1. TeamSTEPPS for Learners April 10, 2013

2. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 TeamSTEPPS TeamSTEPPS for Learners - Webinar Acknowledgements Project Sponsors Jim Battles, PhD (AHRQ) Heidi King, MS (DoD) Project Team Health Research & Educational Trust (HRET) Barb Edson (Project Director) Chris Hund (Project Manager) IMPAQ International David Baker (Team Lead)

3. T EAM STEPPS 05.2 Mod 1 05.2 Page 3 TeamSTEPPS TeamSTEPPS for Learners - Webinar TeamSTEPPS Master Training Two-day training course Train-the-trainer approach Prepares you to serve as a TeamSTEPPS Master Trainer by Providing instruction on TeamSTEPPS tools and strategies Providing an opportunity to develop and plan your TeamSTEPPS implementation Prepares you to serve as a leader for implementing TeamSTEPPS within your organization

4. T EAM STEPPS 05.2 Mod 1 05.2 Page 4 TeamSTEPPS TeamSTEPPS for Learners - Webinar TeamSTEPPS Portal http://www.teamsteppsportal.org/ Please register and create an account! TeamSTEPPS User Support Webinars Tools and resources for use Implementation stories Discussion forums Matchmaking

5. T EAM STEPPS 05.2 Mod 1 05.2 Page 5 TeamSTEPPS TeamSTEPPS for Learners - Webinar 7th Annual National Conference Will highlight :  Innovations in delivery of TeamSTEPPS  Program models from across the clinical spectrum  Sessions focused on liability/risk management  Specific, practical solutions  Networking opportunities Date: June 12 - 13, 2013 Location: The Fairmont Dallas, Dallas, TX Registration: Visit the portal and click on “National Conference” tab

6. T EAM STEPPS 05.2 Mod 1 05.2 Page 6 TeamSTEPPS TeamSTEPPS for Learners - Webinar Help Line (312) 422-2609 Or email: AHRQTeamSTEPPS@aha.orgAHRQTeamSTEPPS@aha.org

7. T EAM STEPPS 05.2 Mod 1 05.2 Page 7 TeamSTEPPS TeamSTEPPS for Learners - Webinar Rules of Engagement Written questions are encouraged throughout the presentation and will be answered during the Q&A session A Q&A session will be held at the end of the presentation The lines will open for call-in questions during the Q&A session

8. T EAM STEPPS 05.2 Mod 1 05.2 Page 8 TeamSTEPPS TeamSTEPPS for Learners - Webinar Today’s Webinar Presenter Karyn Baum, MD, MSEd Director of the Minnesota TeamSTEPPS Training Center Professor of Medicine Associate Chair, Clinical Improvement, Department of Medicine kbaum@umn.edu

9. T EAM STEPPS 05.2 Mod 1 05.2 Page 9 TeamSTEPPS TeamSTEPPS for Learners - Webinar Goals of this Webinar Describe the rationale for integrating team training into health professions education Review several best practices for team training in health professions education List several adjustments to TeamSTEPPS to be made when using the curriculum with learners Discuss challenges specific to teaching TeamSTEPPS in the interprofessional setting

10. T EAM STEPPS 05.2 Mod 1 05.2 Page 10 TeamSTEPPS TeamSTEPPS for Learners - Webinar Why Teach Teamwork to Pre- Licensure Students? It will be their reality Teamwork-the new paradigm for care delivery Time you worked entirely alone? Professionalism Benefits Patient/family Team Society

11. T EAM STEPPS 05.2 Mod 1 05.2 Page 11 TeamSTEPPS TeamSTEPPS for Learners - Webinar William James Mayo, MD --co-founder of Mayo Clinic “The sum total of medical knowledge is now so great and wide-spreading that it would be futile for one man to attempt to acquire, or for any one man to assume that he has, even a good working knowledge of any large part of the whole. The very necessities of the case are driving practitioners into cooperation. The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary.” June 15, 1910

12. T EAM STEPPS 05.2 Mod 1 05.2 Page 12 TeamSTEPPS TeamSTEPPS for Learners - Webinar “Once in practice, health professionals are asked to work in interdisciplinary teams…yet they are not educated together or trained in team-based skills” --IOM, Health Professions Education: A Bridge to Quality

13. T EAM STEPPS 05.2 Mod 1 05.2 Page 13 TeamSTEPPS TeamSTEPPS for Learners - Webinar GME Milestones Internal Medicine: 16 activities that constitute the core of the profession, including: Lead and work within interprofessional health care teams Facilitate the learning of patients, families, and members of the interdisciplinary team Enhance patient safety Improve the quality of health care at both the individual and systems level

