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Keller S, Jelsma JGM, Tschan F, Sevdalis N, Löllgen RM, Creutzfeldt J, Kennedy-Metz LR, Eppich W, Semmer NK, Van Herzeele I, Härenstam KP, de Bruijne MC. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Serv Res 2024; 24:71. [PMID: 38218788 PMCID: PMC10788034 DOI: 10.1186/s12913-024-10555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. METHODS In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. RESULTS Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. CONCLUSIONS Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research (DBMR), Bern University, Bern, Switzerland.
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, KCL, London, UK
| | - Ruth M Löllgen
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, (CAMST), Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lauren R Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
- Psychology Department, Roanoke College, Salem, VA, USA
| | - Walter Eppich
- Department of Medical Education & Collaborative Practice Centre, University of Melbourne, Melbourne, Australia
| | - Norbert K Semmer
- Department of Work Psychology, University of Bern, Bern, Switzerland
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karin Pukk Härenstam
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Escher C, Rystedt H, Creutzfeldt J, Meurling L, Hedman L, Felländer-Tsai L, Kjellin A. All professions can benefit - a mixed-methods study on simulation-based teamwork training for operating room teams. Adv Simul (Lond) 2023; 8:18. [PMID: 37460943 PMCID: PMC10351117 DOI: 10.1186/s41077-023-00257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/09/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Operating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants' reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace. METHODS In a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team. Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years. Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis. RESULTS All occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one's profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration. CONCLUSION Simulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.
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Affiliation(s)
- Cecilia Escher
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden.
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - Hans Rystedt
- Simulator Centre West, Region Västra Götaland, Gothenburg, Sweden
| | - Johan Creutzfeldt
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Lisbet Meurling
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Leif Hedman
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Li Felländer-Tsai
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ann Kjellin
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Dubois H, Creutzfeldt J, Manser T. Behavioural observation tool for patient involvement and collaboration in emergency care teams (PIC-ET-tool). BMC Emerg Med 2023; 23:74. [PMID: 37393240 PMCID: PMC10314478 DOI: 10.1186/s12873-023-00841-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/05/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Patient participation is advocated in various healthcare settings. Instruments for assessment and feedback have been developed to strengthen clinician-patient interaction. In an emergency department context, such instruments are still missing. The study aimed to develop and test an observation tool for emergency teams' behaviour regarding patient involvement and collaboration. METHODS The development of the behavioural observation tool followed a systematic approach. The tool's content was based on various data sources, i.e., published literature, interview and observational data, and expert consensus. An international expert panel reviewed the content and the rating scale and rated its importance for patient involvement and collaboration in a Delphi process. The feasibility and reliability of the tool were tested by trained observers using video recordings of simulated emergencies. Intraclass correlation (ICC) and Kappa-statistics were performed to test the tool's inter-rater reliability. RESULTS The PIC-ET tool, a 22-item observation instrument was developed in which patient involvement and collaboration behaviours are rated from 'no' to 'high' using behavioural anchors. Expert agreement was obtained after three Delphi rounds on the tool content, the behavioural anchors and its importance for patient involvement and collaboration. The content validity was assessed as high, and the tool was found feasible for research. Overall inter-rater reliability was fair (Kappa 0.52). CONCLUSIONS A novel tool for assessing emergency teams' behaviour regarding patient involvement and collaboration is introduced. The tool's psychometric properties were fair to good. Further validation of the PIC-ET tool is recommended for more robust evidence. Future adaptation to different contexts and areas of use, as well as further validity testing may be of value.
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Affiliation(s)
- Hanna Dubois
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, S-14186 Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, S-14186 Sweden
| | - Tanja Manser
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, S-14186 Sweden
- FHNW School of Applied Psychology, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, Olten, CH-4600 Switzerland
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Morian H, Härgestam M, Hultin M, Jonsson H, Jonsson K, Nordahl Amorøe T, Creutzfeldt J. Reliability and validity testing of team emergency assessment measure in a distributed team context. Front Psychol 2023; 14:1110306. [PMID: 37151315 PMCID: PMC10157038 DOI: 10.3389/fpsyg.2023.1110306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teams with varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74-0.92 on the TEAM instrument's three domains of leadership, teamwork, and task management. Internal consistency (Cronbach's alpha) ranged between 0.89-0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams' overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.
