less helpful alerts; (5) Dispersed information: Information required for tasks is not collocated; (6) Inconsistent data organization: Mismatch of the display and the user's mental model; (7) Hidden medication administration technologies (MAT) limitations: Inaccurate beliefs about MAT functionality contribute to overreliance on the technology; (8) Software rigidity causes workarounds; (9) Cumbersome dependencies between technology and the physical environment; and (10) Technology breakdowns require adaptive actions.

DISCUSSION

Errors might persist in medication administration despite successful Bar Code Medication Administration and Electronic Medication Administration Record deployment for reducing errors. Opportunities to improve MAT require a deeper understanding of high-level reasoning in medication administration, including control over the information space, collaboration tools, and decision support.

CONCLUSION

Future medication administration technology should consider a deeper understanding of nursing knowledge work for medication administration.

Impact of Interprofessional Teamwork on Aligning Intensive Care Unit Care with Patient Goals: A Qualitative Study of Transactive Memory Systems

Rationale: Although aligning care with patient goals is fundamental to critical care, this process is often delayed and leads to conflict among patients, families, and intensive care unit (ICU) teams. Interprofessional collaboration within ICU teams is an opportunity to improve goal-aligned care, yet this collaboration is poorly understood. A better understanding of how ICU team members work together to provide goal-aligned care may identify new strategies for improvement. Objectives: Transactive memory systems is a theory of group mind that explains how high-performing teams use a shared memory and collective cognition. We applied this theory to characterize the process of interprofessional collaboration within ICU teams and its relationship with goal-aligned care. Methods: We conducted a secondary analysis of focus group (n = 10) and semistructured interview (n = 8) transcripts, gathered during a parent study at two academic medical centers on the process of ICU care delivery in acute respiratory failure. Participants (N = 70) included interprofessional ICU and palliative care team members, surrogates, and patient survivors. We used directed content analysis, applying transactive memory systems theory and its major components (specialization, coordination, credibility) to examine ICU team collaboration. Results: Participants described each ICU profession as having a specialized role in aligning care with patient goals. Different professions have different opportunities to gather knowledge about patient goals and priorities, which results in dispersion of this knowledge among different team members. To share and use this dispersed knowledge, ICU teams rely on an informal coordination process and "side conversations." This process is a workaround for formal channels (e.g., health records, interprofessional rounds) that do not adequately convey knowledge about patient goals. This informal process does not occur if team members are discouraged from asserting their knowledge because of hierarchy or lack of psychological safety. Conversely, coordination succeeds when team members recognize each other as credible sources of valued knowledge. Conclusions: We found that ICU team members work together to align care with patient goals and priorities, using transactive memory systems. The successful function of these systems can be disrupted or promoted by ICU organizational and cultural factors, which are potential targets for efforts to increase goal-aligned care.

Developing local crisis leadership - A research and training agenda

The crisis triggered by Covid-19 has exposed the interdependencies of modern society and sparked interest in local response to protracted and complex crisis situations. There has been a growing awareness and interest in the key roles of political and professional stakeholders, their emotional regulation and how they influence team performance and outcomes in dealing with uncertainty and complex crisis situations. While cognitive and behavioral aspects of crisis leadership are well researched, less is understood about how one can mitigate negative emotions, instill trust, or restore public faith and support of security forces and emergency response teams during crises. In addressing this gap, we propose a simplified conceptual roadmap for research and training of local crisis leadership. In this, we emphasize complex problem solving, team interaction, team context and technology and team training design. These four factors represent significant barriers if neglected. On the other side, they may be considerable force multipliers when better understood and managed. We suggest how seven research and training questions could be linked to the four conceptual factors and guide an evidence-based approach to develop local crisis leadership.

Measuring the impact of simulation debriefing on the practices of interprofessional trauma teams using natural language processing

BACKGROUND

Natural language processing (NLP) may be a tool for automating trauma teamwork assessment in simulated scenarios.

METHODS

Using the Trauma Nontechnical Skills Assessment (T-NOTECHS), raters assessed video recordings of trauma teams in simulated pre-debrief (Sim1) and post-debrief (Sim2) trauma resuscitations. We developed codes through directed content analysis and created algorithms capturing teamwork-related discourse through NLP. Using a within subjects pre-post design (n = 150), we compared changes in teams' Sim1 versus Sim2 T-NOTECHS scores and automatically coded discourse to identify which NLP algorithms could identify skills assessed by the T-NOTECHS.

