Caution Before Embracing Team Mentoring in Academic Medical Research Training: Recommendations from a Qualitative Study.
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SUBMITTER: Mancuso CA
PROVIDER: S-EPMC8361588 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundExcessive inpatient administrative tasks can lead to adverse consequences for residents and their patients. Furthermore, this burden has been linked to depersonalization, a major component of physician burnout.ObjectiveTo describe the development, implementation, feasibility, acceptability, and early outcomes of Resident Team Assistant (RTA) programs.MethodsThree large academic medical centers created RTA programs in which administrative assistants are incorporated into inpatient medical teams. First steps included a needs assessment and driver diagram creation to identify key issues and to solidify goals. Program directors were assigned, and RTAs were hired, trained, and incorporated into inpatient teams at each institution (2003, 2016, 2018). Program leadership and institutional stakeholders met regularly to discuss development and quality assurance. Surveys and direct interviews were performed to evaluate impact and acceptability. Institutional goals in accordance to RTAs tasks were also investigated.ResultsResident surveys and interviews have shown acceptability with RTAs completing a large percentage of resident administrative tasks while promoting time spent in direct clinical care and job satisfaction. Hospital-specific improvements have included increase in referring physician communication rate and decrease in work hour violations. The programs have maintained high feasibility and sustainability with a relatively low time commitment from leadership and cost for the institutions.ConclusionsThe RTA programs at the 3 institutions have continued to be sustained over time with perceived improvements in administrative task burden and job satisfaction for the residents. They have maintained high acceptability and feasibility in terms of effort and costs for the hospitals.
| S-EPMC7771612 | biostudies-literature
Project description:BackgroundMentorship is perceived to play a significant role in the career development and productivity of academic clinicians, but little is known about the characteristics of mentorship. This knowledge would be useful for those developing mentorship programs.ObjectiveTo complete a systematic review of the qualitative literature to explore and summarize the development, perceptions and experiences of the mentoring relationship in academic medicine.Date sourcesMedline, PsycINFO, ERIC, Scopus and Current Contents databases from the earliest available date to December 2008.Review methodsWe included studies that used qualitative research methodology to explore the meaning and characteristics of mentoring in academic medicine. Two investigators independently assessed articles for relevance and study quality, and extracted data using standardized forms. No restrictions were placed on the language of articles.ResultsA total of 8,487 citations were identified, 114 full text articles were assessed, and 9 articles were selected for review. All studies were conducted in North America, and most focused on the initiation and cultivation phases of the mentoring relationship. Mentoring was described as a complex relationship based on mutual interests, both professional and personal. Mentees should take an active role in the formation and development of mentoring relationships. Good mentors should be sincere in their dealings with mentees, be able to listen actively and understand mentees' needs, and have a well-established position within the academic community. Some of the mentoring functions aim at the mentees' academic growth and others at personal growth. Barriers to mentoring and dysfunctional mentoring can be related to personal factors, relational difficulties and structural/institutional barriers.ConclusionsSuccessful mentoring requires commitment and interpersonal skills of the mentor and mentee, but also a facilitating environment at academic medicine's institutions.
| S-EPMC2811592 | biostudies-literature
Project description:PurposeMentoring is critical for academic success. As science transitions to a team science model, team mentoring may have advantages. The goal of this study was to understand the process, benefits, and challenges of team mentoring relating to career development and research.MethodA national survey was conducted of Building Interdisciplinary Research Careers in Women's Health (BIRCWH) program directors-current and former scholars from 27 active National Institutes of Health (NIH)-funded BIRCWH NIH K12 programs-to characterize and understand the value and challenges of the team approach to mentoring. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically.ResultsResponses were received from 25/27 (93%) program directors, 78/108 (72%) current scholars, and 91/162 (56%) former scholars. Scholars reported that team mentoring was beneficial to their career development (152/169; 90%) and research (148/169; 88%). Reported advantages included a diversity of opinions, expanded networking, development of stronger study designs, and modeling of different career paths. Challenges included scheduling and managing conflicting opinions. Advice by directors offered to junior faculty entering team mentoring included the following: not to be intimidated by senior mentors, be willing to navigate conflicting advice, be proactive about scheduling and guiding discussions, have an open mind to different approaches, be explicit about expectations and mentors' roles (including importance of having a primary mentor to help navigate discussions), and meet in person as a team.ConclusionsThese findings suggest that interdisciplinary/interprofessional team mentoring has many important advantages, but that skills are required to optimally utilize multiple perspectives.
| S-EPMC5263095 | biostudies-literature
Project description:ObjectivesExplore the function of three specific modes of talk (discourse types) in decision-making processes.DesignTen real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.SettingInterdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).ParticipantsAll emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.ResultsThe three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions.ConclusionA discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.