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Affiliation(s)
- Hanna Morian
- Department of Nursing, Umeå University, Umeå, Sweden
- *Correspondence: Hanna Morian,
| | | | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesia and Critical Care Medicine, Umeå University, Umeå, Sweden
| | - Håkan Jonsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Karin Jonsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Torben Nordahl Amorøe
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Simulation Center West, Department of Research, Education, and Development, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
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Escher C, Nagy E, Creutzfeldt J, Dahl O, Ruiz M, Ericson M, Osika W, Meurling L. Fear of making a mistake: a prominent cause of stress for COVID-19 ICU staff-a mixed-methods study. BMJ Open Qual 2023; 12:e002009. [PMID: 36697055 PMCID: PMC9884924 DOI: 10.1136/bmjoq-2022-002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a profound effect on many domains of healthcare. Even in high-income countries such as Sweden, the number of patients has vastly outnumbered the resources in affected areas, in particular during the first wave. Staff caring for patients with COVID-19 in intensive care units (ICUs) faced a very challenging situation that continued for months. This study aimed to describe burnout, safety climate and causes of stress among staff working in COVID-19 ICUs. METHOD A survey was distributed to all staff working in ICUs treating patients with COVID-19 in five Swedish hospitals during 2020 and 2021. The numbers of respondents were 104 and 603, respectively. Prepandemic data including 172 respondents from 2018 served as baseline. RESULTS Staff exhaustion increased during the pandemic, but disengagement decreased compared with prepandemic levels (p<0.001). Background factors such as profession and work experience had no significant impact, but women scored higher in exhaustion. Total workload and working during both the first and second waves correlated positively to exhaustion, as did being regular ICU staff compared with temporary staff. Teamwork and safety climate remained unchanged compared with prepandemic levels.Respondents reported 'making a mistake' as the most stressful of the predefined stressors. Qualitative analysis of open-ended questions identified 'lack of knowledge and large responsibility', 'workload and work environment', 'uncertainty', 'ethical stress' and 'organization and teamwork' as major causes of stress. CONCLUSION Despite large workloads, disengagement at work was low in our sample, even compared with prepandemic levels. High levels of exhaustion were reported by the ICU staff who carried the largest workload. Multiple significant causes of stress were identified, with fear of making a mistake the most significant stressor.
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Affiliation(s)
- Cecilia Escher
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Department of Anesthesia and Intensive Care, Norrtälje Hospital, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Nagy
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Creutzfeldt
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Oili Dahl
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Mini Ruiz
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Mats Ericson
- Division of Ergonomics, Royal Institute of Technology, Stockholm, Sweden
| | - Walter Osika
- Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Lisbet Meurling
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Dubois H, Bergenmar M, Härgestam M, Creutzfeldt J. Patient participation in tele-emergencies - experiences from healthcare professionals in northern rural Sweden. Rural Remote Health 2022; 22:7404. [PMID: 36480908 DOI: 10.22605/rrh7404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Telemedicine provides opportunities for access to health care in remote and underserved areas. In parts of northern rural Sweden telemedicine is used to connect a remote physician by a video-conference system to an emergency room, staffed by nurses during on-call hours. This can be called 'tele-emergency'. Patient participation, often described as mutual information exchange, a trustful relationship and involvement in decision-making, is challenged in emergency care by short encounters, deteriorating patients and a stressful work situation. Nevertheless, patient participation may be important for the patients' experience. Healthcare professionals (HCPs) have been identified as 'gatekeepers' for patient participation, therefore putting their perspective in focus is important. As emergency care in rural areas is increasingly turning toward telemedicine, patient participation in tele-emergencies needs to be better understood. The aim of this study was to explore and characterise HCPs' perspectives of patient participation in tele-emergencies in northern rural Sweden. METHODS A qualitative design based on interviews was used. HCPs working in cottage hospitals in northern rural Sweden were included. Semi-structured interviews were performed, first, in multidisciplinary groups of three informants. Later, because of limited experience of tele-emergencies in the groups, individual interviews with HCPs with substantial experience were added. A qualitative content analysis of the interview transcripts was conducted. RESULTS A total of 44 HCPs from northern inland Sweden participated in the interviews. The content analysis resulted in two themes, six categories and 19 subcategories. Theme 1, 'To see, understand, and to build trust through the digital barrier', contains descriptions of the interpersonal relationship between the patient and the HCPs, and the challenges when interacting with the patient during a tele-emergency. The informants also described a need for boundaries between the professional team and the patient. The categories in theme 1 are 'understanding the patient's point of view', 'building a trustful relationship', and 'needing a private space without the patient'. Theme 2, 'The (im)balance of power - tele-emergency reinforces the positions', mirrors the power asymmetry in the patient-professional relationship, and the potential impact of the tele-emergency on the different roles. Tele-emergencies were described as a risk that potentially could weaken the patient's position, but also as providing an opportunity to share power. Categories in theme 2 are 'medical conditions limit patient participation', 'patient involvement in decision-making requires understanding' and 'the inferior patient and the superior professionals'. CONCLUSION This study sheds light on patient participation in tele-emergencies in a remote rural setting from the HCP's perspective. The tele-emergency set-up affected patient participation by interfering with familiar patient-HCP relationships and changing group dynamics in interactions with the patient. Due to the extensive changes of the conditions for patient participation imposed in tele-emergencies, suggestions for actions improving patient participation are made.
