Interprofessional teamwork for managing medical deterioration in pregnancy: what contributes to good clinical performance in simulated practice?

Autor:	Lavelle M; School of Health Sciences, City University of London, London, UK., Reedy GB; Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK., Simpson T; Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.; Lewisham and Greenwich NHS Trust, London, UK., Banerjee A; Women's Services, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK., Anderson JE; School of Health Sciences, City University of London, London, UK.; Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
Jazyk:	angličtina
Zdroj:	BMJ simulation & technology enhanced learning [BMJ Simul Technol Enhanc Learn] 2021 Jul; Vol. 7 (6), pp. 463-470. Date of Electronic Publication: 2021 Apr 19.
DOI:	10.1136/bmjstel-2020-000700
Abstrakt:	Objectives: To identify the patterns of teamwork displayed by interprofessional teams during simulated management of medical deterioration in pregnancy and examine whether and how they are related to clinical performance in simulated practice. Design: Exploratory observational cohort study. Setting: Interprofessional clinical simulation training with scenarios involving the management of medical deterioration in pregnant women. Participants: Seventeen simulated scenarios involving 62 qualified healthcare staff working within the National Health Service attending clinical simulation training (midwives (n=18), obstetricians (n=24) and medical physicians (n=20)). Main Outcome Measures: Teamwork behaviours over time, obtained through detailed observational analysis of recorded scenarios, using the Temporal Observational Analysis of Teamwork (TOAsT) framework. Clinician rated measures of simulated clinical performance. Results: Scenarios with better simulated clinical performance were characterised by shared leadership between obstetricians and midwives at the start of the scenario, with obstetricians delegating less and midwives disseminating rationale, while both engaged in more information gathering behaviour. Towards the end of the scenario, better simulated clinical performance was associated with dissemination of rationale to the team. More delegation at the start of a scenario was associated with less spontaneous sharing of information and rationale later in the scenario. Teams that shared their thinking at the start of a scenario continued to do so over time. Conclusions: Teamwork during the opening moments of a clinical situation is critical for simulated clinical performance in the interprofessional management of medical deterioration in pregnancy. Shared leadership and the early development of the shared mental model are associated with better outcomes. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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