Simulation Team Training Toolkit

Improve communication and patient safety by incorporating simulation into curriculum and clinical settings.

Audience

This Simulation Team Training Toolkit is intended for educators involved in training interprofessional teams of students, trainees and novice faculty participating in team simulation training sessions in a simulation lab or similar learning environment.

Purpose

To be an aid for helping faculty and instructors set up a complete interprofessional simulation team training session.

To provide a packaged interprofessional team training session using simulation/role-play as the vector by which health professional students can learn together to develop and improve team and communication skills.

To provide novice online training for faculty participating in the team training sessions.

Contents

1. Set-up and Curriculum Guides

The following set-up and curriculum guides were developed to help lead facilitators/course instructors:

A. Understand the fundamental components of setting up an interprofessional team training simulation session, including:
– Agendas
– Ratio of students and facilitators
– Using TeamSTEPPS® language as a method of team communication
– Debriefing an interprofessional training session

B. Set up simulation lab areas:
– Orient technicians to the scenarios
– Orient standardized patients to the scenarios
– Orient students to the scenarios
– Running and debriefing the scenarios

1. Adult Acute Care Scenario Set-up and Curriculum Guide (.pdf).
This guide includes instructions for running three different simulation scenarios:
1. Dyspnea in a Hospitalized Patient (This simulation scenario is available on MedEdPORTAL.*)
2. A Postoperative Patient with Tachycardia
3. A Teenager with Asthma

2. OB Acute Care Scenario Set-up and Curriculum Guide (.pdf).
This guide includes instructions for running three different simulation scenarios:
1. Precipitous Vaginal Delivery
2. Mild Postpartum Hemorrhage (PPH)
3. Mild Postpartum Hemorrhage (PPH) + Error

3. TeamSTEPPS® Debrief Guide (.pdf).
This includes a guide on how to progressively make each scenario’s communication skills more advanced.

*Wilson S, Vorvick L. (2016). Dyspnea in a hospitalized patient: Using simulation to introduce interprofessional collaborative practice concepts. MedEdPORTAL Publications. 12, 10488. https://doi.org/10.15766/mep_2374-8265.10488

2. Facilitator Training

For this type of interprofessional simulation training, it’s recommended that at least one facilitator from each discipline help facilitate the scenarios. The support facilitators can step in and help the students with tougher clinical problems, thereby preventing the rest of students from derailing on their focus of team communication in the scenario. The role of support facilitators is to serve as a resource for students by providing discipline-specific knowledge and coaching, and to assist with orientation, progression of the scenario, and debriefing.

Online Tutorial for Support Faculty The developers of this training created the following online tutorial for support facilitators. It is recommended that facilitators review the online training then go through an in-person “dry-run” of the simulation scenarios with lead facilitators before the day of the student training sessions.

  1. Sample Agenda (.pdf) used for the June 2011 UW “Capstone” Interprofessional Simulation Training (300+ students participated).
  2. Abbreviated Support Facilitator Guides for Adult Acute Care Simulation Training. These guides present the typical agenda for a training day, a case description of the scenario, expectations of faculty participation, debriefing tips and strategies.
    Facilitator Guide (.pdf) for Dyspnea in a Hospitalized Patient
    Facilitator Guide (.pdf) for A Postoperative Patient with Tachycardia
    Facilitator Guide (.pdf) for A Teenager with Asthma
  3. Abbreviated Support Facilitator Guides for OB Acute Care Simulation Training. These guides present the typical agenda for a training day, a case description of the scenario, expectations of faculty participation, debriefing tips and strategies.  Coming soon.
  4. Online Lesson: Introduction to Clinical Simulation [CURRENTLY UNAVAILABLE]. This self-paced lesson reviews the reasons for the growing popularity of simulation and introduces basic concepts in clinical simulation. Approximate duration: 13 minutes
  5. Online Lesson: Briefing and Debriefing—The Key to Learning in Simulation [CURRENTLY UNAVAILABLE]. This self-paced lesson provides a basic overview of debriefing, considerations in debriefing, and some examples of techniques used in debriefing. It is not meant to be comprehensive but will familiarize a novice debriefer to the role and responsibility of a debriefer. Approximate duration: 20 minutes
  6. Online TeamSTEPPS® Training Lesson. Learn theory, basic concepts and vocabulary of TeamSTEPPS® in this self-paced lesson. Runtime: 49:37.
  7. TeamSTEPPS® Glossary (.pdf). A one-page reference guide of commonly used TeamSTEPPS® skills. Developed by: Sharon J. Wilson, RN, MSN, FNP-BC; Diana [Taibi] Buchanan, PhD, RN; Suzan Kardong-Edgren, PhD, RN; Chia-Ju Chiu, PhD, PT; and Debra Liner, Program Operations Specialist.
3. Online Video Example of IP Simulation Training

This video was recorded during an interprofessional simulation training session at the WWAMI Institute for Simulation in Healthcare (formerly known as the UW Institute for Simulation and Interprofessional Studies) at Harborview Medical Center on March 7, 2012. The students appearing in the video are real interprofessional students at UW and consented to being filmed for training purposes. The family member in the video is a standardized patient actor.

Watch the video of orienting the students to the simulation. (Approximate Time: 4 minutes)
Watch the video of running the simulation. (Approximate Time: 13 minutes)
Watch the video of debriefing. (Approximate Time: 11 minutes)

Note: If you do not have a media player that supports .mp4 files, you can download QuickTime at https://www.apple.com/quicktime/download/. It may take several minutes for the video to load depending on your internet speed.