RESULTS

Automatically coded behaviors revealed significant post-debrief increases in teams' simulation discourse: Verbalizing Findings, Acknowledging Communication, Directed Communication, Directing Assessment and Role Assignment, and Leader as Hub for Information.

CONCLUSIONS

Our results suggest NLP can capture changes in trauma team discourse. These findings have implications for the expedition of team assessment and innovations in real-time feedback when paired with speech-to-text technology.

Preliminary evidence for a Tool to Observe the Construction of Knowledge in Interprofessional teams (TOCK-IP)

Collaborative knowledge construction (KC) is an important process in interprofessional learning and a logical assessment target. A tool supporting the formative evaluation of KC behaviors ideally would be: 1) applicable to interprofessional teams of learners in clinical contexts; 2) informed by contemporary learning frameworks; 3) feasible and useful. No existing assessment tool meets these criteria. This paper describes the development and preliminary validity evidence for a Tool for Observing Construction of Knowledge in Interprofessional teams (TOCK-IP). Following literature review and needs assessment, the TOCK-IP was drafted based upon Gunawardena's five-phase KC model. Educational expert review established content validity. Response process and internal structure validity, feasibility, and utility were assessed through step-wise evaluation. Faculty raters applied the tool to four videos of simulated interactions between health professions learners. Faculty ratings were compared to expert consensus ratings. Thematic analysis of post-rating survey and debrief allowed assessment of feasibility and utility. Across videos, faculty raters' agreement was fair (n = 25; Fleiss' kappa = 0.40, <0.001). Excellent agreement (95%) was found for raters' scores compared to consensus rating. Faculty supported tool feasibility and utility. The TOCK-IP meets the three criteria for evaluating team-level KC and offers a progression roadmap to help learners move toward collaborative learning.

Measurement and performance impact of team mental models on process performance

Efficient business process execution is an essential part of an organisation’s success. It depends on good dynamic decision making of process actors that is guided by their mental models of business processes (MMBP). The study investigates the effect of MMBPs on process performance at two levels. At the level of individuals, the impact of MMBP accuracy on performance is analyzed, and at the level of a team, the effect of similarity of MMBPs of all team on performance is researched. At both levels, MMBPs are differentiated in a narrow part that focuses on the mental representations of process steps that precede or follow on the one conducted by the actor and a holistic model that captures the process as a whole. We use laboratory observations with 159 participants in 10 teams from a real effort loan processing role play. We obtain individual MMBP accuracy measures by using a process knowledge test and measure the process performance of teams with the outcome of the role play. Our study contributes in three ways to existing research. First, the measurement approach of individual MMBP accuracy and similarity is extended to the level of teams. Second, the study shows that the accuracy of both narrow and holistic MMBPs as well as similarity of holistic MMBPs positively impact team process performance. Third, by using an observable team process performance measures from a real-effort task, we increase the validity of our findings compared to other research relying on self-assessed performance measures.

Healthcare Professionals' Perceptions of Function-Focused Care Education for Nursing Home Practitioners

A nursing home (NH) care environment necessitates a shared cognition-based education model that maintains effective function-focused care (FFC). This study’s aim was to explore healthcare professionals’ perceptions of function-focused care education for the development of an education model using a shared mental model (SMM) in NHs. Semi-structured interviews with 30 interdisciplinary practitioners from four different professions (nurses, physical therapists, occupational therapists, and social workers) and focus group interviews with 12 experts were conducted. Data were analyzed using content analysis, and the education model development was guided by the shared mental models for data interpretation and formation. Our FFC interdisciplinary educational model incorporates four key learning components: learning contents, educational activities, educational goals/outcome, and environment, and four types of SMMs: team, task, team interaction, and equipment. As for educational contents, a team’s competencies with FFC were found to be team knowledge (physical and psychosocial functional care), team skills to perform FFC successfully (motivation, coaching and supporting, managing discomfort), and team attitude (possessing philosophy perceptions regarding FFC). As for learning outcomes, the shared cognition-based education model suggests not only the evaluation of practitioners, but also the assessment of residents’ aspects.