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Affiliation(s)
- Hanna Dubois
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mia Bergenmar
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden; and Department of Oncology-Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | | | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 171 77 Stockholm, Sweden
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Kaldheim HKA, Fossum M, Munday J, Creutzfeldt J, Slettebø Å. Professional competence development through interprofessional simulation-based learning assists perioperative nurses in postgraduation acute clinical practice situations: A qualitative study. J Clin Nurs 2022; 32:2757-2772. [PMID: 35665552 DOI: 10.1111/jocn.16377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore recently graduated perioperative nurses' experiences of interprofessional simulation-based learning during postgraduate education and investigate whether and how this learning approach contributed to the development of their professional competence in meeting acute clinical situations. BACKGROUND Perioperative nursing requires specialised education that offers professional development to ensure high-quality nursing care and patient safety in acute situations. Interprofessional simulation-based learning exposes students to acute situations in a safe environment without the risk of harming the patient, and it prepares postgraduate nursing students for clinical practice. Despite extensive research regarding simulation-based learning, there is a lack of knowledge on what impact such training has on perioperative nursing students after graduation. DESIGN An explorative qualitative design was used, and this study is reported in accordance with the COREQ guidelines. METHOD Between March 2019-November 2020, 16 perioperative nurses participated in semi-structured individual interviews three to five months after their graduation from five different educational institutions. During their postgraduate education, they had participated in interprofessional simulation-based learning that included acute clinical situations. A phenomenological hermeneutical analysis was applied to the data involving three steps: naïve reading, structural analysis and comprehensive understanding. RESULTS During the naïve reading, three themes emerged: competence in handling acute situations, competence in interprofessional teamwork and professional identity development. CONCLUSION Interprofessional simulation-based learning in perioperative nursing education developed relevant and important competence, including professional identity development, among perioperative nursing students. As recent graduates, their professional competence was transferred to clinical practice and developed further. RELEVANCE TO CLINICAL PRACTICE Findings indicate that interprofessional simulation-based learning is an important educational approach in perioperative nursing education. It is essential to use effective learning approaches to develop competencies that are transferable to clinical practice and improve perioperative nurses' performance as recent graduates. Therefore, interprofessional simulation-based learning should be implemented into perioperative nursing education.
