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Dybdal Kayser J, Kjær Ersbøll A, Kolbe M, Østergaard D, Dieckmann P. Medical Students' Speak Up Barriers: A Randomized Controlled Trial With Written Vignettes. J Patient Saf 2024:01209203-990000000-00208. [PMID: 38506474 DOI: 10.1097/pts.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Little is known about medical students' speak-up barriers upon recognizing or becoming aware of risky or deficient actions of others. Improving our knowledge on these helps in preparing student to function in actual health care organizations. The aim was to examine medical students' perceived reasons for silence in respect to different speak-up situations (i.e., vignette content) and to test if vignette difficulty had an effect on reasons indicated. METHODS This study was a randomized, controlled, single-blind trial, with text-based vignettes to investigate speak-up barriers. Vignette contents described speak-up situations that varied systematically with respect to speak up barrier (i.e., environmental norm, uncertainty, hierarchy) and difficulty (i.e., easy, difficult). For each vignette, participants indicated which speak-up barriers they regarded as important.Descriptive analysis was performed for the study population, the numbers of barriers perceived and rating of vignette difficulty. Logistic regression analysis was used to examine the association between barriers perceived and vignette contents, designed vignette difficulty and subjectively rated vignette difficulty. RESULTS A total of 265 students were included. The response rate was 100%. Different barriers were relevant for the different vignettes and varied in a consistent way with the theme of the vignette. Significantly more speak-up barriers were indicated for participants with the difficult version for vignette 1 (not an environmental norm) and vignette 3 (hierarchy) with odds ratio (OR) = 1.52 and 95% confidence interval (95% CI: 1.33-1.73) and OR = 1.25 (95% CI: 1.09-1.44). For (OR) estimates, confidence intervals were rather large. CONCLUSIONS Perceived barriers for speak-up vary consistently with the characteristics of the situation and more barriers preventing speak up were related to the difficult versions of the vignettes.
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Affiliation(s)
- Jesper Dybdal Kayser
- From the Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark
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Gasciauskaite G, Lunkiewicz J, Braun J, Kolbe M, Seelandt J, Spahn DR, Nöthiger CB, Tscholl DW. Burnout and its determinants among anaesthesia care providers in Switzerland: a multicentre cross-sectional study. Anaesthesia 2024; 79:168-177. [PMID: 37970939 DOI: 10.1111/anae.16171] [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] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
The escalating epidemic of burnout in healthcare professionals affects provider well-being, patient care and sustainability of healthcare systems. The objective of this study was to determine the prevalence of burnout among anaesthesia care providers (consultants, trainees or nurse anaesthetists) in Switzerland and identify risk factors to develop strategies for prevention. This multicentre cross-sectional study was conducted at 22 anaesthesia departments in the German-speaking part of Switzerland, using an online questionnaire. Burnout assessment was performed using the Maslach Burnout Inventory. Additionally, the questionnaire included questions on workplace and personal risk factors. Of 1630 anaesthesia care providers contacted, 688 (42%) completed the survey. Among respondents who specified their work positions (n = 676), 52% (149/287) of nurses and 59% (229/389) of physicians were at high risk of burnout; and 9% (26/287) of nurses and 18% (70/389) of physicians met the criteria for burnout syndrome. Logistic regression analysis found significant associations between burnout and perceived lack of support at work among physicians (odds ratio (95%CI) 2.66 (1.40-5.24), p = 0.004); being a trainee in the 1st and 2nd year of training (2.91 (1.14-7.41), p = 0.024); being a trainee with > 5 years of experience (2.78 (1.08-6.98), p = 0.031); and male gender among nurses (4.13 (1.62-11.2), p = 0.004) and physicians (2.32 (1.22-4.47), p = 0.011). Work-related errors due to high workload or fatigue were reported by 65% (444/688) and consideration of leaving the profession due to working conditions was expressed by 46% (319/688) of respondents. Anaesthetic care providers in German-speaking Switzerland experience a considerable prevalence of burnout, influenced mainly by workplace factors.
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Affiliation(s)
- G Gasciauskaite
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - J Lunkiewicz
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - J Braun
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - M Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - J Seelandt
- Director of Training and Faculty Development, Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - D R Spahn
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - C B Nöthiger
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - D W Tscholl
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
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Gasciauskaite G, Castellucci C, Malorgio A, Budowski AD, Schweiger G, Kolbe M, Fries D, Grande B, Nöthiger CB, Spahn DR, Roche TR, Tscholl DW, Akbas S. User Perceptions of Visual Clot in a High-Fidelity Simulation Study: Mixed Qualitative-Quantitative Study. JMIR Hum Factors 2024; 11:e47991. [PMID: 38206666 PMCID: PMC10811569 DOI: 10.2196/47991] [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: 04/07/2023] [Revised: 10/17/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Viscoelastic hemostatic assays, such as rotational thromboelastometry (ROTEM) or thromboelastography, enable prompt diagnosis and accelerate targeted treatment. However, the complex interpretation of the results remains challenging. Visual Clot-a situation awareness-based visualization technology-was developed to assist clinicians in interpreting viscoelastic tests. OBJECTIVE Following a previous high-fidelity simulation study, we analyzed users' perceptions of the technology, to identify its strengths and limitations from clinicians' perspectives. METHODS This is a mixed qualitative-quantitative study consisting of interviews and a survey. After solving coagulation scenarios using Visual Clot in high-fidelity simulations, we interviewed anesthesia personnel about the perceived advantages and disadvantages of the new tool. We used a template approach to identify dominant themes in interview responses. From these themes, we defined 5 statements, which were then rated on Likert scales in a questionnaire. RESULTS We interviewed 77 participants and 23 completed the survey. We identified 9 frequently mentioned topics by analyzing the interview responses. The most common themes were "positive design features," "intuitive and easy to learn," and "lack of a quantitative component." In the survey, 21 respondents agreed that Visual Clot is easy to learn and 16 respondents stated that a combination of Visual Clot and ROTEM would help them manage complex hemostatic situations. CONCLUSIONS A group of anesthesia care providers found Visual Clot well-designed, intuitive, and easy to learn. Participants highlighted its usefulness in emergencies, especially for clinicians inexperienced in coagulation management. However, the lack of quantitative information is an area for improvement.
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Affiliation(s)
- Greta Gasciauskaite
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Clara Castellucci
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Amos Malorgio
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Giovanna Schweiger
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Fries
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Donat R Spahn
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Tadzio R Roche
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - David W Tscholl
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Samira Akbas
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
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Stefanidis D, Cook D, Kalantar-Motamedi SM, Muret-Wagstaff S, Calhoun AW, Lauridsen KG, Paige JT, Lockey A, Donoghue A, Hall AK, Patocka C, Palaganas J, Gross IT, Kessler D, Vermylen J, Lin Y, Aebersold M, Chang TP, Duff J, Kolbe M, Rutherford-Hemming T, Decker S, Collings A, Toseef Ansari M. Society for Simulation in Healthcare Guidelines for Simulation Training. Simul Healthc 2024; 19:S4-S22. [PMID: 38240614 DOI: 10.1097/sih.0000000000000776] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. METHODS Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. OBJECTIVE These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare. RESULTS Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided. CONCLUSIONS The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.
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Affiliation(s)
- Dimitrios Stefanidis
- From the Department of Surgery (D.S., S.-M.K.-M.), Indiana University School of Medicine, Indianapolis, IN; Department of Internal Medicine (D.C.), Mayo Clinic, Rochester, MN; Department of Surgery (S.M.-W.), Emory University, Atlanta, GA; Department of Pediatrics (A.W.C.), University of Louisville School of Medicine and Norton Children's Medical Group, Louisville, KY; Department of Medicine (K.G.L.), Randers Regional Hospital, Randers, Denmark; Research Center for Emergency Medicine (K.G.L.), Aarhus University, Aarhus, Denmark; Department of Surgery (J.T.P.), LSU Health New Orleans School of Medicine, New Orleans, LA; Emergency Department (A.L.), Calderdale and Huddersfield NHS Trust, Halifax; School of Human and Health Sciences (A.L.), University of Huddersfield, Huddersfield, UK; Critical Care Medicine and Pediatrics (A.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Emergency Medicine (A.K.H.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine (C.P.), Cumming School of Medicine University of Calgary, Calgary, AB, Canada; Department of Health Professions Education (J.P.), School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA; Department of Pediatrics (I.T.G.), Section of Emergency Medicine, Yale University, New Haven, CT; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY,; Department of Medicine and Medical Education (J.V.), Feinberg School of Medicine, Northwestern University, Chicago, IL; KidSIM Simulation Research Program (Y.L.), Alberta Children's Hospital, Calgary, Canada; University of Michigan School of Nursing (M.A.), Ann Arbor, MI; Las Madrinas Simulation Center, Children's Hospital (T.C.), University South California, Los Angeles, CA; Department of Pediatrics (J.D.), University of Alberta, Edmonton, Alberta, Canada; Simulation Center (M.K.), University Hospital Zurich, ETH Zurich, Switzerland; Department of Nursing (T.R.-H.), University of North Carolina, Chapel Hill, NC; Department of Nursing (S.D.), Texas Tech University Health Sciences Center, Lubbock, TX; Department of Surgery (A.C.), University of Louisville, Louisville, KY; and Independent Methodologist (M.T.A.), Ottawa, Ontario, Canada
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Duff JP, Morse KJ, Seelandt J, Gross IT, Lydston M, Sargeant J, Dieckmann P, Allen JA, Rudolph JW, Kolbe M. Debriefing Methods for Simulation in Healthcare: A Systematic Review. Simul Healthc 2024; 19:S112-S121. [PMID: 38240623 DOI: 10.1097/sih.0000000000000765] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT Debriefing is a critical component in most simulation experiences. With the growing number of debriefing concepts, approaches, and tools, we need to understand how to debrief most effectively because there is little empiric evidence to guide us in their use. This systematic review explores the current literature on debriefing in healthcare simulation education to understand the evidence behind practice and clarify gaps in the literature. The PICO question for this review was defined as "In healthcare providers [P], does the use of one debriefing or feedback intervention [I], compared to a different debriefing or feedback intervention [C], improve educational and clinical outcomes [O] in simulation-based education?" We included 70 studies in our final review and found that our current debriefing strategies, frameworks, and techniques are not based on robust empirical evidence. Based on this, we highlight future research needs.
