Field studies in simulation-based team training

Abstract: Simulation technology enables students and staff to learn and practice teamwork skills without risk to patients. Simulation was introduced in Swedish healthcare less than 30 years ago but other industries e.g. aviation had already since long used this technology in order to practice technical and teamwork skills. Therefore healthcare could learn from aviation and others regarding simulation-based teamwork training. Since simulators are expensive and training is demanding regarding faculty, simulation-based education has rightly been questioned. Is simulation-based teamwork training really a reasonable priority in public healthcare? The common theme in this thesis is to add evidence on how simulation-based teamwork training can be money well spent. The studies included are all performed during regular simulation-based teamwork courses. This approach enabled inclusion of experienced staff as well as students from a number of settings, but also posed limitations, as the courses could not be fully standardized. The first two studies assessed situational motivation as a prerequisite for learning in simulation-based education and beyond. Intrinsic motivation is known to enhance deep learning and retention of knowledge and increased significantly with training both in a cohort of medical students and in inter-professional training for professional operating room staff. The five participating operating room professions all increased situational motivation alike. Analysis of interviews conducted after training could provide information regarding how participants were motivated and how knowledge and skills from the simulation can be transferred to the workplace. Interestingly staff perceived barriers to communication in the operating room and the training was mentioned as a possibility to enhance safety and improve communication. The third study specifically investigated participants ́ and educators ́ perceptions of low and higher fidelity simulators. Interestingly few differences regarding participants ́ individual reactions to training with low tech compared to a more sophisticated manikin was found. On the other hand, low tech was more demanding for the facilitators. It seems like skillful instruction can compensate for lower technology. The finding led to the fourth study where the facilitators ́ actions were assessed in more detail in a qualitative multidisciplinary multicenter study on in-scenario instruction. A significant variation regarding methods used and features of instruction such as tempo and timing was found and instruction had an impact on participants ́ actions and interaction. Altogether, the studies underpin the possibilities to use simulators for learning and practicing teamwork skills not only in undergraduate training, but also in inter-professional training for experienced staff. Results suggest that design and facilitation of the training are essential to optimize benefit from simulation technology.