14. T EAM STEPPS 05.2 Mod 1 05.2 Page 14 TeamSTEPPS TeamSTEPPS for Learners - Webinar QSEN Institute

15. T EAM STEPPS 05.2 Mod 1 05.2 Page 15 TeamSTEPPS TeamSTEPPS for Learners - Webinar IPEC Interprofessional Education Collaborative AACN, AACP, ADEA, AACOM, AAMC, and ASPH 4 domains: Values/ethics Roles/responsibilities Interprofessional communication Teams and teamwork

16. T EAM STEPPS 05.2 Mod 1 05.2 Page 16 TeamSTEPPS TeamSTEPPS for Learners - Webinar Example 1: IM Clinic The problems: Patient satisfaction was low Clinic was not functional Clinic director did not feel there was a culture of safety Intervention: Train the entire clinic in TeamSTEPPS 90-minute training session Didactic Heavily-edited TeamSTEPPS slides focusing on certain areas more than others

17. T EAM STEPPS 05.2 Mod 1 05.2 Page 17 TeamSTEPPS TeamSTEPPS for Learners - Webinar Outcomes and Lessons Learned Outcomes Knowledge of teamwork rose Culture improved Scheduling improved Lessons Dovetails nicely with Medical Home concept Include everyone (including learners) Shut down clinic Make it mandatory

18. T EAM STEPPS 05.2 Mod 1 05.2 Page 18 TeamSTEPPS TeamSTEPPS for Learners - Webinar Example 2: Pre-licensure students Medicine and Nursing Objectives Recognize the effect of medical error and the importance of communication and teamwork in preventing errors Recall teamwork and communication strategies Recognize team skills or restate Put into practice those team skills that they have encountered during the course in a simulated clinical environment

19. T EAM STEPPS 05.2 Mod 1 05.2 Page 19 TeamSTEPPS TeamSTEPPS for Learners - Webinar Details Half-day workshop Who All first year nursing students All third year medical students What Lecture, then small group sessions, then summary session TeamSTEPPS used to create curriculum

20. T EAM STEPPS 05.2 Mod 1 05.2 Page 20 TeamSTEPPS TeamSTEPPS for Learners - Webinar Details Lecture Background on quality and safety Effects of medical errors Specific TeamSTEPPS strategies Small groups Both MD and RN students (facilitators as well) “Ice breaker” Videos and case discussions using TeamSTEPPS

21. T EAM STEPPS 05.2 Mod 1 05.2 Page 21 TeamSTEPPS TeamSTEPPS for Learners - Webinar Simulation Self-selected their roles Part One: Resuscitate a trauma victim Part Two: Manage the same patient after a “sign out” Patient develops an MI Structured debrief Final lecture after simulation to review major concepts

22. T EAM STEPPS 05.2 Mod 1 05.2 Page 22 TeamSTEPPS TeamSTEPPS for Learners - Webinar Outcomes Approximately 50% response rate on surveys Knowledge Improved after (p<0.001) 12-item non-validated test Recognition of skills Able to identify skills on video Less able to identify “missed opportunities” Attitudes Nursing students’ attitudes increased No change for medical students High satisfaction, especially with simulation (96%)

23. T EAM STEPPS 05.2 Mod 1 05.2 Page 23 TeamSTEPPS TeamSTEPPS for Learners - Webinar Example 3: Clinical Students As part of their third/fourth year, students complete 5 “interdisciplinary” seminars from a menu of topics, one being Patient Safety using TeamSTEPPS 6 medicine, 6 nursing and 6 pharmacy students from local schools participated in each seminar which focuses on Patient Safety/TeamSTEPPS seminar Almost all students had completed some clinical/ward training

24. T EAM STEPPS 05.2 Mod 1 05.2 Page 24 TeamSTEPPS TeamSTEPPS for Learners - Webinar Results Significant improvement pre/post student attitude scores (p<.01) RN and Rx students: greater value on working with other healthcare professionals than MD students (p<.01) Rx students felt more strongly than MD students that shared learning with others would help (p<.05) Compared to RN’s, MD and Rx students more strongly viewed a nurse’s role as that of support for physicians (p<.01) MD students felt they had to acquire more knowledge than pharmacy and nursing students (p<.01) Overall rating = 4.69/5.00 Training with other healthcare professional students was the most valuable part of the seminar