Scoping reviews in medical education: A scoping review

OBJECTIVES

Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities.

METHOD

The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review.

RESULTS

One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal.

CONCLUSIONS

Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.

Better Decision-Making: Shared Mental Models and the Clinical Competency Committee

BACKGROUND

Shared mental models (SMMs) help groups make better decisions. Clinical competency committees (CCCs) can benefit from the development and use of SMMs in their decision-making as a way to optimize the quality and consistency of their decisions.

OBJECTIVE

We reviewed the use of SMMs for decision making in graduate medical education, particularly their use in CCCs.

METHODS

In May 2020, the authors conducted a narrative review of the literature related to SMMs. This review included the SMM related to teams, team functioning, CCCs, and graduate medical education.

RESULTS

The literature identified the general use of SMMs, SMMs in graduate medical education, and strategies for building SMMs into the work of the CCC. Through the use of clear communication and guidelines, and a shared understanding of goals and expectations, CCCs can make better decisions. SMMs can be applied to Milestones, resident performance, assessment, and feedback.

CONCLUSIONS

To ensure fair and robust decision-making, the CCC must develop and maintain SMMs through excellent communication and understanding of expectations among members.

Learning about stress from building, drilling and flying: a scoping review on team performance and stress in non-medical fields

BACKGROUND

Teamwork is essential in healthcare, but team performance tends to deteriorate in stressful situations. Further development of training and education for healthcare teams requires a more complete understanding of team performance in stressful situations. We wanted to learn from others, by looking beyond the field of medicine, aiming to learn about a) sources of stress, b) effects of stress on team performance and c) concepts on dealing with stress.

METHODS

A scoping literature review was undertaken. The three largest interdisciplinary databases outside of healthcare, Scopus, Web of Science and PsycINFO, were searched for articles published in English between 2008 and 2020. Eligible articles focused on team performance in stressful situations with outcome measures at a team level. Studies were selected, and data were extracted and analysed by at least two researchers.

RESULTS

In total, 15 articles were included in the review (4 non-comparative, 6 multi- or mixed methods, 5 experimental studies). Three sources of stress were identified: performance pressure, role pressure and time pressure. Potential effects of stress on the team were: a narrow focus on task execution, unclear responsibilities within the team and diminished understanding of the situation. Communication, shared knowledge and situational awareness were identified as potentially helpful team processes. Cross training was suggested as a promising intervention to develop a shared mental model within a team.

CONCLUSION

Stress can have a significant impact on team performance. Developing strategies to prevent and manage stress and its impact has the potential to significantly increase performance of teams in stressful situations. Further research into the development and use of team cognition in stress in healthcare teams is needed, in order to be able to integrate this 'team brain' in training and education with the specific goal of preparing professionals for team performance in stressful situations.

Toward the Development of the Perfect Medical Team: Critical Components for Adaptation

OBJECTIVE

Medical teams play a vital role in the delivery of safe and effective patient care. Toward the goal of becoming a high-reliability health system, the authors posit that the "perfect" medical team is one that develops their attitudes, behaviors, and cognitions (ABCs) to facilitate adaptation.

METHODS

The authors synthesized the literature (frameworks, measures, and conceptual models) on teamwork in healthcare (k = 161) to develop an evidence-based model of ABCs, which current evidence suggests, are requisite for medical team adaptation. Clinical vignettes were garnered from the media and other sources to illustrate how these ABCs-or failure in using these ABCs-can lead to positive or negative events in healthcare.

RESULTS

The resulting model contains the most frequently included ABCs in healthcare teamwork models, measures, and frameworks: psychological safety (41, 25.5%), situation assessment (66, 41.0%), shared mental models (56, 34.8%), team leadership behaviors (78, 48.4%), role awareness (64, 39.7%), team decision-making (61, 37.9%) and planning (41, 25.5%), conflict management (51, 31.7%), task coordination (71, 44.1%), adaptation (46, 28.6%), and backup behavior (54, 33.5%). The authors posit that communication and organizational conditions-other highly cited components-(141, 87.6%, and 90, 55.9%, respectively) serve as moderators of these relationships.