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Affiliation(s)
- Jonathan P Duff
- From the Department of Pediatrics (J.P.D.), University of Alberta. Edmonton, Canada; College of Nursing and Health Professions (K.J.M.), Drexel University, Philadelphia, PA; Simulation Centre (J.S., M.K.), University Hospital, Zurich, Switzerland; Department of Pediatrics, Section of Emergency Medicine (I.T.G.), Yale University School of Medicine, New Haven, CT; Treadwell Virtual Library (M.L.), Massachusetts General Hospital, Boston, MA; Faculty of Medicine (J.S.), Dalhousie University, Halifax, Canada; Copenhagen Academy for Medical Education and Simulation (CAMES) (P.D.), Herlev, Denmark; Department of Quality and Health Technology (P.D.), University of Stavanger, Stavanger, Norway; Department of Public Health (P.D.), University of Copenhagen, Denmark; Department of Family and Preventive Medicine (J.A.A.), University of Utah, Salt Lake City, UT; Center for Medical Simulation (J.W.R.), Boston, MA; and ETH Zurich (M.K.), Zurich, Switzerland
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Stutz L, Koertgen B, Scheier T, Klaentschi T, Junge H, Kolbe M, Grande B. Improving compliance with isolation measures in the operating room: a prospective simulation study comparing the effectiveness and costs of simulation-based training vs video-based training. J Hosp Infect 2023; 141:167-174. [PMID: 37696472 DOI: 10.1016/j.jhin.2023.07.027] [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: 03/22/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Different isolation measures are required according to the routes of transmission of pathogens. Few studies have compared different forms of hygiene training in terms of efficiency and/or improvement of perception towards hygiene measures. This study aimed to evaluate the benefits of different forms of isolation training in the operating room, and their respective effects on the perception of hygiene measures by comparing simulation training with video-based training. METHODS This multi-centre, prospective, randomized, controlled trial compared hygiene knowledge, psychological safety and perception of training among healthcare workers after in-centre simulation training and conventional video-based training. RESULTS Neither type of training led to a significant improvement in knowledge or perceived psychological safety (F=0.235, P=0.629, η2=0.003). Participants in the simulation group reported higher levels of willingness to speak up in the depicted scenario compared with participants who received video-based training. Participants perceived the simulation-based training significantly more positively than the video-based training. CONCLUSION Clear definition of the goals of training based on the pre-existing level of knowledge of the participants is crucial. For future studies, it would be interesting to investigate the long-term effect and continuing benefits concerning the implementation of hygiene regulations after different types of training.
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Affiliation(s)
- L Stutz
- Institute of Anaesthesiology, Cantonal Hospital Grisons, Chur, Switzerland
| | - B Koertgen
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - T Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - T Klaentschi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - H Junge
- Institute of Anaesthesiology, Cantonal Hospital Grisons, Chur, Switzerland; Grisons Institute for Patient Safety and Simulation, Chur, Switzerland
| | - M Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - B Grande
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
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Wyss M, Kolbe M, Grande B. Make a difference: implementation, quality and effectiveness of the WHO Surgical Safety Checklist-a narrative review. J Thorac Dis 2023; 15:5723-5735. [PMID: 37969258 PMCID: PMC10636476 DOI: 10.21037/jtd-22-1807] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/24/2023] [Indexed: 11/17/2023]
Abstract
Background and Objective The positive effects of the WHO Surgery Safety Checklist (WHO SSC) have been demonstrated by a large amount of quantitative studies. With this review, the focus changes to the content of qualitative studies on WHO SSC to identify possible research gaps. In this way, gaps in the content of the execution of individual checklists can be closed. Methods The two research platforms "Ovid Medline" and "PubMed" formed a solid basis for the literature research. The search was conducted until the 19th of September 2022. The following group terms were used: "checklist", "surgery", "implementation", and "WHO Surgical Safety Checklist". Subsequently, the literature research was limited to studies between 2011 and 2021 in either English or German. Key Content and Findings Overall, a positive effect was found in all qualitative studies on WHO SSC with respect to leadership, teamwork, timing and acceptance. Acceptance through effective implementation of the SSC deserves special mention. Several studies highlighted the lack of understanding and training, which led to variation in execution. A large number of studies agree that the WHO SSC is fostering teamwork and improving communication. However, there are also hurdles and barriers in the application that seem to have an influence on the effectiveness. Conclusions The exact mechanisms of the advantage and application of the checklist are still poorly understood. Further research in this area is needed for a better understanding of the underlying work culture and consequently improving patient safety.
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Affiliation(s)
- Muriel Wyss
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Bastian Grande
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Castellucci C, Malorgio A, Budowski AD, Akbas S, Kolbe M, Grande B, Braun J, Noethiger CB, Spahn DR, Tscholl DW, Roche TR. Coagulation Management of Critically Bleeding Patients With Viscoelastic Testing Presented as a 3D-Animated Blood Clot (The Visual Clot): Randomized Controlled High-Fidelity Simulation Study. J Med Internet Res 2023; 25:e43895. [PMID: 37824182 PMCID: PMC10603564 DOI: 10.2196/43895] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/23/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Guidelines recommend using viscoelastic coagulation tests to guide coagulation management, but interpreting the results remains challenging. Visual Clot, a 3D animated blood clot, facilitates interpretation through a user-centered and situation awareness-oriented design. OBJECTIVE This study aims to compare the effects of Visual Clot versus conventional viscoelastic test results (rotational thrombelastometry [ROTEM] temograms) on the coagulation management performance of anesthesia teams in critical bleeding situations. METHODS We conducted a prospective, randomized, high-fidelity simulation study in which anesthesia teams (consisting of a senior anesthesiologist, a resident anesthesiologist, and an anesthesia nurse) managed perioperative bleeding scenarios. Teams had either Visual Clot or ROTEM temograms available to perform targeted coagulation management. We analyzed the 15-minute simulations with post hoc video analysis. The primary outcome was correct targeted coagulation therapy. Secondary outcomes were time to targeted coagulation therapy, confidence, and workload. In addition, we have conducted a qualitative survey on user acceptance of Visual Clot. We used Poisson regression, Cox regression, and mixed logistic regression models, adjusted for various potential confounders, to analyze the data. RESULTS We analyzed 59 simulations. Teams using Visual Clot were more likely to deliver the overall targeted coagulation therapy correctly (rate ratio 1.56, 95% CI 1.00-2.47; P=.05) and administer the first targeted coagulation product faster (hazard ratio 2.58, 95% CI 1.37-4.85; P=.003). In addition, participants showed higher decision confidence with Visual Clot (odds ratio 3.60, 95% CI 1.49-8.71; P=.005). We found no difference in workload (coefficient -0.03, 95% CI -3.08 to 2.88; P=.99). CONCLUSIONS Using Visual Clot led to a more accurate and faster-targeted coagulation therapy than using ROTEM temograms. We suggest that relevant viscoelastic test manufacturers consider augmenting their complex result presentation with intuitive, easy-to-understand visualization to ease users' burden from unnecessary cognitive load and enhance patient care.
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Affiliation(s)
- Clara Castellucci
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Amos Malorgio
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexandra Dinah Budowski
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Samira Akbas
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bastian Grande
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Simulation Centre, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Braun
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christoph B Noethiger
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Werner Tscholl
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tadzio Raoul Roche
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Kolbe M, Goldhahn J, Useini M, Grande B. "Asking for help is a strength"-how to promote undergraduate medical students' teamwork through simulation training and interprofessional faculty. Front Psychol 2023; 14:1214091. [PMID: 37701867 PMCID: PMC10494543 DOI: 10.3389/fpsyg.2023.1214091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/28/2023] [Accepted: 08/01/2023] [Indexed: 09/14/2023] Open
Abstract
The ability to team up and safely work in any kind of healthcare team is a critical asset and should be taught early on in medical education. Medical students should be given the chance to "walk the talk" of teamwork by training and reflecting in teams. Our goal was to design, implement and evaluate the feasibility of a simulation-based teamwork training (TeamSIM) for undergraduate medical students that puts generic teamwork skills centerstage. We designed TeamSIM to include 12 learning objectives. For this pre-post, mixed-methods feasibility study, third-year medical students, organized in teams of 11-12 students, participated and observed each other in eight simulations of different clinical situation with varying degrees of complexity (e.g., deteriorating patient in ward; trauma; resuscitation). Guided by an interprofessional clinical faculty with simulation-based instructor training, student teams reflected on their shared experience in structured team debriefings. Using published instruments, we measured (a) students' reactions to TeamSIM and their perceptions of psychological safety via self-report, (b) their ongoing reflections via experience sampling, and (c) their teamwork skills via behavior observation. Ninety four students participated. They reported positive reactions to TeamSIM (M = 5.23, SD = 0.5). Their mean initial reported level of psychological safety was M = 3.8 (SD = 0.4) which rose to M = 4.3 (SD = 0.5) toward the end of the course [T(21) = -2.8, 95% CI -0.78 to-0.12, p = 0.011 (two-tailed)]. We obtained n = 314 headline reflections from the students and n = 95 from the faculty. For the students, the most frequent theme assigned to their headlines involved the concepts taught in the course such as "10 s for 10 min." For the faculty, the most frequent theme assigned to their headlines were reflections on how their simulation session worked for the students. The faculty rated students' teamwork skills higher after the last compared to the first debriefing. Undergraduate medical students can learn crucial teamwork skills in simulations supported by an experienced faculty and with a high degree of psychological safety. Both students and faculty appreciate the learning possibilities of simulation. At the same time, this learning can be challenging, intense and overwhelming. It takes a team to teach teamwork.