25. T EAM STEPPS 05.2 Mod 1 05.2 Page 25 TeamSTEPPS TeamSTEPPS for Learners - Webinar REVIEW A Systematic Review of Teamwork Training Interventions in Medical Student and Resident Education Chakraborti, et al., J Gen Intern Med 23:846–53, 2008. Thirteen studies met inclusion criteria. All curricula employed active learning methods; the majority (77%) included multidisciplinary training. Conclusions: Appear to be modestly effective in the short term Curricula may be more effective when they address more of the teamwork principles

26. T EAM STEPPS 05.2 Mod 1 05.2 Page 26 TeamSTEPPS TeamSTEPPS for Learners - Webinar Common Ways to Teach TeamSTEPPS Pre-clinical Classroom Formal class Set-aside day or part of larger workshop With or without simulation Clinical years As part of larger implementation “Set aside” time within clinical rotation Simulation less commonly used, but only due to resources

27. T EAM STEPPS 05.2 Mod 1 05.2 Page 27 TeamSTEPPS TeamSTEPPS for Learners - Webinar Lessons for Adjusting for Learners Students (esp early) do not know each other’s roles Consider spending time on this issue They have assumptions Learners are adult learners They learn best in context They learn best when they think they need to know something They often want to be involved in planning educational experiences

28. T EAM STEPPS 05.2 Mod 1 05.2 Page 28 TeamSTEPPS TeamSTEPPS for Learners - Webinar Lessons Continued Know the clinical experience of your learners Slides need language adjustment Exercises need same Less is more A few skills and attitudes Consider the culture they will use this material within Culture eats strategy for lunch A good debrief is worth 1000 words

29. T EAM STEPPS 05.2 Mod 1 05.2 Page 29 TeamSTEPPS TeamSTEPPS for Learners - Webinar Interprofessional Challenges/Answers Cultural We don’t know/trust/value each other! Different languages History When is the right time to learn together? We do not reward this work well Logistical Schedules (hardest part) Space May not have professions in one school

30. T EAM STEPPS 05.2 Mod 1 05.2 Page 30 TeamSTEPPS TeamSTEPPS for Learners - Webinar More Challenges Political Regulatory Local Accreditations—these are not only going way, but forcing issue Resources: People and things Stems from leaderships’ commitment to this work

31. T EAM STEPPS 05.2 Mod 1 05.2 Page 31 TeamSTEPPS TeamSTEPPS for Learners - Webinar Conclusions Future healthcare professionals will practice in world where teamwork is expected Many ways to teach team skills, including TeamSTEPPS Increasing evidence base Interprofessional settings TeamSTEPPS material requires some basic adaptation for use with learners

32. T EAM STEPPS 05.2 Mod 1 05.2 Page 32 TeamSTEPPS TeamSTEPPS for Learners - Webinar More Information on Education Mayer CM et al. “Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units.” Joint Comm J on Qual and Safety 2011; 37(8):365. Stead K, Kumar S, et al. “Teams communicating through STEPPS” Med J of Australia 2009; 190(11): 128. Capella J, Smith S, et al. “Teamwork training improves the clinical care of trauma patients.” J Surgical Education 2010; 67(6): 439-43. SJ Weaver et al, The anatomy of healthcare team training. Acad Med 2010;85: 1746-60. McCulloch P, Rathbone J, and Catchpole K. Interventions to improve teamwork and communication among healthcare staff. Brit J of Surgery 2011;98: 469-79. Chakraborti C, Boonyasai R, Wright SM, Kern D. A systematic review of teamwork training interventions in medical student and resident education. JGIM 2008;23(6): 846-53.

33. T EAM STEPPS 05.2 Mod 1 05.2 Page 33 TeamSTEPPS TeamSTEPPS for Learners - Webinar Questions and Answers

34. T EAM STEPPS 05.2 Mod 1 05.2 Page 34 TeamSTEPPS TeamSTEPPS for Learners - Webinar Interprofessional Education at the 2013 National Conference At the 2013 National Conference in Dallas, Texas we will have a variety of IPE related sessions during the course of the two day conference.

35. T EAM STEPPS 05.2 Mod 1 05.2 Page 35 TeamSTEPPS TeamSTEPPS for Learners - Webinar Discussion Forum Have you implemented team training in health professions education? If so, what are some best practices that you have found to be successful? What is the biggest challenge you face/have faced specific to teaching TeamSTEPPS to learners ? What are some of your “lessons learned” from teaching TeamSTEPPS and the importance of teamwork to an interprofessional class of students? What outcomes or benefits of interprofessional education have you experienced or observed at your institution? http://teamsteppsportal.org/forum

36. T EAM STEPPS 05.2 Mod 1 05.2 Page 36 TeamSTEPPS TeamSTEPPS for Learners - Webinar Thank You! For more information, please contact our team at: AHRQTeamSTEPPS@aha.org