| S-EPMC6231597 | biostudies-literature
Project description:Objectives:The aim of this study is to evaluate a simulation-based team performance course for medical students and compare its low- and high-fidelity components. Study design:This is a prospective crossover observational study. Groups participated in one low- and one high-fidelity session twice. Low-fidelity scenarios included management of an emergency case on a simulated-patient, whereas high-fidelity scenarios constituted of multiple-trauma cases where simulated-patients wore a hyper-realistic suit. Team performance was assessed objectively, using the TEAM™ tool, and subjectively using questionnaires. Questionnaires were also used to assess presence levels, stress levels and evaluate the course. Results:Participants' team performance was higher in the low-fidelity intervention as assessed by the TEAM™ tool. An overall mean increase in self-assessed confidence towards non-technical skills attitudes was noted after the course, however there was no difference in self-assessed performance between the two interventions. Both reported mean stress and presence levels were higher for the high-fidelity module. Evaluation scores for all individual items of the questionnaire were ?4.60 in both NTS modules. Students have assessed the high-fidelity module higher (4.88 out of 5, SD = 0.29) compared to low-fidelity module (4.74 out of 5, SD = 0.67). Conclusions:Both the low- and high-fidelity interventions demonstrated an improvement in team performance of the attending medical students. The high-fidelity intervention was more realistic, yet more stressful. Furthermore, it proved to be superior in harvesting leadership, teamwork and task management skills. Both modules were evaluated highly by the students, however, future research should address retention of the taught skills and adaptability of such interventions.
| S-EPMC7292889 | biostudies-literature
Project description:ObjectiveThe current study examines the feasibility and potential effects of long distance, remote simulation training on team dynamics.DesignThe study design was a prospective study evaluating team dynamics before and after remote simulation.SubjectsStudy subjects consisted of interdisciplinary teams (attending physicians, physicians in training, advanced care practitioners, and/or nurses).SettingThe study was conducted at nine training sites in eight countries.InterventionsStudy subjects completed 2-3 simulation scenarios of acute crises before and after training with the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN).Measurements and main resultsPre- and post-CERTAIN training simulations were evaluated by two independent reviewers utilizing the Team Emergency Assessment Measure (TEAM), which is a 11-item questionnaire that has been validated for assessing teamwork in the intensive care unit. Any discrepancies of greater than 1 point between the two reviewers on any question on the TEAM assessment were sent to a third reviewer to judge. The score that was deemed discordant by the third judge was eliminated. Pre- and post-CERTAIN training TEAM scores were averaged and compared. Of the nine teams evaluated, six teams demonstrated an overall improvement in global team performance following CERTAIN virtual training. For each of the 11 TEAM assessments, a trend toward improvement following CERTAIN training was noted; however, no assessment had universal improvement. 'Team composure and control' had the least absolute score improvement following CERTAIN training. The greatest improvement in the TEAM assessment scores was in the 'team's ability to complete tasks in a timely manner' and in the 'team leader's communication to the team'.ConclusionThe assessment of team dynamics using long distance, virtual simulation training appears to be feasible and may result in improved team performance during simulated patient crises; however, language and video quality were the two largest barriers noted during the review process.
| S-EPMC6008595 | biostudies-literature
Project description:BackgroundThe rapid response system has been implemented in many hospitals worldwide and, reportedly, the timing of medical emergency team (MET) attendance in relation to the duration of hospitalization is associated with the mortality of MET patients. We evaluated the relationship between duration of hospitalization before MET activation and patient mortality. We compared cases of MET activation for early, intermediate, and late deterioration to patient characteristics, activation characteristics, and patient outcomes. We also aimed to determine the relationship, after adjusting for confounders, between the duration of hospitalization before MET activation and patient mortality.Materials and methodsWe retrospectively evaluated patients who triggered MET activation in general wards from March 2009 to February 2015 at the Asan Medical Center in Seoul. Patients were categorized as those with early deterioration (less than 2 days after admission), intermediate deterioration (2-7 days after admission), and late deterioration (more than 7 days after admission) and compared them to patient characteristics, activation characteristics, and patient outcomes.ResultsOverall, 7114 patients were included. Of these, 1793 (25.2%) showed early deterioration, 2113 (29.7%) showed intermediate deterioration, and 3208 (45.1%) showed late deterioration. Etiologies of MET activation were similar among these groups. The clinical outcomes significantly differed among the groups (intensive care unit transfer: 34.1%, 35.6%, and 40.4%; p < 0.001 and mortality: 26.3%, 31.5%, and 41.2%; p < 0.001 for early, intermediate, and late deterioration, respectively). Compared with early deterioration and adjusted for confounders, the odds ratio of mortality for late deterioration was 1.68 (1.46-1.93).ConclusionsNearly 50% of the acute clinically-deteriorating patients who activated the MET had been hospitalized for more than 7 days. Furthermore, they presented with higher rates of mortality and ICU transfer than patients admitted for less than 7 days before MET activation and had mortality as an independent risk factor.