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Affiliation(s)
- Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Jörg Goldhahn
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Mirdita Useini
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
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Matson DM, Battezzati L, Galenko PK, Gandin CA, Gangopadhyay AK, Henein H, Kelton KF, Kolbe M, Valloton J, Vogel SC, Volkmann T. Electromagnetic levitation containerless processing of metallic materials in microgravity: rapid solidification. NPJ Microgravity 2023; 9:65. [PMID: 37582930 PMCID: PMC10427700 DOI: 10.1038/s41526-023-00310-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/26/2023] [Indexed: 08/17/2023] Open
Abstract
Space levitation processing allows researchers to conduct benchmark tests in an effort to understand the physical phenomena involved in rapid solidification processing, including alloy thermodynamics, nucleation and growth, heat and mass transfer, solid/liquid interface dynamics, macro- and microstructural evolution, and defect formation. Supported by ground-based investigations, a major thrust is to develop and refine robust computational tools based on theoretical and applied approaches. This work is accomplished in conjunction with experiments designed for precise model validation with application to a broad range of industrial processes.
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Affiliation(s)
- D M Matson
- Department of Mechanical Engineering, Tufts University, Medford, MA, 02155, USA.
| | - L Battezzati
- Dipartimento di Chimica e Centro NIS, Università di Torino, Via P, Giuria 7, 10125, Torino, Italy
| | - P K Galenko
- Otto-Schott-Institut für Materialforschung, Friedrich Schiller Universität Jena, Jena, Germany
| | - Ch-A Gandin
- MINES Paris, PSL University, CEMEF UMR CNRS 7635, CS10207, 06904, Sophia Antipolis, France
| | - A K Gangopadhyay
- Department of Physics and the Institute of Materials Science & Engineering, Washington University, St. Louis, MO, 63130-4899, USA
| | - H Henein
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, T6G 2G6, Canada
| | - K F Kelton
- Department of Physics and the Institute of Materials Science & Engineering, Washington University, St. Louis, MO, 63130-4899, USA
| | - M Kolbe
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft- und Raumfahrt (DLR), 51170, Köln, Germany
| | - J Valloton
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, T6G 2G6, Canada
| | - S C Vogel
- Materials Science and Technology Division, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - T Volkmann
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft- und Raumfahrt (DLR), 51170, Köln, Germany
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11
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Seelandt JC, Boos M, Kolbe M, Kämmer JE. How to enrich team research in healthcare by considering five theoretical perspectives. Front Psychol 2023; 14:1232331. [PMID: 37637888 PMCID: PMC10448055 DOI: 10.3389/fpsyg.2023.1232331] [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: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.
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Affiliation(s)
| | - Margarete Boos
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
| | - Michaela Kolbe
- Simulation Center, University Hospital Zürich, Zürich, Switzerland
- ETH Zurich, Zürich, Switzerland
| | - Juliane E. Kämmer
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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12
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Bienefeld N, Kolbe M, Camen G, Huser D, Buehler PK. Human-AI teaming: leveraging transactive memory and speaking up for enhanced team effectiveness. Front Psychol 2023; 14:1208019. [PMID: 37599773 PMCID: PMC10436524 DOI: 10.3389/fpsyg.2023.1208019] [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: 04/18/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
In this prospective observational study, we investigate the role of transactive memory and speaking up in human-AI teams comprising 180 intensive care (ICU) physicians and nurses working with AI in a simulated clinical environment. Our findings indicate that interactions with AI agents differ significantly from human interactions, as accessing information from AI agents is positively linked to a team's ability to generate novel hypotheses and demonstrate speaking-up behavior, but only in higher-performing teams. Conversely, accessing information from human team members is negatively associated with these aspects, regardless of team performance. This study is a valuable contribution to the expanding field of research on human-AI teams and team science in general, as it emphasizes the necessity of incorporating AI agents as knowledge sources in a team's transactive memory system, as well as highlighting their role as catalysts for speaking up. Practical implications include suggestions for the design of future AI systems and human-AI team training in healthcare and beyond.
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Affiliation(s)
- Nadine Bienefeld
- Work and Organizational Psychology, Department of Management, Technology, and Economics, ETH Zürich, Zurich, Switzerland
| | - Michaela Kolbe
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Giovanni Camen
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dominic Huser
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Karl Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Intensive Care Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
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13
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Weiss KE, Kolbe M, Lohmeyer Q, Meboldt M. Measuring teamwork for training in healthcare using eye tracking and pose estimation. Front Psychol 2023; 14:1169940. [PMID: 37325757 PMCID: PMC10264622 DOI: 10.3389/fpsyg.2023.1169940] [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: 02/20/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Teamwork is critical for safe patient care. Healthcare teams typically train teamwork in simulated clinical situations, which require the ability to measure teamwork via behavior observation. However, the required observations are prone to human biases and include significant cognitive load even for trained instructors. In this observational study we explored how eye tracking and pose estimation as two minimal invasive video-based technologies may measure teamwork during simulation-based teamwork training in healthcare. Mobile eye tracking, measuring where participants look, and multi-person pose estimation, measuring 3D human body and joint position, were used to record 64 third-year medical students who completed a simulated handover case in teams of four. On one hand, we processed the recorded data into the eye contact metric, based on eye tracking and relevant for situational awareness and communication patterns. On the other hand, the distance to patient metric was processed, based on multi-person pose estimation and relevant for team positioning and coordination. After successful data recording, we successfully processed the raw videos to specific teamwork metrics. The average eye contact time was 6.46 s [min 0 s - max 28.01 s], while the average distance to the patient resulted in 1.01 m [min 0.32 m - max 1.6 m]. Both metrics varied significantly between teams and simulated roles of participants (p < 0.001). With the objective, continuous, and reliable metrics we created visualizations illustrating the teams' interactions. Future research is necessary to generalize our findings and how they may complement existing methods, support instructors, and contribute to the quality of teamwork training in healthcare.
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Affiliation(s)
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Quentin Lohmeyer
- Product Development Group Zurich, ETH Zurich, Zurich, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, ETH Zurich, Zurich, Switzerland
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14
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Weiss KE, Kolbe M, Nef A, Grande B, Kalirajan B, Meboldt M, Lohmeyer Q. Data-driven resuscitation training using pose estimation. Adv Simul (Lond) 2023; 8:12. [PMID: 37061746 PMCID: PMC10105636 DOI: 10.1186/s41077-023-00251-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/29/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) training improves CPR skills while heavily relying on feedback. The quality of feedback can vary between experts, indicating a need for data-driven feedback to support experts. The goal of this study was to investigate pose estimation, a motion detection technology, to assess individual and team CPR quality with the arm angle and chest-to-chest distance metrics. METHODS After mandatory basic life support training, 91 healthcare providers performed a simulated CPR scenario in teams. Their behaviour was simultaneously rated based on pose estimation and by experts. It was assessed if the arm was straight at the elbow, by calculating the mean arm angle, and how close the distance between the team members was during chest compressions, by calculating the chest-to-chest distance. Both pose estimation metrics were compared with the expert ratings. RESULTS The data-driven and expert-based ratings for the arm angle differed by 77.3%, and based on pose estimation, 13.2% of participants kept the arm straight. The chest-to-chest distance ratings by expert and by pose estimation differed by 20.7% and based on pose estimation 63.2% of participants were closer than 1 m to the team member performing compressions. CONCLUSIONS Pose estimation-based metrics assessed learners' arm angles in more detail and their chest-to-chest distance comparably to expert ratings. Pose estimation metrics can complement educators with additional objective detail and allow them to focus on other aspects of the simulated CPR training, increasing the training's success and the participants' CPR quality. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Kerrin E Weiss
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland.
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Andrina Nef
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Institute of Anaesthesiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Bravin Kalirajan
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
| | - Quentin Lohmeyer
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
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15
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Gasciauskaite G, Malorgio A, Castellucci C, Budowski A, Schweiger G, Kolbe M, Grande B, Noethiger CB, Spahn DR, Roche TR, Tscholl DW, Akbas S. User Perceptions of ROTEM-Guided Haemostatic Resuscitation: A Mixed Qualitative-Quantitative Study. Bioengineering (Basel) 2023; 10:bioengineering10030386. [PMID: 36978777 PMCID: PMC10044818 DOI: 10.3390/bioengineering10030386] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Viscoelastic point-of-care haemostatic resuscitation methods, such as ROTEM or TEG, are crucial in deciding on time-efficient personalised coagulation interventions. International transfusion guidelines emphasise increased patient safety and reduced treatment costs. We analysed care providers' perceptions of ROTEM to identify perceived strengths and areas for improvement. We conducted a single-centre, mixed qualitative-quantitative study consisting of interviews followed by an online survey. Using a template approach, we first identified themes in the responses given by care providers about ROTEM. Later, the participants rated six statements based on the identified themes on five-point Likert scales in an online questionnaire. Seventy-seven participants were interviewed, and 52 completed the online survey. By analysing user perceptions, we identified ten themes. The most common positive theme was "high accuracy". The most common negative theme was "need for training". In the online survey, 94% of participants agreed that monitoring the real-time ROTEM temograms helps to initiate targeted treatment more quickly and 81% agreed that recurrent ROTEM training would be beneficial. Anaesthesia care providers found ROTEM to be accurate and quickly available to support decision-making in dynamic and complex haemostatic situations. However, clinicians identified that interpreting ROTEM is a complex and cognitively demanding task that requires significant training needs.
