IN-SITU CLINICAL SIMULATION PROGRAM: IMPROVING EDUCATION OUTCOMES THROUGH RESEARCH FEEDBACK
In-situ simulations are widely used for medical training. MedStar Obstetric Safety Training (MOST) was developed as a multi-disciplinary in-situ clinical simulation program focused on enhancing patient outcomes and improvement of teamwork in emergency response situations in the perinatal area. MOST is a component of the culture of safety initiative at MedStar Health.
Obstetricians, neonatologists, anesthesiologists, midwives and perinatal nurses participate in this program that focuses on mastering decision-making and communication skills. The scenarios are ones that are rare but catastrophic.
Departments select scenarios based on current needs and preferences. Participants of this particular training included midwives, resident physicians and nurses. The Clinical Simulation Center (CSC) provided the technical and educational support for the training.
Maternal code blue on the postpartum unit (scenario 1) and a precipitous delivery of a preterm fetus on the antepartum unit (scenario 2) were used for the simulation-based training.
MOST trainers and participants completed the State Obstetric and Pediatric Research Collaboration’s (STORC) Clinical Teamwork Scale (CTS). CTS is a validated tool that measures key factors in teamwork: communication, situational awareness, decision making, role responsibility and patient friendliness.
Two teams participated in the training, each undergoing a standard cycle of training procedures. The multi-disciplinary teams listened to a didactic presentation on effective teamwork and then participated in the simulated scenarios. The team performed scenario 1 and then completed the tool. Next the faculty conducted a debriefing. The team then participated in scenario 2 and completed the CTS for a second time.
Responses collected from the team members were entered into an Excel spreadsheet and imported into SPSS 19.0 (Statistical Package for Social Sciences, IBM). Recognizing the small sample and preliminary nature of the research inquiry, it was decided to analyze the data using a non-parametric comparison by Wilcoxon Signed Rank Test for pre- and post-debriefing assessment. Research feedback was then implemented to inform team leaders and members on tendencies in evaluation.
The teams were uniform with regard to gender, age and professional role. It was observed utilizing Wilcoxon test that there were statistically significant positive changes (p < 0.05) for the first team (N=5) from the first evaluation to the second one (following the debriefing) on communication items (e.g. improved team oriented and direct communication), as well as with regard to overall situational awareness. However, for the second team (N=4) similar results were not observed, but significant change was demonstrated for the role responsibility parameter.
As the research feedback and study findings were discussed with the clinical director an interesting hypothesis was formulated for further investigation involving the team leaders. The first leader was an experienced midwife with more than 5 years in her current position, while the second leader was a less experienced midwife who had only been in practice for approximately four months. It is suggested that the education research outcomes should include the measurement of team leadership that can mediate the effect of the in-situ clinical simulation training.