CONCLUSIONS

The authors argue that each of these ABCs is critical for enhancing team adaptation and subsequently increasing patient safety. A list of practical tools and educational strategies that teams and organizations can use to improve their performance on each of these ABCs is provided.

An interaction analysis model to study knowledge construction in interprofessional education: proof of concept

A goal of interprofessional clinical learning experiences is to facilitate learning through co-construction of knowledge in support of patient care. Yet, little is known about knowledge construction processes among health professions students working together to care for patients. Understanding knowledge construction processes can guide health professions educators in the design of interventions to support knowledge construction and high-quality learning in clinical placements. In this article, we describe findings from a proof of concept study that explores the feasibility and utility of using Gunawardena's Interaction Analysis Model (IAM) to evaluate health professions students' knowledge construction processes in clinical placements. The IAM has been used to study knowledge construction processes in computer-supported collaborative learning environments, but not in interprofessional education. The IAM describes five phases of knowledge construction - sharing/comparing; exploring dissonance; co-constructing meaning; testing; coming to agreement/applying co-constructed knowledge - each representing a progressively higher-level learning process. Application of the IAM to learner dialogue proved labor-intensive but feasible and useful as a research tool to characterize learners' knowledge construction behaviors. Our findings suggest that the IAM warrants further study and may offer a framework to guide the design of clinical placements and analysis of interprofessional learning behaviors.

"Getting Everyone on the Same Page": Interprofessional Team Training to Develop Shared Mental Models on Interprofessional Rounds

AIM

This study aimed to evaluate the effect of a team training program to support shared mental model (SMM) development in interprofessional rounds.

DESIGN AND PARTICIPANTS

A three-arm randomized controlled trial study was conducted for interprofessional teams of 207 health profession learners who were randomized into three groups.

PROGRAM DESCRIPTION

The full team training program included a didactic training part on cognitive tools and a virtual simulation to support clinical teamwork in interprofessional round. Group 1 was assigned to the full program, group 2 to the didactic part, and group 3 (control group) with no intervention. The main outcome measure was team performance in full scale simulation. Secondary outcome was interprofessional attitudes.

PROGRAM EVALUATION

Teamwork performance and interprofessional attitude scores of the full intervention group were significantly higher (P < 0.05) than those of the control group. The two intervention groups had significantly higher (P < 0.05) attitude scores on interprofessional teamwork compared with the control group.

DISCUSSION

Our study indicates the need of both cognitive tools and experiential learning modalities to foster SMM development for the delivery of optimal clinical teamwork performances. Given its scalability and practicality, we anticipate a greater role for virtual simulations to support interprofessional team training.

A mixed methods study examining teamwork shared mental models of interprofessional teams during hospital discharge

BACKGROUND

Little is known about how team processes impact providers' abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams' organised understanding of individual member's roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when discharging patients.

METHODS

This mixed methods study examined teamwork-SMMs of inpatient interprofessional discharge teams at a single hospital. For each discharge event, we collected data from the patient and their discharge team (nurse, physician and coordinator) using interviews and questionnaires. We quantitatively determined the discharge teams' teamwork-SMM components of quality and convergence using the Shared Mental Model Scale, and then explored their relationships to patient-reported preparation for posthospital care. We used qualitative thematic analysis of narrative cases to examine the contextual differences of discharge teams with higher versus lower teamwork-SMMs.

RESULTS

The sample included a total of 106 structured patient interviews, 192 provider day-of-discharge questionnaires and 430 observation hours to examine 64 discharge events. We found that inpatient teams with better teamwork-SMMs (ie, higher perceptions of teamwork quality or greater convergence) were more effective at preparing patients for post-hospital care. Additionally, teams with high and low teamwork-SMMs had different experiences with team cohesion, communication openness and alignment on the patient situation.

CONCLUSIONS

Examining the quality and agreement of teamwork-SMMs among teams provides a better understanding of how teams coordinate care and may facilitate the development of specific team-based interventions to improve patient care at hospital discharge.