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Affiliation(s)
- Greta Gasciauskaite
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Amos Malorgio
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Clara Castellucci
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Alexandra Budowski
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Giovanna Schweiger
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Gloriastrasse 19, 8091 Zurich, Switzerland
| | - Bastian Grande
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Christoph B Noethiger
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Tadzio R Roche
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - David W Tscholl
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Samira Akbas
- Institute of Anaesthesiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
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16
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Kolbe M, Grande B, Lehmann-Willenbrock N, Seelandt JC. Helping healthcare teams to debrief effectively: associations of debriefers' actions and participants' reflections during team debriefings. BMJ Qual Saf 2023; 32:160-172. [PMID: 35902231 DOI: 10.1136/bmjqs-2021-014393] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 10/25/2021] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants' reflection in debriefings. METHODS In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants' verbalisation of a mental model as a particular form of reflection. RESULTS The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers' observation to debriefers' opinion (z=9.85, p<0.001), from opinion to debriefers' open-ended question (z=9.52, p<0.001) and from open-ended question to participants' mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes. CONCLUSION When debriefers pair their observations and opinions with open-ended questions, paraphrase participants' statements and ask specific questions, they help participants reflect during debriefings.
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Affiliation(s)
- Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland .,ETH Zürich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland.,Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
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17
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Vauk S, Seelandt JC, Huber K, Grande B, Kolbe M. Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study. Br J Anaesth 2022; 129:776-787. [PMID: 36075775 DOI: 10.1016/j.bja.2022.07.050] [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: 12/31/2021] [Revised: 06/27/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Speaking up with concerns is critical for patient safety. We studied whether witnessing a civil (i.e. polite, respectful) response to speaking up would increase the occurrence of further speaking up by hospital staff members as compared with witnessing a pseudo-civil (i.e. vague and slightly dismissive) or rude response. METHODS In this RCT in a single, large academic teaching hospital, a single simulated basic life support scenario was designed to elicit standardised opportunities to speak up. Participants in teams of two or three were randomly assigned to one of three experimental conditions in which the degree of civility in reacting to speaking up was manipulated by an embedded simulated person. Speaking up behaviour was assessed by behaviour coding of the video recordings of the team interactions by applying 10 codes using The Observer XT 14.1. Data were analysed using multilevel modelling. RESULTS The sample included 125 interprofessional hospital staff members (82 [66%] women, 43 [34%] men). Participants were more likely to speak up when they felt psychologically safe (γ=0.47; standard error [se]=0.19; 95% confidence interval [CI], 0.09-0.85; P=0.017). Participants were more likely to speak up in the rude condition than in the other conditions (γ=0.28; se=0.12; 95% CI, 0.05-0.52; P=0.019). Across conditions, participants spoke up most frequently by structuring inquiry (n=289, 31.52%), proactive (n=240, 26.17%), and reactive (n=148, 16.14%) instruction statements, and gestures (n=139, 15.16%). CONCLUSION Our study challenges current assumptions about the interplay of civility and speaking up behaviour in healthcare.
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Affiliation(s)
- Stefanie Vauk
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Julia C Seelandt
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Katja Huber
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; ETH Zurich, Zurich, Switzerland.
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18
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Chatziefthymiou S, Kuzikov M, Afandi S, Crosas E, Pompidor G, Taberman H, Windschügel B, Labahn J, Kolbe M, Hakanpää J. Inhibitor screening and structural characterization of virulence factors from SARS-CoV-2. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322093986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Abstract
ZusammenfassungAusbildungskonzepte, die eine Simulation von Fällen und Szenarien aller Art nutzen, haben breiten Eingang in Curricula und Praxis gefunden. Ein Vertrauen in technische Simulationsmethoden ohne qualifizierte Ausbildung in der Methode kann schaden. Deswegen sollte nach der Auswahl der korrekten Simulationsmethode großer Wert auf die Durchführung der Simulation gelegt werden. Neben einem strukturierten Design der simulierten Szenarien und der korrekten technischen Durchführung ist für den Lernerfolg vor allem das Debriefing, die Nachbesprechung, entscheidend. Prüfungen mit Simulation als Methode sind nur zu empfehlen, wenn sie von Trainings getrennt durchgeführt werden und die Bewertung nach transparenten, validierten Kriterien erfolgt.
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20
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Ljubenovic A, Said S, Braun J, Grande B, Kolbe M, Spahn DR, Nöthiger CB, Tscholl DW, Roche TR. Anesthesia providers' visual attention in simulated anesthesia emergencies using conventional number-based and avatar-based patient monitoring: a prospective, eye-tracking study. JMIR Serious Games 2022; 10:e35642. [PMID: 35172958 PMCID: PMC8984829 DOI: 10.2196/35642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/05/2022] [Accepted: 02/17/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Inadequate situational awareness accounts for two-thirds of preventable complications in anesthesia. An essential tool for situational awareness in the perioperative setting is the patient monitor. However, the conventional monitor has several weaknesses. Avatar-based patient monitoring may address these shortcomings and promote situation awareness, a prerequisite for good decision making. OBJECTIVE The spatial distribution of visual attention is a fundamental process for achieving adequate situation awareness and thus a potential quantifiable surrogate for situation awareness. Moreover, measuring visual attention with a head-mounted eye-tracker may provide insights into usage and acceptance of the new avatar-based patient monitoring modality. METHODS This prospective eye-tracking study compared anesthesia providers' visual attention on conventional and avatar-based patient monitors during simulated critical anesthesia events. We defined visual attention, measured as fixation count and dwell time, as our primary outcome. We correlated visual attention with the potential confounders: performance in managing simulated critical anesthesia events (task performance), work experience, and profession. We used mixed linear models to analyze the results. RESULTS Fifty-two teams performed 156 simulations. After a manual quality check of the eye-tracking footage, we excluded 57 simulations due to technical problems and quality issues. Participants had a median of 198 (IQR 92.5 - 317.5) fixations on the patient monitor with a median dwell time of 30.2 (IQR 14.9 - 51.3) seconds. We found no significant difference in participants' visual attention when using avatar-based patient monitoring or conventional patient monitoring. However, we found that with each percentage point of better task performance, the number of fixations decreased by about 1.39 (coefficient -1.39; 95%CI: -2.44 to -0.34; P=.02), and the dwell time diminished by 0.23 seconds (coefficient -0.23; 95%CI: -0.4 to -0.06; P=.01). CONCLUSIONS Using eye-tracking, we found no significant difference in visual attention when anesthesia providers used avatar-based monitoring or conventional patient monitoring in simulated critical anesthesia events. However, we identified visual attention in conjunction with task performance as a surrogate for situational awareness. CLINICALTRIAL Business Management System for Ethics Committees Number Req-2020-00059.
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Affiliation(s)
- Arsène Ljubenovic
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Sadiq Said
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Julia Braun
- Departments of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, CH
| | - Bastian Grande
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH.,Simulation Centre, University Hospital Zurich, Zurich, CH
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, CH
| | - Donat R Spahn
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Christoph B Nöthiger
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - David W Tscholl
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Tadzio R Roche
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
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21
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Grande B, Zalunardo MP, Kolbe M. How to train thoracic anesthesia for residents and consultants? Curr Opin Anaesthesiol 2022; 35:69-74. [PMID: 34889801 DOI: 10.1097/aco.0000000000001080] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The training of anesthesiologists in thoracic surgery is a significant challenge. International professional societies usually provide only a case number-based or time-based training concept. There are only a few concepts of simulation trainings in thoracic anesthesia and interprofessional debriefings on a daily basis are rarely applied. In this review, we will show how professional curricula should aim for competence rather than number of cases and why simulation-based training and debriefing should be implemented. RECENT FINDINGS Recent curricula recommend so-called entrustable professional activities (EPAs)as a way out of the dilemma between the number of cases vs. competence. With these EPAs, competence can be mapped and prerequisites defined.Training concepts from simulation in healthcare have so far not explicitly reached anesthesia for thoracic surgery. In addition to mere technical training, combined technical-behavioral training forms have proven to be an effective training targeting the entire team in the context of the actual working environment in the operating theatre. SUMMARY Interdisciplinary and interprofessional learning can take place in simulation trainings and on a daily basis through postevent debriefings. When these debriefings are conducted in a structured way, an improvement in the performance of the entire team can be the result. The basis for these debriefings - as well as for other training approaches - is psychological safety, which should be established and maintained together with all professions involved.