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Affiliation(s)
| | - Mariann Fossum
- Department of Health and Nursing Science, University of Agder, Grimstad, Norway
| | - Judy Munday
- Department of Health and Nursing Science, University of Agder, Grimstad, Norway.,School of Nursing/Centre for Health Transformation, Queensland University of Technology, Brisbane, Victoria, Australia
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Åshild Slettebø
- Department of Health and Nursing Science, University of Agder, Grimstad, Norway
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Möller H, Creutzfeldt J, Valeskog K, Rystedt H, Edelbring S, Fahlstedt M, Felländer-Tsai L, Abrandt Dahlgren M. Technology-Enhanced Learning of Human Trauma Biomechanics in an Interprofessional Student Context. Teach Learn Med 2022; 34:135-144. [PMID: 33792438 DOI: 10.1080/10401334.2021.1893735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Phenomenon: This study aimed to investigate how students can develop their understanding of trauma biomechanics by means of technology-enhanced learning-an interactive visualization tool developed to enhance understanding of the biomechanics underlying an injury via dynamic imaging sequences. Approach: Students were invited to explore the content as a learning resource during an interprofessional clinical placement on an orthopedic ward. Thirty volunteer medical, nursing, and physiotherapy/occupational therapy students participated in 10 interprofessional groups of three participants. They were video recorded while interacting with learning software that was divided into five sections: Work Up, General Information, Biomechanical Case Study, Biomechanical Risk Assessment, and Treatment. Investigators probed students' learning experiences via four focus group discussions. A sociomaterial perspective was adopted, directing the analytical focus to how students' made use of talk, gestures, bodies, and material objects to understand the visualized phenomena. Findings: When connecting the visualization to a patient case, certain features of the technology stood out as important for promoting engagement and understanding trauma mechanisms. Decreased tempo, showing the directions and dynamics of trauma biomechanics in slow-motion, and color coding of the strain on the affected structures were especially important for evoking the emotional responses. The visualization tool also supported students' explorations of causal relationships between external forces and their biomedical effects. These features emphasize the sociomaterial relation between the design of the technology and the student activities. Insights: Dynamic visualization of biomechanical events has the potential to improve the understanding of injury mechanisms and specifically to identify anatomical structures at high risk of injury. Dynamic visualizations for educational purposes seem to promote possibilities for learners to contextualize visual representations relative to one's own body. Educational methods and practice need explicit attention and development in order to use the full potential of the visualization technology for learning for the health care professions.
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Affiliation(s)
- Hans Möller
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
- Center for Spine Surgery in Stockholm, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Division of Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Valeskog
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hans Rystedt
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
| | | | - Madelen Fahlstedt
- Division of Neuronic Engineering, Royal Institute of Technology (KTH), Stockholm, Sweden
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
- Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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Dubois H, Creutzfeldt J, Törnqvist M, Bergenmar M. Patient participation in gastrointestinal endoscopy - From patients' perspectives. Health Expect 2020; 23:893-903. [PMID: 32372493 PMCID: PMC7495085 DOI: 10.1111/hex.13066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/24/2020] [Accepted: 04/04/2020] [Indexed: 12/15/2022] Open
Abstract
Background Patient participation is associated with satisfaction and improved health‐related outcomes. In gastrointestinal endoscopy, patient participation is an underexplored area. Objective To gain understanding on patients' experiences, attitudes and preferences concerning patient participation in the endoscopy pathway. Methods Semi‐structured interviews with endoscopy patients (n = 17, female n = 8, male n = 9, ages 19‐80 years) were performed. Interview transcripts were analysed using qualitative content analysis. Participants were recruited by purposive sampling from an endoscopy unit in a Swedish university hospital. Inclusion:≥ 18 years, fluency in Swedish and recent experience of endoscopy at the unit. Results Five generic categories emerged, two within the area of the patient's role, which was described as active or passive/included or excluded. Another three generic categories related to factors, critical to active participation, including organizational aspects, impressions of staff and individual circumstances were identified. In this context, patient participation described in the interviews was on a low to basic level, although sometimes reaching a higher level when staff ‘invited’ patients in decision making. Discussion This study contributes to the understanding of patient participation in endoscopy. Patients are in an inferior position and need support from the staff for an active role in their care. Although there were variations on the perceived importance of different factors, a heavy responsibility lies on the endoscopy staff to acknowledge the patients' individual needs and to facilitate patient participation. Conclusions Endoscopy staff has a key role in supporting patient participation. In endoscopy settings, patient participation is vulnerable to multiple factors.