| S-EPMC7894955 | biostudies-literature
Project description:IntroductionCancer screenings are key preventive services that patients receive in primary care. Health care professional students are generally taught about major society guidelines and U.S. Preventive Services Task Force recommendations for cancer screenings. Unfortunately, students and novice providers may view these influential recommendations as a rule book by which to provide care. Experienced providers recognize that not every patient fits neatly into clinical guidelines. Appropriate use of cancer screening entails an understanding of patient preferences, patient-specific health factors, and screening risks and associated pitfalls.MethodsThis 2-hour team-based learning (TBL) session immerses learners in three challenging patient scenarios that are designed to stimulate nuanced discussion of cancer screening using controversial cases. The scenarios encompass the following cases: (1) a 68-year-old man actively seeking prostate cancer screening, (2) a heavy smoker with psychiatric illness and alcoholism being considered for lung cancer screening, and (3) a 42-year-old woman seeking to become pregnant who inquires about breast cancer screening.ResultsThe materials were originally designed for fourth-year students on an ambulatory medicine rotation. Our students universally viewed this activity as a high-quality presentation applicable to their careers. They strongly agreed that the cases facilitated a deeper understanding of the nuances of cancer screening.DiscussionThis TBL encourages learners to critically appraise cancer screening guidelines and apply them to real-life examples. It is applicable for learners who understand the complexities of patient care but still suffer from a guidelines-are-rules mentality.
| S-EPMC6338177 | biostudies-literature
Project description:BackgroundHospitals are increasingly replacing pagers with clinical texting systems that allow users to use smartphones to send messages while maintaining compliance for privacy and security. As more institutions adopt such systems, the need to understand the impact of such transitions on team communication becomes ever more significant.MethodsWe conducted focus groups with hospitalists and individual interviews with nurses at one academic medical center in the Midwest. All interviews and focus groups were audiorecorded, transcribed, and deidentified for analysis. All transcripts and notes were independently read by two members of the research team and coded for themes.ResultsTwenty-one hospitalists and eight nurses participated in the study. Although study participants spoke favorably of texting, they identified more dissatisfactions with texting than benefits. There were disagreements regarding appropriate texting practices both within and between the hospitalists and nurses.ConclusionDespite the benefits of texting, there is room for improving team communication and understanding in the realm of clinical texting. A lack of shared understanding regarding when and how to use texting may require long-term solutions that address teamwork and appropriateness.
| S-EPMC8926456 | biostudies-literature
Project description:ObjectiveEmergency medical services (EMS) professionals infrequently transport children leading to difficulty in recognition and management of pediatric critical illness. Simulation provides an opportunity to train EMS professionals on pediatric emergencies. The objective of this study was to examine the effect of serial simulation training over 6 months on EMS psychomotor and cognitive performance during team-based care.MethodsThis was a longitudinal prospective study of a simulation curriculum enrolling EMS professionals over a 6-month period during which they performed three high-fidelity simulations at 3-month intervals. The simulation scenarios included a 15-month-old seizure (T0), 1-month-old with hypoglycemia (T1), and 4-year-old clonidine ingestion (T2). All scenarios were standardized and required recognition and management of respiratory failure and decompensated shock. Scenarios were videotaped and two investigators scored EMS team interventions during simulations using a standardized scoring tool. Inter-rater reliability was assessed on 30% of videos using kappa analysis. Volumes of administered intravenous fluid (IVF) and medications were measured to assess for errors in administration. The primary outcome was the change in scenario score from T0 to T2.ResultsA total of 135 team-based simulations were conducted over the study period (48, 40, and 47 at T0, T1, and T2, respectively). Inter-rater reliability between reviewers was very good (κ = 0.7). Median simulation score improved from T0 to T2 (24 vs 31, p < 0.001, maximum score possible = 42). The proportion of completed tasks increased across multiple categories including improved recognition of respiratory decompensation (19% vs. 56%), management of the pediatric airway (44% vs. 88%), and timeliness of vascular access (10% vs. 38%). Correct IVF administration varied by scenario (25% vs. 52% vs. 30%, p = 0.02).ConclusionSerial simulation improved EMS team-based care in both recognition and management of pediatric emergencies. A standardized pediatric simulation curriculum can be used to train EMS professionals on pediatric emergencies and improve performance.
| S-EPMC8166302 | biostudies-literature