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Affiliation(s)
- Bastian Grande
- University Hospital Zurich, Institute of Anesthesiology, Zurich, Switzerland
- University Hospital Zurich, Simulation Center
- ETH Zurich, Departement of Health Sciences and Technology, Zurich, Switzerland
| | | | - Michaela Kolbe
- University Hospital Zurich, Simulation Center
- ETH Zurich, Departement of Health Sciences and Technology, Zurich, Switzerland
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Hitz F, Ribi K, Grote G, Kolbe M, Schmitz C, Lamb BW, Ruhstaller T, Berchtold P, Sevdalis N. Team functioning across different tumour types: Insights from a Swiss cancer center using qualitative and quantitative methods. Cancer Rep (Hoboken) 2021; 5:e1541. [PMID: 34582132 PMCID: PMC9351662 DOI: 10.1002/cnr2.1541] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/18/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Multidisciplinary care is pivotal in cancer centres and the interaction of all cancer disease specialists in decision making processes is state‐of‐the‐art. Aim To describe differences of MDTMs by tumour type. Methods Twelve multidisciplinary team meetings (MDTMs) with participation of different cancer disease specialists at a tertiary hospital were assessed by an exploratory sequential mixed method approach with interviews, observations and a survey to address the following five topics: organisational structure and supporting technology; leadership; teamwork; decision‐making, perceived value and motivation. Thirteen persons with different tumour specialities and levels of seniority were interviewed. The 12 MDTMs were observed twice by uninvolved persons and evaluated by the participating physicians with a survey. Results There were no systematic differences between MDTMs for different tumour types with the exception of the non‐disease specific type MDTM, which was the only one for which the organisational structure was not driven by an electronic tool. However, several factors could be identified that generally influenced the functioning of the MDTMs. In particular, the quality of decision‐making was highly dependent on the availability of case‐based information and the presence of relevant cancer disease specialists. Leadership and teamwork were rated as important and were comparable across the MDTM. Team participants' motivation and perceived value of MDTMs was high across all meetings. Conclusion MDTM at a single institution did not demonstrate disease specific characteristics. An effective MDTM, irrespective of the tumour type, can be successfully structured by technical means and a chairperson coordinating the interaction of cancer disease specialists to improve the decision‐making process.
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Affiliation(s)
- Felicitas Hitz
- Oncology Haemtology, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Karin Ribi
- International Breast Cancer Study Group, Coordinating Center, Bern, Switzerland
| | - Gudela Grote
- Department of Management, Technology and Economics, ETH Zürich, Zürich, Switzerland
| | - Michaela Kolbe
- Department "Simulationszentrum", University Hospital Zürich, Zürich, Switzerland
| | | | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Thomas Ruhstaller
- Brustzentrum Ostschweiz and University of Basel, St.Gallen, Switzerland
| | | | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College, London, UK
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Lemke R, Burtscher MJ, Seelandt JC, Grande B, Kolbe M. Associations of form and function of speaking up in anaesthesia: a prospective observational study. Br J Anaesth 2021; 127:971-980. [PMID: 34511257 DOI: 10.1016/j.bja.2021.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/14/2020] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Speaking up with concerns in the interest of patient safety has been identified as important for the quality and safety of patient care. The study objectives were to identify how anaesthesia care providers speak up, how their colleagues react to it, whether there is an association among speak up form and reaction, and how this reaction is associated with further speak up. METHODS Data were collected over 3 months at a single centre in Switzerland by observing 49 anaesthesia care providers while performing induction of general anaesthesia in 53 anaesthesia teams. Speaking up and reactions to speaking up were measured by event-based behaviour coding. RESULTS Instances of speaking up were classified as opinion (59.6%), oblique hint (37.2%), inquiry (30.7%), and observation (16.7%). Most speak up occurred as a combination of different forms. Reactions to speak up included short approval (36.5%), elaboration (35.9%), no verbal reaction (26.3%), or rejection (1.28%). Speaking up was implemented in 89.1% of cases. Inquiry was associated with an increased likelihood of recipients discussing the respective issue (odds ratio [OR]=13.6; 95% confidence interval [CI], 5.9-31.5; P<0.0001) and with a decreased likelihood of implementing the speak up during the same induction (OR=0.27; 95% CI, 0.08-0.88; P=0.03). Reacting with elaboration to the first speak up was associated with decreased further speak up during the same induction (relative risk [RR]=0.42; 95% CI, 0.21-0.83; P=0.018). CONCLUSION Our study provides insights into the form and function of speaking up in clinical environments and points to a perceived dilemma of speaking up via questions.
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Affiliation(s)
- Rahel Lemke
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Michael J Burtscher
- School of Applied Psychology, Zurich University of Applied Sciences, Switzerland; Universtiy of Zurich, Switzerland
| | - Julia C Seelandt
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; ETH Zurich, Zurich, Switzerland.
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Affiliation(s)
- Michaela Kolbe
- University Hospital Zurich, Simulation Centre, Switzerland
- ETH Zurich, Switzerland
| | - Sven Schmutz
- University Hospital Bern, Inselspital, Switzerland
| | | | - Walter J Eppich
- RCSI University of Medicine and Health Sciences, RCSI SIM Centre for Simulation Education and Research, Ireland
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Cheng A, Eppich W, Epps C, Kolbe M, Meguerdichian M, Grant V. Embracing informed learner self-assessment during debriefing: the art of plus-delta. Adv Simul (Lond) 2021; 6:22. [PMID: 34090514 PMCID: PMC8180042 DOI: 10.1186/s41077-021-00173-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 01/18/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022] Open
Abstract
The healthcare simulation field has no shortage of debriefing options. Some demand considerable skill which serves as a barrier to more widespread implementation. The plus-delta approach to debriefing offers the advantages of conceptual simplicity and ease of implementation. Importantly, plus-delta promotes learners' capacity for a self-assessment, a skill vital for safe clinical practice and yet a notorious deficiency in professional practice. The plus-delta approach confers the benefits of promoting uptake of debriefing in time-limited settings by educators with both fundamental but also advanced skills, and enhancing essential capacity for critical self-assessment informed by objective performance feedback. In this paper, we describe the role of plus-delta in debriefing, provide guidance for incorporating informed learner self-assessment into debriefings, and highlight four opportunities for improving the art of the plus delta: (a) exploring the big picture vs. specific performance issues, (b) choosing between single vs. double-barreled questions, (c) unpacking positive performance, and (d) managing perception mismatches.
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Affiliation(s)
- A. Cheng
- KidSIM Simulation Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, T3B 6A8 Canada
| | - W. Eppich
- RSCI SIM Centre for Simulation Education and Research RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - C. Epps
- Departments of Anesthesiology and Interprofessional Education, University of Tennessee Health Science Center, Memphis, USA
| | - M. Kolbe
- Simulation Center, UniversitatsSpital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - M. Meguerdichian
- Department of Emergency Medicine, NYC Health + Hospitals/Harlem, NYC Health + Hospitals/Simulation Center, Columbia University, New York, USA
| | - V. Grant
- KidSIM Simulation Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, T3B 6A8 Canada
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Seelandt JC, Walker K, Kolbe M. "A debriefer must be neutral" and other debriefing myths: a systemic inquiry-based qualitative study of taken-for-granted beliefs about clinical post-event debriefing. Adv Simul (Lond) 2021; 6:7. [PMID: 33663598 PMCID: PMC7931165 DOI: 10.1186/s41077-021-00161-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to identify taken-for-granted beliefs and assumptions about use, costs, and facilitation of post-event debriefing. These myths prevent the ubiquitous uptake of post-event debriefing in clinical units, and therefore the identification of process, teamwork, and latent safety threats that lead to medical error. By naming these false barriers and assumptions, the authors believe that clinical event debriefing can be implemented more broadly. METHODS We interviewed an international sample of 37 clinicians, educators, scholars, researchers, and healthcare administrators from hospitals, universities, and healthcare organizations in Western Europe and the USA, who had a broad range of debriefing experience. We adopted a systemic-constructivist approach that aimed at exploring in-depth assumptions about debriefing beyond obvious constraints such as time and logistics and focused on interpersonal relationships within organizations. Using circular questions, we intended to uncover new and tacit knowledge about barriers and facilitators of regular clinical debriefings. All interviews were transcribed and analyzed following a comprehensive process of inductive open coding. RESULTS In total, 1508.62 min of interviews (25 h, 9 min, and 2 s) were analyzed, and 1591 answers were categorized. Many implicit debriefing theories reflected current scientific evidence, particularly with respect to debriefing value and topics, the complexity and difficulty of facilitation, the importance of structuring the debriefing and engaging in reflective practice to advance debriefing skills. We also identified four debriefing myths which may prevent post-event debriefing from being implemented in clinical units. CONCLUSION The debriefing myths include (1) debriefing only when disaster strikes, (2) debriefing is a luxury, (3) senior clinicians should determine debriefing content, and (4) debriefers must be neutral and nonjudgmental. These myths offer valuable insights into why current debriefing practices are ad hoc and not embedded into daily unit practices. They may help ignite a renewed momentum into the implementation of post-event debriefing in clinical settings.
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Affiliation(s)
- Julia Carolin Seelandt
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Katie Walker
- New York City, Health + Hospitals Simulation Center, 1400 Pelham Parkway South, Building 4, 2nd Floor, Bronx, NY 10461 USA
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
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Cheng A, Kolbe M, Grant V, Eller S, Hales R, Symon B, Griswold S, Eppich W. A practical guide to virtual debriefings: communities of inquiry perspective. Adv Simul (Lond) 2020; 5:18. [PMID: 32817805 PMCID: PMC7422458 DOI: 10.1186/s41077-020-00141-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 11/28/2022] Open
Abstract
Many simulation programs have recently shifted towards providing remote simulations with virtual debriefings. Virtual debriefings involve educators facilitating conversations through web-based videoconferencing platforms. Facilitating debriefings through a computer interface introduces a unique set of challenges. Educators require practical guidance to support meaningful virtual learning in the transition from in-person to virtual debriefings. The communities of inquiry conceptual framework offer a useful structure to organize practical guidance for conducting virtual debriefings. The communities of inquiry framework describe the three key elements-social presence, teaching presence, and cognitive presence-all of which contribute to the overall learning experience. In this paper, we (1) define the CoI framework and describe its three core elements, (2) highlight how virtual debriefings align with CoI, (3) anticipate barriers to effective virtual debriefings, and (4) share practical strategies to overcome these hurdles.