4. TeamSTEPPS® Paper Chain Team Exercise

This Paper Chain Team Exercise training lesson is intended to be used during interprofessional team training sessions. The objective is for trainees learn and use TeamSTEPPS® team communication skills without knowing it as they build a paper chain with as many loops as possible. The activity highlights the need for strong team communication and teaches students TeamSTEPPS® skills throughout the exercise.

TeamSTEPPS® Paper Chain Team Exercise

This paper chain training exercise was developed by the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) Institute for Simulation in Healthcare (WISH) at the University of Washington.

5. Evaluation Forms for Students and Facilitators

The following course evaluation forms were distributed to student trainees and their facilitators during the March 2011 and 2012 interprofessional student error disclosure training sessions at University of Washington.

Student/Peer Simulation Evaluation Form (.pdf)
Self-/Facilitator Simulation Evaluation Form (.pdf)

Developed by: Karen McDonough, MD; Debra Liner and the UW Macy Grant Team.

6. Validated Pre-/Post-training Assessment Tools

Instructors wanting assess the progressive learning of students participating in the interprofessional simulation team training can use the following pre/post assessment tool validated by assessment researchers from the Macy grant at University of Washington during the June 2011 interprofessional simulation team training sessions. To read about results of the UW June 2011 pre/post assessment, click here.

Pre-training Assessment Tool (.pdf)
Post-training Assessment Tool (.pdf)

Developed by: Doug Brock, PhD; Erin Abu-Rish Blakeney, PhD, RN; Linda Vorvick, MD; Sharon Wilson, RN, MSN; Debra Liner; Doug Schaad, PhD; Katherine Blondon.

7. Performance Assessment of Communication and Teamwork (PACT) Tool Set

The Macy Interprofessional Collaborative Project was funded by the Macy and Hearst Foundations to develop a simulation-based, team training program for health professional students. The overall goal of the program is to improve the delivery of safe, high quality care by promoting interprofessional team communication. TeamSTEPPS® developed by the Agency for Healthcare Research and Quality (AHRQ) was chosen as the framework for the training program. A Performance Assessment for Communication and Teamwork (PACT) tool set was developed using the TeamSTEPPS® framework to assess performance on teamwork and communication in simulated scenarios.

The PACT tool set includes three tools: 1) PACT-novice, 2) PACT-expert, and 3) PACT-video. This package includes the 3 PACT tools, a list of definitions of key terms and concepts, a rater training program, a coding protocol, a coding reference, and a description of the behavioral markers to help utilize the PACT tools more effectively.

Tools

  • PACT-novice (.pdf) is designed for novice raters who are not familiar with TeamSTEPPS® or who do not have previous coder training experience to perform a real-time assessment. PACT-novice contains the 5 TeamSTEPPS® constructs and sample behaviors of constructs are provided on the tool. Raters are asked to rate the constructs using a 5-point quality scale and to record notes in the “comment” column. A list of definitions of key terms and concepts describing team communication was developed to accompany the PACT-novice tool in order to help raters understand key concepts of TeamSTEPPS®.
  • PACT-expert (.pdf) is designed for experienced raters who are familiar with TeamSTEPPS® to perform a real-time assessment. PACT-expert contains 19 behavioral markers that were drawn from the PACT-video. These 19 behavioral markers were representative of the behavioral markers observed in the videos of effective team communication. Raters are asked to use a 4-point Likert scale of quality (poor-excellent) to assess each behavioral marker, as well as the 5 overall TeamSTEPPS® constructs.
  • PACT-video (.pdf) is designed for institutions that want to have more detailed information on team performance. Extensive training for raters to use PACT-video is recommended. PACT-video contains 5 behavioral markers under each construct (26 behavioral markers in total). PACT-video has frequency and quality scales to collect both quantitative and qualitative information.

Supporting Documents

Note: We are in the process of gathering the validation evidence for the tools. The PACT tool set was developed to assess performance from a team perspective not as individuals. Because the nature of current healthcare system is very dynamic, the makeup of a team changes constantly. There is potential to use PACT-expert and PACT-video for individual performance assessments. However, other uses of the tools are still under evaluation and development.

Developed by: Chia-Ju Chiu, PhD-C, Douglas Brock, PhD; Erin Abu-Rish, PhD-C; and UW Macy Assessment Team members: Linda Vorvick, MD; Sharon Wilson, RN, MSN, FNP-BC; Dana Hammer, PhD, PharmD; Douglas Schaad, PhD; Katherine Blondon, MD; and Brenda Zierler, PhD, RN, FAAN.

Acknowledgements

The content of this toolkit was developed by the Macy grant team at the University of Washington, who were funded in 2008 to develop and integrate interprofessional team training into existing curriculum in the Health Sciences schools of Medicine, Nursing, Pharmacy and the Physician Assistant Program. This training was piloted with a group of 49 students in June 2010 and rolled out to a group of 300+ students in June 2011. This training continues to be provided to students each Spring Quarter through the TeamBITS Program at the WWAMI Institute for Simulation in Healthcare (WISH) University of Washington Medical Center and Harborview Medical Center facilities. One scenario from this training toolkit has been peer reviewed and published by MedEdPORTAL.

Wilson S, Vorvick L. (2016). Dyspnea in a hospitalized patient: Using simulation to introduce interprofessional collaborative practice concepts. MedEdPORTAL Publications. 12, 10488. https://doi.org/10.15766/mep_2374-8265.10488

The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) developed TeamSTEPPS®, an evidence-based set of teamwork tools aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals. For more information about TeamSTEPPS®, visit https://www.ahrq.gov/teamstepps/index.html.

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