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Affiliation(s)
- Hanna Dubois
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | | | - Mia Bergenmar
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden
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Kaldheim HKA, Bergland Å, Ølnes MA, Hofsø K, Dihle A, Creutzfeldt J, Zhang C, Steindal SA. Use of simulation-based learning among perioperative nurses and students: A scoping review. Nurse Educ Today 2019; 73:31-37. [PMID: 30476823 DOI: 10.1016/j.nedt.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/31/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Simulation-based learning has been extensively explored, especially in baccalaureate nursing programmes. Recently, simulation-based learning has been introduced in perioperative nursing. The aim of this scoping review is to investigate work published on the use of simulation-based learning in the field of perioperative nursing. DESIGN AND DATA SOURCES A scoping review was conducted using the methodological framework of Arksey and O'Malley to identify a broad range of relevant literature, regardless of study design. A comprehensive and systematic search was performed using Medline, CINAHL, Eric, Svemed+, PsychINFO and Embase in May 2016 and then was updated in February 2018. Each database was searched for literature published between 1st January 2005 and 8th February 2018. REVIEW METHOD Two authors independently assessed literature eligibility and extracted data to answer our research question 'What is known about the use of simulation-based learning in the field of perioperative nursing?' RESULTS Nine articles and one doctoral thesis were included in the review. There appears to be a paucity of research or results-oriented evidence regarding the use of simulation-based learning in the field of perioperative nursing. Different goals of simulation-based learning were reported. It was difficult to confirm whether these goals had been reached as none of the articles included control groups, and no evaluations had been undertaken against Kirkpatrick's level 3 to see changes in participants' behaviours, and level 4, to determine whether the training had a positive impact on, for example, patient outcomes. CONCLUSION Owing to the lack of research and the inadequate descriptions of design and method in simulation-based learning in most of the articles included, there is little evidence in the existing literature to guide practitioners of this learning in the field of perioperative nursing. This indicates a need for further research in this area.
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Affiliation(s)
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Oslo, Norway.
| | | | - Kristin Hofsø
- Lovisenberg Diaconal University College, Oslo, Norway.
| | - Alfhild Dihle
- Oslo Met-Oslo Metropolitan University, Oslo, Norway.
| | - Johan Creutzfeldt
- Center for advanced medical simulation and training, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, K32, Karolinska University Hospital, Stockholm 14186, Sweden.
| | - Chao Zhang
- The University of Nebraska Medical Center College of Nursing, Lincoln, NE 68588, United States.
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Dubois H, Schmidt PT, Creutzfeldt J, Bergenmar M. Person-centered endoscopy safety checklist: Development, implementation, and evaluation. World J Gastroenterol 2017; 23:8605-8614. [PMID: 29358869 PMCID: PMC5752721 DOI: 10.3748/wjg.v23.i48.8605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the development and implementation of a person-centered endoscopy safety checklist and to evaluate the effects of a “checklist intervention”.
METHODS The checklist, based on previously published safety checklists, was developed and locally adapted, taking patient safety aspects into consideration and using a person-centered approach. This novel checklist was introduced to the staff of an endoscopy unit at a Stockholm University Hospital during half-day seminars and team training sessions. Structured observations of the endoscopy team’s performance were conducted before and after the introduction of the checklist. In addition, questionnaires focusing on patient participation, collaboration climate, and patient safety issues were collected from patients and staff.
RESULTS A person-centered safety checklist was developed and introduced by a multi-professional group in the endoscopy unit. A statistically significant increase in accurate patient identity verification by the physicians was noted (from 0% at baseline to 87% after 10 mo, P < 0.001), and remained high among nurses (93% at baseline vs 96% after 10 mo, P = nonsignificant). Observations indicated that the professional staff made frequent attempts to use the checklist, but compliance was suboptimal: All items in the observed nurse-led “summaries” were included in 56% of these interactions, and physicians participated by directly facing the patient in 50% of the interactions. On the questionnaires administered to the staff, items regarding collaboration and the importance of patient participation were rated more highly after the introduction of the checklist, but this did not result in statistical significance (P = 0.07/P = 0.08). The patients rated almost all items as very high both before and after the introduction of the checklist; hence, no statistical difference was noted.
CONCLUSION The intervention led to increased patient identity verification by physicians - a patient safety improvement. Clear evidence of enhanced person-centeredness or team work was not found.