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Affiliation(s)
- Adam Cheng
- KidSIM-ASPIRE Research Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Canada
| | - Michaela Kolbe
- Simulation Center, UniversitatsSpital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Vincent Grant
- KidSIM-ASPIRE Research Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Canada
| | - Susan Eller
- Center for Immersive And Simulation-based Learning, Stanford University, Stanford, USA
| | - Roberta Hales
- Center for Simulation, Advanced Education and Innovation, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Benjamin Symon
- Simulation Training Optimising Resuscitation for Kids (STORK), Queensland Children’s Hospital, School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Sharon Griswold
- Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, M.C. H043, P.O. Box 850, Hershey, PA USA
| | - Walter Eppich
- Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
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Abstract
Purpose
Voicing concerns and suggestions is crucial for preventing medical errors and improving patient safety. Research suggests that hierarchy in health-care teams impair open communication. Hierarchy, however, can vary with changing team composition, particularly during acute care situations where more senior persons join the team later on. The purpose of this study is to investigate how changes in hierarchy and leadership were associated with nurses’ voice frequency and nurses’ time to voice during simulated acute care situations.
Design/methodology/approach
This study’s sample consisted of 78 health-care providers (i.e. nurses, residents and consultants) who worked in 39 teams performing complex clinical scenarios in the context of interprofessional, simulation-based team training. Scenarios were videotaped and communication behaviour was coded using a systematic coding scheme. To test the hypotheses, multilevel regression analyses were conducted.
Findings
Hierarchy and leadership had no significant effect on nurses’ voice frequency. However, there were significant relationships between nurses’ time to voice and both hierarchy (γ = 30.00, p = 0.002; 95 per cent confidence interval [CI] = 12.43; 47.92) as well as leadership (γ = 0.30, p = 0.001; 95 per cent CI = 0.12; 0.47). These findings indicate that when more physicians are present and leadership is more centralised, more time passes until the first nurses’ voice occurred.
Originality/value
This study specifies previous findings on the relationships between hierarchy, leadership and nurses’ voice. Our findings suggest that stronger hierarchy and more centralised leadership delay nurses’ voice but do not affect the overall frequency of voice.
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Weis H, Kargl F, Kolbe M, Koza MM, Unruh T, Meyer A. Self- and interdiffusion in dilute liquid germanium-based alloys. J Phys Condens Matter 2019; 31:455101. [PMID: 31342943 DOI: 10.1088/1361-648x/ab354e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Self- and inter-diffusion coefficients in liquid Ge and dilute Ge-based Ge-Si, Ge-Au, Ge-In, Ge-Ce and Ge-Gd alloys-containing 2 at% additions, respectively, are measured using a comprehensive approach of measuring techniques: quasi-elastic neutron scattering, in situ long-capillary experiments combined with x-ray radiography, and a long-capillary experiment under microgravity conditions. Resulting inter- and Ge self-diffusion coefficients are equal within error bars for each investigated alloy. The interdiffusion coefficients are smaller for the alloys containing Ce and Gd, However, no dependence of the atomic mass of the minor additions, that varies by about a factor of seven between Si and Au, on the diffusion coefficients could be observed. This demonstrates that in a loosely-packed metallic liquid with fast diffusive dynamics the diffusion mechanism is highly collective in nature.
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Affiliation(s)
- H Weis
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft- und Raumfahrt (DLR), 51170 Köln, Germany
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Kolbe M, Eppich W, Rudolph J, Meguerdichian M, Catena H, Cripps A, Grant V, Cheng A. Managing psychological safety in debriefings: a dynamic balancing act. BMJ STEL 2019; 6:164-171. [DOI: 10.1136/bmjstel-2019-000470] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/27/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022]
Abstract
Debriefings should promote reflection and help learners make sense of events. Threats to psychological safety can undermine reflective learning conversations and may inhibit transfer of key lessons from simulated cases to the general patient care context. Therefore, effective debriefings require high degrees of psychological safety—the perception that it is safe to take interpersonal risks and that one will not be embarrassed, rejected or otherwise punished for speaking their mind, not knowing or asking questions. The role of introductions, learning contracts and prebriefing in establishing psychological safety is well described in the literature. How to maintain psychological safety, while also being able to identify and restore psychological safety during debriefings, is less well understood. This review has several aims. First, we provide a detailed definition of psychological safety and justify its importance for debriefings. Second, we recommend specific strategies debriefers can use throughout the debriefing to build and maintain psychological safety. We base these recommendations on a literature review and on our own experiences as simulation educators. Third, we examine how debriefers might actively address perceived breaches to restore psychological safety. Re-establishing psychological safety after temporary threats or breaches can seem particularly daunting. To demystify this process, we invoke the metaphor of a ‘safe container’ for learning; a space where learners can feel secure enough to work at the edge of expertise without threat of humiliation. We conclude with a discussion of limitations and implications, particularly with respect to faculty development.
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Abstract
In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.
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Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Margarete Boos
- Institute for Psychology, University of Göttingen, Göttingen, Germany
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Kolbe M, Grande B, Marty A, Manka R, Taramasso M, Nietlispach F, Pomar JL, Maisano F, Reser D. Making Heart Team Discussions Work. Structural Heart 2019. [DOI: 10.1080/24748706.2019.1572254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Switzerland
- ETH Zurich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - Adrian Marty
- Simulation Center, University Hospital Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, Heart Center, University Hospital Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, Heart Center, University Hospital Zurich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, Heart Center, University Hospital Zurich, Switzerland
| | - Jose Luis Pomar
- Hospital Clinico de Barcelona, University of Barcelona, Spain
| | - Francesco Maisano
- Department of Cardiovascular Surgery, Heart Center, University Hospital Zurich, Switzerland
| | - Diana Reser
- Department of Cardiovascular Surgery, Heart Center, University Hospital Zurich, Switzerland
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Arion T, Eberhardt W, Feikes J, Gottwald A, Goslawski P, Hoehl A, Kaser H, Kolbe M, Li J, Lupulescu C, Richter M, Ries M, Roth F, Ruprecht M, Tydecks T, Wüstefeld G. Transverse resonance island buckets for synchrotron-radiation based electron time-of-flight spectroscopy. Rev Sci Instrum 2018; 89:103114. [PMID: 30399919 DOI: 10.1063/1.5046923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/07/2018] [Indexed: 06/08/2023]
Abstract
At the Metrology Light Source (MLS), the compact electron storage ring of the Physikalisch-Technische Bundesanstalt (PTB) with a circumference of 48 m, a specific operation mode with two stable closed orbits for stored electrons was realized by transverse resonance island buckets. One of these orbits is closing only after three turns. In combination with single-bunch operation, the new mode was applied for electron time-of-flight spectroscopy with an interval of the synchrotron radiation pulses which is three times the revolution period at the MLS of 160 ns. The achievement is of significant importance for PTB's future programs of angular-resolved electron spectroscopy with synchrotron radiation and similar projects at other compact electron storage rings. The scheme applied here for selecting the photons originating from a particular orbit by optical imaging has been used before in fs slicing applications and may be relevant for the BESSY VSR project of the Helmholtz-Zentrum Berlin.
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Affiliation(s)
- T Arion
- Center for Free-Electron Laser Science/DESY, Notkestraße 85, D-22607 Hamburg, Germany
| | - W Eberhardt
- Center for Free-Electron Laser Science/DESY, Notkestraße 85, D-22607 Hamburg, Germany
| | - J Feikes
- Helmholtz-Zentrum Berlin, Albert-Einstein-Straße 15, 12489 Berlin, Germany
| | - A Gottwald
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - P Goslawski
- Helmholtz-Zentrum Berlin, Albert-Einstein-Straße 15, 12489 Berlin, Germany
| | - A Hoehl
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - H Kaser
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - M Kolbe
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - J Li
- Helmholtz-Zentrum Berlin, Albert-Einstein-Straße 15, 12489 Berlin, Germany
| | - C Lupulescu
- Institute of Optics and Atomic Physics, TU Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - M Richter
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - M Ries
- Helmholtz-Zentrum Berlin, Albert-Einstein-Straße 15, 12489 Berlin, Germany
| | - F Roth
- Institute for Experimental Physics, TU Bergakademie Freiberg, Leipziger Straße 23, 09599 Freiberg, Germany
| | - M Ruprecht
- Helmholtz-Zentrum Berlin, Albert-Einstein-Straße 15, 12489 Berlin, Germany
| | - T Tydecks
- Helmholtz-Zentrum Berlin, Albert-Einstein-Straße 15, 12489 Berlin, Germany
| | - G Wüstefeld
- Helmholtz-Zentrum Berlin, Albert-Einstein-Straße 15, 12489 Berlin, Germany
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Abstract
Adaptive team coordination is a central topic in the team dynamics literature. Most team adaptation research to date addresses team responses to demands for flexibility triggered by dynamic external forces. Little explicit attention has been paid to demands for stability created by continued pressures on efficiency and control. To capture this dual nature of adaptive coordination, we propose to characterize adaptation triggers in terms of stability and flexibility demands and suggest four modes of adaptive coordination that enable teams to adequately balance these demands. Grounded in team as well as organizational literatures, we explicate the specific patterns of coordination mechanisms comprising each mode of coordination, termed experiential, exploitative, exploratory, and ambidextrous coordination. The new insights offered into team adaptive coordination can spur research that further integrates team and organizational perspectives on adaptation processes.
