A Taxonomy of Delivery and Documentation Deviations During Delivery of High-Fidelity Simulations.

INTRODUCTION: We developed a taxonomy of simulation delivery and documentation deviations noted during a multicenter, high-fidelity simulation trial that was conducted to assess practicing physicians' performance. Eight simulation centers sought to implement standardized scenarios over 2 years. Rules, guidelines, and detailed scenario scripts were established to facilitate reproducible scenario delivery; however, pilot trials revealed deviations from those rubrics. A taxonomy with hierarchically arranged terms that define a lack of standardization of simulation scenario delivery was then created to aid educators and researchers in assessing and describing their ability to reproducibly conduct simulations. METHODS: Thirty-six types of delivery or documentation deviations were identified from the scenario scripts and study rules. Using a Delphi technique and open card sorting, simulation experts formulated a taxonomy of high-fidelity simulation execution and documentation deviations. The taxonomy was iteratively refined and then tested by 2 investigators not involved with its development. RESULTS: The taxonomy has 2 main classes, simulation center deviation and participant deviation, which are further subdivided into as many as 6 subclasses. Inter-rater classification agreement using the taxonomy was 74% or greater for each of the 7 levels of its hierarchy. Cohen kappa calculations confirmed substantial agreement beyond that expected by chance. All deviations were classified within the taxonomy. CONCLUSIONS: This is a useful taxonomy that standardizes terms for simulation delivery and documentation deviations, facilitates quality assurance in scenario delivery, and enables quantification of the impact of deviations upon simulation-based performance assessment.

Adapting Simulation Curricula to the Future Needs of Anesthesiology.

We have discussed some examples of the types of program development strategies that are in common use and have presented examples of the type of performance gaps that can occur when a coordinated curriculum development process is not applied (or is applied in an uncoordinated fashion). We have outlined one method to develop a simulation-based curriculum focusing more on ways to identify how to "simulate what is needed" rather than using the "simulate what we know" style. We believe that curricula must be designed to continually evolve rather being conceived as a single finished program. We have attempted to illustrate what a designed simulation curriculum for training anesthesiology residents and faculty in the PSH might look like, and we have provided a sample scenario to illustrate how this process could be presented (Supplemental Digital Content 2, http://links.lww.com/AIA/A23, Supplemental Digital Content 3, http://links.lww.com/AIA/A24). Our hope is that this model may be applied to create simulation education curricula in a wide variety of areas. We suggest that it be a part of any attempt to create a standardized, longitudinal simulation-based assessment for residents or practitioners. A cohesive, strategic approach to simulation curriculum design and implementation will be required as we seek to create the same type of effective safety training in medicine that has been present in other high-risk professions.

Physician communication in the operating room.

In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education.

Improved climate, culture, and communication through multidisciplinary training and instruction.

OBJECTIVE: The objective of the study was to determine the effectiveness of multidisciplinary team training on organizational culture and team communication. STUDY DESIGN: The training included a 6-step protocol: (1) a pretest survey assessing cultural attitudes and perceptions, (2) a baseline high-fidelity simulation session, (3) invitational medical rhetoric instruction, (4) a second high-fidelity simulation session, (5) a posttest survey assessing changed cultural attitudes and perceptions, and (6) a debriefing with participants. Teams of 4 physicians trained together: 2 obstetricians and 2 anesthesiologists. Forty-four physicians completed the training protocol during 2010 and 2011. RESULTS: Paired-sample t tests demonstrated significant decreases in autonomous cultural attitudes and perceptions (t = 8.23, P < .001) and significant increases in teamwork cultural attitudes and perceptions (t = -4.05, P < .001). Paired-sample t tests also demonstrated significant increases in communication climate that invited participation and integrated information from both medical services (t = -5.80, P < .001). CONCLUSION: The multidisciplinary team training program specified in this report resulted in increased teamwork among obstetricians and anesthesiologists.