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Affiliation(s)
- Hanna Dubois
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
| | - Peter T Schmidt
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm 17177, Sweden
| | - Johan Creutzfeldt
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm 17177, Sweden
| | - Mia Bergenmar
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm 17176, Sweden
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12
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Escher C, Rystedt H, Creutzfeldt J, Meurling L, Nyström S, Dahlberg J, Edelbring S, Nordahl Amorøe T, Hult H, Felländer-Tsai L, Abrandt-Dahlgren M. Method matters: impact of in-scenario instruction on simulation-based teamwork training. Adv Simul (Lond) 2017; 2:25. [PMID: 29450026 PMCID: PMC5806459 DOI: 10.1186/s41077-017-0059-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/16/2017] [Indexed: 12/22/2022] Open
Abstract
Background The rationale for introducing full-scale patient simulators in training to improve patient safety is to recreate clinical situations in a realistic setting. Although high-fidelity simulators mimic a wide range of human features, simulators differ from the body of a sick patient. The gap between the simulator and the human body implies a need for facilitators to provide information to help participants understand scenarios. The authors aimed at describing different methods that facilitators in our dataset used to provide such extra scenario information and how the different methods to convey information affected how scenarios played out. Methods A descriptive qualitative study was conducted to examine the variation of methods to deliver extra scenario information to participants. A multistage approach was employed. The authors selected film clips from a shared database of 31 scenarios from three participating simulation centers. A multidisciplinary research team performed a collaborative analysis of representative film clips focusing on the interplay between participants, facilitators, and the physical environment. After that, the entire material was revisited to further examine and elaborate the initial findings. Results The material displayed four distinct methods for facilitators to convey information to participants in simulation-based teamwork training. The choice of method had impact on the participating teams regarding flow of work, pace, and team communication. Facilitators’ close access to the teams’ activities when present in the simulation suite, either embodied or disembodied in the simulation, facilitated the timing for providing information, which was critical for maintaining the flow of activities in the scenario. The mediation of information by a loudspeaker or an earpiece from the adjacent operator room could be disturbing for team communication. Conclusions In-scenario instruction is an essential component of simulation-based teamwork training that has been largely overlooked in previous research. The ways in which facilitators convey information about the simulated patient have the potential to shape the simulation activities and thereby serve different learning goals. Although immediate timing to maintain an adequate pace is necessary for professionals to engage in training of medical emergencies, novices may gain from a slower tempo to train complex clinical team tasks systematically.
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Affiliation(s)
- Cecilia Escher
- 1CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden.,2CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Rystedt
- 3Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
| | - Johan Creutzfeldt
- 1CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden.,2CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
| | - Lisbet Meurling
- 1CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden.,2CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Nyström
- 4Department of Behavior Sciences and Learning, Linköping University, Linköping, Sweden
| | - Johanna Dahlberg
- 5Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Samuel Edelbring
- 6Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,7Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | - Håkan Hult
- 1CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Li Felländer-Tsai
- 1CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden.,2CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
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Escher C, Creutzfeldt J, Meurling L, Hedman L, Kjellin A, Felländer-Tsai L. Medical students' situational motivation to participate in simulation based team training is predicted by attitudes to patient safety. BMC Med Educ 2017; 17:37. [PMID: 28183316 PMCID: PMC5301395 DOI: 10.1186/s12909-017-0876-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 02/03/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Patient safety education, as well as the safety climate at clinical rotations, has an impact on students' attitudes. We explored medical students' self-reported motivation to participate in simulation-based teamwork training (SBTT), with the hypothesis that high scores in patient safety attitudes would promote motivation to SBTT and that intrinsic motivation would increase after training. METHODS In a prospective cohort study we explored Swedish medical students' attitudes to patient safety, their motivation to participate in SBTT and how motivation was affected by the training. The setting was an integrated SBTT course during the surgical semester that focused on non-technical skills and safe treatment of surgical emergencies. Data was collected using the Situational Motivation Scale (SIMS) and the Attitudes to Patient Safety Questionnaire (APSQ). RESULTS We found a positive correlation between students' individual patient safety attitudes and self-reported motivation (identified regulation) to participate in SBTT. We also found that intrinsic motivation increased after training. Female students in our study scored higher than males regarding some of the APSQ sub-scores and the entire group scored higher or on par with comparable international samples. CONCLUSION In order to enable safe practice and professionalism in healthcare, students' engagement in patient safety education is important. Our finding that students' patient safety attitudes show a positive correlation to motivation and that intrinsic motivation increases after training underpins patient safety climate and integrated teaching of patient safety issues at medical schools in order to help students develop the knowledge, skills and attitudes required for safe practice.