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Kandler L, Tscholl DW, Kolbe M, Seifert B, Spahn DR, Noethiger CB. Using educational video to enhance protocol adherence for medical procedures. Br J Anaesth 2018; 116:662-9. [PMID: 27106970 DOI: 10.1093/bja/aew030] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Better education of clinicians is expected to enhance patient safety. An important component of education is adherence to standard protocols, which are mainly available in written form. Believing in the potential power of videos, we hypothesized that the introduction of an educational video, based on an institutional standard protocol, would foster adherence to the protocol. METHODS We conducted a prospective intervention study of 425 anaesthesia procedures and teams (202 pre-video and 223 post-video) involving 1091 team members (516 pre-video and 575 post-video) in seven individual operating areas (with a total of 30 operating rooms) in a university hospital. Failure of adherence to safety-critical tasks during rapid sequence anaesthesia inductions was assessed during systematic on-site observations pre- and post-introduction of an educational video demonstrating evidence-based and best practice guidelines. RESULTS The odds for failure of adherence to safety-critical tasks between the pre- and post-intervention period were reduced, odds ratio 0.34 (95% confidence interval 0.27-0.42, P<0.001). The risk for failure of adherence was reduced significantly for eight of the 14 safety-critical tasks (all P<0.001). CONCLUSIONS This study provides empirical evidence for the effectiveness of an educational video to enhance adherence to a standard protocol during complex medical procedures. The introduction of a video can reduce failure of adherence to safety-critical tasks and contribute to patient safety. We recommend the introduction of videos to improve protocol adherence.
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Affiliation(s)
- Lukas Kandler
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - David W Tscholl
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Michaela Kolbe
- Organization, Work and Technology Group, ETH Zurich, Weinbergstrasse 56/58, 8092 Zurich, Switzerland Quality Management and Patient Safety, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Burkhardt Seifert
- Biostatistics, Epidemiology, and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Christoph B Noethiger
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Abstract
Due to increasing complexity in healthcare, clinicians must often make decisions under uncertain conditions in which teams must be flexible and process emerging information "on the fly" in order to adapt to changing circumstances. A crucial strategy that helps teams to adapt, learn, and develop is team reflexivity (TR) - a team's ability to collectively reflect on group objectives, strategies, processes, and outcomes of past and current performance and to adapt accordingly. We provide 12 evidence-based tips on incorporating TR into simulation-based team training (SBTT). The first three points elaborate on basic principles of TR, when TR can take place and why it matters. The following nine tips are then organized according to three phases in which teams are able to engage in TR: pre-action, in-action, and post-action. SBTT represents an ideal venue to train various TR behaviors that foster team learning and improve patient care.
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Affiliation(s)
- Jan B Schmutz
- a Department of Management , Technology and Economics, ETH Zurich , Zurich , Switzerland
| | - Michaela Kolbe
- b Simulation Centre , University Hospital Zurich , Zurich , Switzerland
| | - Walter J Eppich
- c Departments of Pediatrics and Medical Education , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
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Kippnich M, Wallström F, Kolbe M, Erhard H, Kippnich U, Wurmb T. [Comparison of two models of a treatment area with respect to treatment times in critically ill patients : A pilot study]. Anaesthesist 2018; 67:592-598. [PMID: 29947817 DOI: 10.1007/s00101-018-0461-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/23/2018] [Revised: 05/12/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the case of a mass casualty incident an advanced medical post (AMP) plays a central role in the medical care by ambulance service and civil protection units. Besides the traditional organization with one triage category per medical services tent, it can also be structured in a mixed form (i.e. a defined number of patients with different triage categories are assigned to each medical services tent). To date it remains unclear which organization format is better in order to rapidly evacuate those patients with the highest priority. METHODS The Medical Task Force of Lower Franconia treated 50 identical and standardized training patients including 18 triage category red/emergency (36%), 12 triage category yellow/urgent (24%), 18 triage category green/non-urgent (36%) and 2 triage category black/dead (4%) in the course of a scheduled field exercise within two consecutive training sessions (first session: classical structure, second session: mixed structure). The training patients were represented by a dynamic patient simulation, whereby simulation cards showed injury patterns and the external appearance of the patients at a defined point which required certain interventions. The patients' conditions changed when these measures were accomplished or neglected. The length of stay of the patients with the triage category red/emergency at the AMP (start of triage to start evacuation) as well as the overall number of evacuated patients were collated and compared. RESULTS Out of 18 patients with the triage category red/emergency, 13 patients in each session were evacuated in one pass. During the first session the mean evacuation time at the AMP was 25 min and during the second session the mean evacuation time was 18 min. After the end of the 90 min of exercise time in the first session 14 non-critical patients (triage categories yellow/urgent and green/non-urgent, n = 30) were still left at the AMP (16 evacuated) and in the second session 12 (18 evacuated). CONCLUSION Depending on the mission requirements the mixed form of AMP organization can provide several advantages. In addition to rapid operational readiness and high flexibility the patient distribution by triage category could be processed better and the evacuation time of critical patients could be shortened.
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Affiliation(s)
- M Kippnich
- Sektion Notfall- und Katastrophenmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland. .,Bezirksverband Unterfranken, Bereitschaften, Bayerisches Rotes Kreuz, Würzburg, Deutschland.
| | - F Wallström
- Bezirksverband Unterfranken, Bereitschaften, Bayerisches Rotes Kreuz, Würzburg, Deutschland
| | - M Kolbe
- Bezirksverband Unterfranken, Bereitschaften, Bayerisches Rotes Kreuz, Würzburg, Deutschland
| | - H Erhard
- Bezirksverband Unterfranken, Bereitschaften, Bayerisches Rotes Kreuz, Würzburg, Deutschland
| | - U Kippnich
- Bezirksverband Unterfranken, Bereitschaften, Bayerisches Rotes Kreuz, Würzburg, Deutschland
| | - T Wurmb
- Sektion Notfall- und Katastrophenmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
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Weiss M, Kolbe M, Grote G, Spahn DR, Grande B. We can do it! Inclusive leader language promotes voice behavior in multi-professional teams. The Leadership Quarterly 2018. [DOI: 10.1016/j.leaqua.2017.09.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Electrostatic levitation is applied in order to undercool liquid glass forming NiZr significantly below its melting temperature. For NiZr large undercoolings are found to be highly reproducible with this experimental method. One single NiZr sample of high purity is undercooled 200 consecutive times which leads to a distribution function of undercooling temperatures. Within a statistical approach of classical nucleation theory, the undercooling distribution is analyzed yielding parameters, e.g., a pre-exponential factor of KV ≈ 1035 m-3 s-1, which indicates homogeneous nucleation. This result is consistent with the crystallization behavior of NiZr at high undercooling and with the corresponding microstructural analysis. Since NiZr is a representative of the very common CrB structure type, with 132 isostructural phases existing, understanding its nucleation behavior adds important knowledge to the nucleation of binary alloys in general.
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Affiliation(s)
- R Kobold
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft-und Raumfahrt (DLR), 51170 Köln, Germany
| | - M Kolbe
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft-und Raumfahrt (DLR), 51170 Köln, Germany
| | - W Hornfeck
- Department of Structure Analysis, Institute of Physics of the Czech Academy of Sciences, Na Slovance 2, 18221 Prague, Czech Republic
| | - D M Herlach
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft-und Raumfahrt (DLR), 51170 Köln, Germany
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Kolbe M, Rudolph JW. What’s the headline on your mind right now? How reflection guides simulation-based faculty development in a master class. BMJ STEL 2018; 4:126-132. [DOI: 10.1136/bmjstel-2017-000247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 01/06/2023]
Abstract
IntroductionThe demand for highly skilled simulation-based healthcare educators (SBEs) is growing. SBEs charged with developing other SBEs need to be able to model and conduct high-quality feedback conversations and ‘debrief the debriefing’. Direct, non-threatening feedback is one of the strongest predictors of improved performance in health professions education. However, it is a difficult skill to develop. Developing SBEs who can coach and support other SBEs is an important part of the faculty development pipeline. Yet we know little about how they get better at skilled feedback and the ability to reflect on it. There is scant evidence about their thoughts, feelings and dilemmas about this advanced learning process. To address this gap, we examined advanced SBE’s subjective experience as they grappled with challenges in a 4-day advanced SBE course. Their reflections will help target faculty development efforts.MethodsUsing a repeated, identical free-writing task, we asked “What is the headline for what is on your mind right now?”ResultsA five-theme mosaic of self-guiding reflections emerged: (1) metacognitions about one’s learning process, (2) evaluations of sessions or tools, (3) notes to self, (4) anticipations of applying the new skills in the future, and (5) tolerating the tension between pleasant and unpleasant emotions.ConclusionsThe results extend simulation-based education science by advocating the motivational role of noting inconsistencies between one’s intention and impact and the central role of self-regulation, emotion, and experiencing feedback and debriefing from multiple perspectives for improving advanced skills of SBEs. Recommendations for faculty development are discussed.
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Burtscher MJ, Jordi Ritz EM, Kolbe M. Differences in talking-to-the-room behaviour between novice and expert teams during simulated paediatric resuscitation: a quasi-experimental study. BMJ STEL 2018; 4:165-170. [DOI: 10.1136/bmjstel-2017-000268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/03/2022]
Abstract
BackgroundTeam coordination represents an important factor for clinical performance. Research in this area suggests that not only behaviour frequencies but also patterns of team coordination constitute a central aspect of teamwork. However, little is known about potential differences in coordination patterns between novice teams (ie, teams of inexperienced members) and expert teams (ie, teams of experienced members). The current study addresses this gap by investigating the use of talking-to-the-room—an important implicit coordination behaviour—in novice teams versus expert teams.AimTo illustrate differences in coordination behaviour between novice and expert teams. This will provide important knowledge for simulation-based training.MethodsThe study was conducted in the context of two resuscitation training courses (introductory course and refresher course) for staff members at a children’s hospital. Volunteers from both courses participated in the study. They were randomly assigned to 16 teams each consisting of one physician and two nurses. The study used a quasi-experimental design with two conditions (novice vs expert). Participants of the introductory course were assigned to the novice condition (eight teams), and participants of the refresher course were assigned to the expert condition (eight teams). All teams completed the same standardised paediatric resuscitation scenario. They were videotaped during the simulation, and team coordination behaviour was coded using Co-ACT.ResultsLag-sequential analysis of 1902 distinct coordination acts revealed that novice teams and expert teams differed significantly in their coordination behaviour. Expert teams were characterised by patterns in which implicit coordination behaviour (ie, talking to the room) was followed by further implicit coordination behaviour and not followed by explicit coordination behaviour (ie, instructions), whereas the reverse was found for novice teams.ConclusionThe current study highlights role of coordination patterns for understanding teamwork in healthcare and provides important insights for team training.