The role of rural communities in the recruitment and retention of women physicians

Rural communities in the United States have a shortage of primary care physicians. Women physicians are more likely than male physicians to choose primary care specialties but less likely to locate in rural areas. With an increasing proportion of women physicians, it is important to understand community characteristics that encourage their recruitment and retention. This qualitative study explored community characteristics that influenced successful rural practice. We conducted telephone interviews with 25 women family physicians in rural practice in the United States in 2012. Interviews continued until saturation of themes was reached. Data were analyzed using immersion and crystallization. Community themes associated with successful rural practice included: fit with the community; spouse/partner fit with the community; relationships with individuals; and relationships with the community. Family ties, training experience within the community, social networks, and investment in the community were positive factors, while political/cultural differences were negative. Community integration arose from compatibility between the physicians' goals and community characteristics, opportunities for a spouse/partner, friendships, and a feeling of community purpose. This information can be used by rural communities to recruit and retain physicians, and by physicians, medical students, and those who advise them to promote successful rural practice.

Outcomes, accreditation, interprofessional education, and the Tower of Babel

Effective education necessitates a shared mental model of what and how learners should be taught. Students in various healthcare professions education programs learn together most effectively when programs have a shared mental model for education. Because healthcare professions education programs must satisfy their respective accreditation standards, the terminology of those standards reflects that body's shared mental model for education. Thus, interprofessional education (IPE) would be facilitated by common educational lexicon across accrediting bodies. In this study, the terminology used in the accreditation standards from several healthcare professions educational programs was measured. An analysis was conducted to illustrate whether terms used by accreditors were internally consistent and whether there was consistency across professions. Counts of learning outcomes terms used revealed little internal consistency within each set of standards. Additionally, the terms in the various standards documents used to describe educational outcomes were not consistent across accreditors. Individual healthcare professions educational programs find IPE difficult to implement and maintain for pre-professional students. This study suggests that these programs' learning outcomes, which are regulated by accreditation standards, probably conflict with implementation of IPE initiatives. Strategies to normalize learning outcomes language and develop shared mental models for IPE are needed.

"Doctor Jazz": Lessons that medical professionals can learn from jazz musicians

BACKGROUND

The worlds of a physician and a jazz musician seem entirely different. Various studies, however, relating the concepts behind jazz music to medical practice and education, have been published. The aim of this essayistic review is to summarize previously described concepts behind jazz music and its required artistic skills that could be translated to medicine, encouraging doctors, medical students and medical educators to see their professional environment from a different perspective.

METHODS

A systematic search was conducted using PubMed, Embase, and ERIC databases, combining keywords with regard to jazz, medicine and medical education. Background information concerning jazz music and several jazz musicians was retrieved through an additional nonsystematic search using Google Scholar.

RESULTS

Lessons with regard to improvisational skills, both in communication with patients and in a technical context, communication skills, leadership, interprofessional teamwork and coping with errors are presented.

CONCLUSIONS

Doctors and medical students could learn various lessons from jazz music performance and jazz musicians. The potential and the possibilities of implementing jazz into the medical curriculum, in order to contribute to the development of professional skills and attitudes of medical students, could be explored further.

The Fostering Resilience through Art in Medical Education (FRAME) workshop: a partnership with the Philadelphia Museum of Art

Background: Provider burnout remains a serious problem facing medical training programs and has been shown to affect more than half of internal medicine residents. In addition to broader efforts to revamp a health care system that contributes to this epidemic, exposure to the medical humanities offers potential to promote engagement, resilience, and restoration of meaning in residents' daily lives. Objective: We aim to create a reproducible, evidence-based workshop utilizing artful thinking routines to prepare trainees to combat burnout with reflection, perspective-taking, and community-building. Methods: A single, 4-hour workshop for senior internal medicine residents, centered on visual artistic analysis, was offered in June 2017 at the Philadelphia Museum of Art. Pre- and post-workshop burnout metrics and survey evaluation data were analyzed using a mixed-methods approach. Results: Workshop participation was offered to 29 internal medicine residents, of whom 17 (59%) participated. All survey respondents (n=13) rated the workshop as excellent and would recommend it to colleagues. Moderate decreases in the observed frequencies of both high emotional exhaustion scores (64.7% before the workshop to 55.5% following the workshop) and high depersonalization scores (70.6% before the workshop to 55.5% following the workshop) were observed. Conclusions: While results are preliminary in nature, the workshop was received favorably and demonstrated modest decreases in emotional exhaustion and depersonalization. We are encouraged to explore and repeat this workshop with modifications to identify its optimal position in the broader landscape of emerging wellness curricula.