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Affiliation(s)
- Cecilia Escher
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Lisbet Meurling
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Leif Hedman
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Ann Kjellin
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Li Felländer-Tsai
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
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14
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Creutzfeldt J, Hedman L, Felländer-Tsai L. Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students' Experiences Using a Multiplayer Virtual World. JMIR Serious Games 2016; 4:e22. [PMID: 27986645 PMCID: PMC5203677 DOI: 10.2196/games.6448] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/15/2016] [Accepted: 11/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine. Objective The objective of this study was to reach a better understanding of the learners’ reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR). Methods Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students’ perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants. Results Four categories characterizing the students’ experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning. Conclusions Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance.
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Affiliation(s)
- Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
| | - Leif Hedman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Umeå University, Umeå, Sweden
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
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15
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Creutzfeldt J, Hedman L, Felländer-Tsai L. Using Virtual World Training to Increase Situation Awareness during Cardiopulmonary Resuscitation. Stud Health Technol Inform 2014; 196:83-85. [PMID: 24732485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Situation awareness (SA) is a critical non-technical skill which affects outcome during emergency medical endeavors. Using a modified self-report instrument a significant increase of SA was found during multiplayer virtual world CPR team training among 12 medical students. Further a correlation between SA and attention was noted. Being a vital factor during the process of video-game play, we argue that this skill is suitably practiced using this training method.
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Affiliation(s)
| | - Leif Hedman
- Department of Clinical Science, Intervention and Technology
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16
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Creutzfeldt J, Hedman L, Heinrichs L, Youngblood P, Felländer-Tsai L. Cardiopulmonary resuscitation training in high school using avatars in virtual worlds: an international feasibility study. J Med Internet Res 2013; 15:e9. [PMID: 23318253 PMCID: PMC3636066 DOI: 10.2196/jmir.1715] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 08/06/2012] [Accepted: 10/03/2012] [Indexed: 11/13/2022] Open
Abstract
Background Approximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today’s youth (ie, the digital native generation). Objective Our main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training. Methods In this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables. Results The participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0.72) to 6.5/7 (SD 0.57, P<.001). In the Swedish follow-up, it subsequently increased from 5.7/7 (SD 0.56) to 6.3/7 (SD 0.38, P=.006). In the Swedish group, the mean concentration value increased from 52.4/100 (SD 9.8) to 62.7/100 (SD 8.9, P=.05); in the US group, the concentration value increased from 70.8/100 (SD 7.9) to 82.5/100 (SD 4.7, P<.001). We found a significant positive correlation (P<.001) between self-efficacy and concentration scores. Overall, the participants were moderately or highly immersed and the software was easy to use. Conclusions By using online MMVWs, team training in CPR is feasible and reliable for this international group of high school students (Sweden and United States). A high level of appreciation was reported among these adolescents and their self-efficacy increased significantly. The described training is a novel and interesting way to learn CPR teamwork, and in the future could be combined with psychomotor skills training.
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Affiliation(s)
- Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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17
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Creutzfeldt J, Hedman L, Felländer-Tsai L. Effects of pre-training using serious game technology on CPR performance--an exploratory quasi-experimental transfer study. Scand J Trauma Resusc Emerg Med 2012; 20:79. [PMID: 23217084 PMCID: PMC3546885 DOI: 10.1186/1757-7241-20-79] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 11/22/2012] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Multiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students' retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training. METHODS Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance. RESULTS The 6 months group displayed greater CPR-related knowledge than the control group, 93 (±11)% compared to 65 (±28)% (p < 0.05), the 18 months group scored in between (73 (±23)%).At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (±0.5), 1.5 (±1.0) and 4.5 (±1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (±44)% in the control group (p < 0.05) and 44 (±49)% in 18 months group where incorrectly paced; differences that disappeared during training. CONCLUSIONS This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.