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Kolbe M, Marty A, Seelandt J, Grande B. How to debrief teamwork interactions: using circular questions to explore and change team interaction patterns. Adv Simul (Lond) 2016; 1:29. [PMID: 29449998 PMCID: PMC5806384 DOI: 10.1186/s41077-016-0029-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 08/17/2016] [Accepted: 10/26/2016] [Indexed: 11/10/2022] Open
Abstract
We submit that interaction patterns within healthcare teams should be more comprehensively explored during debriefings in simulation-based training because of their importance for clinical performance. We describe how circular questions can be used for that purpose. Circular questions are based on social constructivism. They include a variety of systemic interviewing methods. The goals of circular questions are to explore the mutual dependency of team members’ behavior and recurrent behavior patterns, to generate information, to foster perspective taking, to “fluidize” problems, and to put actions into relational contexts. We describe the nature of circular questions, the benefits they offer, and ways of applying them during debriefings.
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Affiliation(s)
- Michaela Kolbe
- 1University Hospital Zurich, Simulation Center, Rämistrasse 100, 8091 Zurich, Switzerland.,2ETH, Zurich, Switzerland
| | - Adrian Marty
- 1University Hospital Zurich, Simulation Center, Rämistrasse 100, 8091 Zurich, Switzerland.,3University Hospital Zurich, Institute for Anaesthesiology, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Julia Seelandt
- 1University Hospital Zurich, Simulation Center, Rämistrasse 100, 8091 Zurich, Switzerland.,4University Hospital Zurich, Quality Management and Patient Safety, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Bastian Grande
- 1University Hospital Zurich, Simulation Center, Rämistrasse 100, 8091 Zurich, Switzerland.,3University Hospital Zurich, Institute for Anaesthesiology, Rämistrasse 100, 8091 Zurich, Switzerland
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Weiss M, Kolbe M, Grote G, Spahn DR, Grande B. Why didn’t you say something? Effects of after-event reviews on voice behaviour and hierarchy beliefs in multi-professional action teams. European Journal of Work and Organizational Psychology 2016. [DOI: 10.1080/1359432x.2016.1208652] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schulze M, Grande B, Kolbe M, Kriech S, Nöthiger CB, Kohler M, Spahn DR, Franzen D. SafAIRway: an airway training for pulmonologists performing a flexible bronchoscopy with nonanesthesiologist administered propofol sedation: A prospective evaluation. Medicine (Baltimore) 2016; 95:e3849. [PMID: 27281093 PMCID: PMC4907671 DOI: 10.1097/md.0000000000003849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Nonanesthesiologist administered propofol (NAAP) sedation for flexible bronchoscopy is controversial, because there is no established airway management (AM) training for pulmonologists. The aim was to investigate the performance and acceptance of a proposed AM algorithm and training for pulmonologists performing NAAP sedation. The algorithm includes using 3 maneuvers including bag mask ventilation (BMV), laryngeal tube (LT), and needle cricothyrotomy (NCT). During training (consisting of 2 sessions with a break of 9 weeks in between), these maneuvers were demonstrated and exercised, followed by 4 consecutive attempts to succeed with each of these devices. The primary outcome was the improvement of completion time needed for a competent airway. Secondary outcomes were the trainees' overall reactions to the training and algorithm, and the perceptions of psychological safety (PS). The 23 staff members of the Department of Pulmonology performed a total of 552 attempts at AM procedures (4 attempts at each of the 3 maneuvers in 2 sessions), and returned a total of 42 questionnaires (4 questionnaires were not returned). Median completion times of LT and NCT improved significantly between Sessions 1 and 2 (P = 0.005 and P = 0.04, respectively), whereas BMV was only marginally improved (P = 0.05). Trainees perceived training to be useful and expressed satisfaction with this training and the algorithm. The perception of PS increased after training. An AM algorithm and training for pulmonologists leads to improved technical AM skills, and is considered useful by trainees and raised their perception of PS during training. It thus represents a promising program.
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Affiliation(s)
| | - Bastian Grande
- Institute of Anesthesiology
- Simulation Center, University Hospital Zurich
| | | | - Sarah Kriech
- Simulation Center, University Hospital Zurich
- ETH Zurich
| | | | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel Franzen
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- ∗Correspondence: Daniel Franzen, Department of Pulmonology, University Hospital Zurich, Raemistr. 100, 8091 Zurich, Switzerland (e-mail: )
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Raemer DB, Kolbe M, Minehart RD, Rudolph JW, Pian-Smith MCM. Improving Anesthesiologists' Ability to Speak Up in the Operating Room: A Randomized Controlled Experiment of a Simulation-Based Intervention and a Qualitative Analysis of Hurdles and Enablers. Acad Med 2016; 91:530-539. [PMID: 26703413 DOI: 10.1097/acm.0000000000001033] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE The authors addressed three questions: (1) Would a realistic simulation-based educational intervention improve speaking-up behaviors of practicing nontrainee anesthesiologists? (2) What would those speaking-up behaviors be when the issue emanated from a surgeon, a circulating nurse, or an anesthesiologist colleague? (3) What were the hurdles and enablers to speaking up in those situations? METHOD The authors conducted a simulation-based randomized controlled experiment from March 2008-February 2011 at the Center for Medical Simulation, Boston, Massachusetts. During a mandatory crisis management course for practicing nontrainee anesthesiologists from five Boston institutions, a 50-minute workshop on speaking up was conducted for intervention (n = 35) and control (n = 36) groups before or after, respectively, an experimental scenario with three events. The authors analyzed videos of the experimental scenarios and debriefing sessions. RESULTS No statistically significant differences between the intervention and control group subjects with respect to speaking-up actions were observed in any of the three events. The five most frequently mentioned hurdles to speaking up were uncertainty about the issue, stereotypes of others on the team, familiarity with the individual, respect for experience, and the repercussion expected. The five most frequently mentioned enablers were realizing the speaking-up problem, having a speaking-up rubric, certainty about the consequences of speaking up, familiarity with the individual, and having a second opinion or getting help. CONCLUSIONS An educational intervention alone was ineffective in improving the speaking-up behaviors of practicing nontrainee anesthesiologists. Other measures to change speaking-up behaviors could be implemented and might improve patient safety.
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Affiliation(s)
- Daniel B Raemer
- D.B. Raemer is associate professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and senior director of clinical programs, Center for Medical Simulation, Boston, Massachusetts. M. Kolbe is faculty member, Organization, Work and Technology Group, Department of Management, Technology and Economics, ETH Zurich, and director, Simulation Center, University Hospital Zurich, Zurich, Switzerland. R.D. Minehart is assistant professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and teaching faculty, Center for Medical Simulation, Boston, Massachusetts. J.W. Rudolph is assistant clinical professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and director, Institute for Medical Simulation, Center for Medical Simulation, Boston, Massachusetts. M.C.M. Pian-Smith is associate professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and teaching faculty, Center for Medical Simulation, Boston, Massachusetts
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Wacker J, Kolbe M. Leadership and teamwork in anesthesia – Making use of human factors to improve clinical performance. Trends in Anaesthesia and Critical Care 2014. [DOI: 10.1016/j.tacc.2014.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Speaking up with suggestions, problems, or doubts is important—especially in health care action teams where each team member’s input can be crucial for the treatment of a patient. Implementing a high-fidelity simulation study, we investigated individual predictors of speaking up in acute care teams (ACTs). Participants were 27 physicians and 27 nurses from a hospital who completed measures on self-perceived agency (i.e., assertiveness, persistence, independence) and communion (i.e., helpfulness, friendliness, sociability). In two-person teams, they managed simulated critical events that required speaking up. In line with our hypotheses, we found that agency positively and communion negatively predicted actual speaking up behavior. We discuss the differential effects of agency and communion on speaking up and thereby highlight theoretical and practical implications.
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Neumann MD, Cobet C, Kaser H, Kolbe M, Gottwald A, Richter M, Esser N. A synchrotron-radiation-based variable angle ellipsometer for the visible to vacuum ultraviolet spectral range. Rev Sci Instrum 2014; 85:055117. [PMID: 24880425 DOI: 10.1063/1.4878919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A rotating analyzer spectroscopic polarimeter and ellipsometer with a wide-range θ-2θ goniometer installed at the Insertion Device Beamline of the Metrology Light Source in Berlin is presented. With a combination of transmission- and reflection-based polarizing elements and the inherent degree of polarization of the undulator radiation, this ellipsometer is able to cover photon energies from about 2 eV up to 40 eV. Additionally, a new compensator design based on a CaF2 Fresnel rhomb is presented. This compensator allows ellipsometric measurements with circular polarization in the vacuum ultraviolet spectral range and thus, for example, the characterization of depolarizing samples. The new instrument was initially used for the characterization of the polarization of the beamline. The technical capabilities of the ellipsometer are demonstrated by a cohesive wide-range measurement of the dielectric function of epitaxially grown ZnO.
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Affiliation(s)
- M D Neumann
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., 12489 Berlin, Germany
| | - C Cobet
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., 12489 Berlin, Germany
| | - H Kaser
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany
| | - M Kolbe
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany
| | - A Gottwald
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany
| | - M Richter
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany
| | - N Esser
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., 12489 Berlin, Germany
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