Measuring situation awareness and team effectiveness in pediatric acute care by using the situation global assessment technique

Situation awareness (SA) is an important human factor and necessary for effective teamwork and patient safety. Human patient simulation (HPS) with video feedback allows for a safe environment where health care professionals can develop both technical and teamwork skills. It is, however, very difficult to observe and measure SA directly. The Situation Global Assessment Technique (SAGAT) was developed by Endsley to measure SA during real-time simulation. Our objective was to measure SA among team members during simulation of acute pediatric care scenarios on the medical ward and its relationship with team effectiveness. Twenty-four pediatric teams, consisting of two nurses, one resident, and one consultant, participated in three acute care scenarios, using high-fidelity simulation. Individual SAGAT scores contained shared and complimentary knowledge questions on different levels of SA. Within each scenario, two "freezes" were incorporated to assess SA of each team members' clinical assessment and decision-making. SA overlap within the team (team SA) was computed and compared to indicators of team effectiveness (time to goal achievement, consensus on primary problem, diagnosis, task prioritization, leadership, and teamwork satisfaction). In 13 scenarios (18%), the team failed to reach the primary goals within the prescribed time of 1200 s. There was no significant difference in failure of goal completion between the scripted scenarios; however, there was a significant difference between scenario 3 and the other scenarios in time to goal completion. In all three scenarios, SA overlap level 2 (consensus on primary problem during the first freeze and consensus on diagnosis during the second freeze) leads to significantly faster achievement of the predefined goals. There was a strong relationship between team SA on the primary problem and diagnosis and team SA on task prioritization. Consensus on leadership within the team was low. Teamwork satisfaction was more influenced by knowledge about the importance of the assigned task than outcome of the scenario.Conclusion: The use of SAGAT enables us to measure SA of team members during real-time simulation of acute care scenarios. Although there is no direct connection between team SA and goal achievement, SAGAT provides insight in differences in SA among team members, and the process of shared mental model formation. By measuring SA, issues that may improve team effectiveness (prioritizing tasks, enhancing shared mental models, and providing leadership) can be trained and assessed during medical team simulation, enhancing teamwork in health care settings. What is known? • Teamwork skills such as communication, leadership, and situational awareness have become increasingly recognized as essential for good performance in pediatric resuscitation. However, the assessment of pediatric team performance in these clinical situations has been traditionally difficult. • The Situation Awareness Global Assessment Technique (SAGAT) is a method of objectively and directly measuring SA during a team simulation using "freezes" at predetermined points in time with participants reporting on "what is going on" from their perspective on the situation. What is new? • We assessed SA, and its relationship with team effectiveness, in multidisciplinary pediatric teams performing simulated critical events in critically ill children on the medical ward using the SAGAT model, outside the emergency room setting. • In all three scenarios, consensus on the primary problem (shared mental model) leads to faster achievement of predefined goals. Consensus on leadership was overall low, without a significant impact on goal achievement.

The Impact of Multimodal Communication on a Shared Mental Model, Trust, and Commitment in Human–Intelligent Virtual Agent Teams

There is an increasing interest in the use of intelligent virtual agents (IVAs) to work in teams with humans. To achieve successful outcomes for these heterogeneous teams, many of the aspects found in successful human teams will need to be supported. These aspects include behavioural (i.e., multimodal communication), cognitive (i.e., a shared mental model (SMM)), and social (trust and commitment). Novelly, this paper aims to investigate the impact of IVA’s multimodal communication on the development of a SMM between humans and IVAs. Moreover, this paper aims to explore the impact of the developed SMM on a human’s trust in an IVA’s decisions and a human’s commitment to honour his/her promises to an IVA. The results from two studies involving a collaborative activity showed a significant positive correlation between team multimodal communication (i.e., behavioural aspect) and a SMM between teammates (i.e., cognitive aspect). Moreover, the result showed that there is a significant positive correlation between the developed SMM and a human’s trust in the IVA’s decision and the human’s commitment to honour his/her promises (the establishment of the social aspect of teamwork). Additionally, the results showed a cumulative effect of all of these aspects on human–agent team performance. These results can guide the design of human–agent teamwork multimodal communication models.