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Affiliation(s)
- Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Stockholm, 141 86, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Leif Hedman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Stockholm, 141 86, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Stockholm, 141 86, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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18
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Creutzfeldt J, Hedman L, Medin C, Heinrichs WL, Felländer-Tsai L. Exploring virtual worlds for scenario-based repeated team training of cardiopulmonary resuscitation in medical students. J Med Internet Res 2010; 12:e38. [PMID: 20813717 PMCID: PMC2956337 DOI: 10.2196/jmir.1426] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 02/26/2010] [Accepted: 05/25/2010] [Indexed: 11/13/2022] Open
Abstract
Background Contemporary learning technologies, such as massively multiplayer virtual worlds (MMVW), create new means for teaching and training. However, knowledge about the effectiveness of such training is incomplete, and there are no data regarding how students experience it. Cardiopulmonary resuscitation (CPR) is a field within medicine in high demand for new and effective training modalities. Objective In addition to finding a feasible way to implement CPR training, our aim was to investigate how a serious game setting in a virtual world using avatars would influence medical students’ subjective experiences as well as their retention of knowledge. Methods An MMVW was refined and used in a study to train 12 medical students in CPR in 3-person teams in a repeated fashion 6 months apart. An exit questionnaire solicited reflections over their experiences. As the subjects trained in 4 CPR scenarios, measurements of self-efficacy, concentration, and mental strain were made in addition to measuring knowledge. Engagement modes and coping strategies were also studied. Parametric and nonparametric statistical analyses were carried out according to distribution of the data. Results The majority of the subjects reported that they had enjoyed the training, had found it to be suitable, and had learned something new, although several asked for more difficult and complex scenarios as well as a richer virtual environment. The mean values for knowledge dropped during the 6 months from 8.0/10 to 6.25/10 (P = .002). Self-efficacy increased from before to after each of the two training sessions, from 5.9/7 to 6.5/7 (P = .01) after the first and from 6.0/7 to 6.7/7 (P = .03) after the second. The mean perceived concentration value increased from 54.2/100 to 66.6/100 (P = .006), and in general the mental strain was found to be low to moderate (mean = 2.6/10). Conclusions Using scenario-based virtual world team training with avatars to train medical students in multi-person CPR was feasible and showed promising results. Although we found no evidence of stimulated recall of CPR procedures in our test-retest study, the subjects were enthusiastic and reported increased concentration during the training. We also found that subjects’ self-efficacy had increased after the training. Despite the need for further studies, these findings imply several possible uses of MMVW technology for future emergency medical training.
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Affiliation(s)
- Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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Creutzfeldt J, Hedman L, Medin C, Stengård K, Felländer-Tsai L. Retention of knowledge after repeated virtual world CPR training in high school students. Stud Health Technol Inform 2009; 142:59-61. [PMID: 19377114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We investigated the retention of knowledge and skills after repeated Virtual World MOS (VWMOS) team training of CPR in high school students. An experimental group of 9 students were compared to a control group of 7 students. Both groups initially received traditional CPR training and the experimental group also received 2 VWMOS sessions six months apart. Although we found no significant differences in general basic life support knowledge, the changes that occurred in the CPR guidelines were retained 18 months after the last Virtual World training session in the experimental group. Moreover fewer deviations from the CPR guidelines occurred.
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20
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Creutzfeldt J, Hedman L, Medin C, Wallin CJ, Felländer-Tsai L. Effects of repeated CPR training in virtual worlds on medical students' performance. Stud Health Technol Inform 2008; 132:89-94. [PMID: 18391263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report on a study that investigates the relationship between repeated training of teams managing a medical emergency (CPR) in a Virtual World and performance outcome measures in a group of 12 medical students. The focus of the training was on individual actions, but also on interaction and behavior in the team. Current CPR training seems to lack important team training aspects which this type of training is addressing. Although a pilot study, we found clear indications of improved performance related to reduced number of errors and an increased CPR efficiency. This type of educational technology could be expanded to other groups for a similar purpose because of its easiness to use, adaptability and interactivity.
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Affiliation(s)
- J Creutzfeldt
- CLINTEC, Division of Anesthesiology, Karolinska Institutet, Stockholm, Sweden.
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Creutzfeldt J, Hedman L, Medin C, Wallin CJ, Hendrick A, Youngblood P, Heinrichs WL, Felländer-Tsai L. Implementing virtual worlds for systematic training of prehospital CPR in medical school. Stud Health Technol Inform 2007; 125:82-4. [PMID: 17377239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report on a study that investigates the relationship between repeated training of teams managing medical emergencies in the Virtual World and affective learning outcomes in a group of 12 medical students. The focus of the training was on individual actions, but also on interaction and behaviour in the team. Current CPR training seems to lack important team training aspects which this type of training is addressing. We found an increase in flow experience and in self efficacy. This type of training could probably be expanded to other groups for a similar purpose because of its easiness to use, adaptability and interactivity.
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Affiliation(s)
- J Creutzfeldt
- CLINTEC, division of anesthesiology, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden.
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