Situation, Background, Assessment, Recommendation (SBAR) Education for Health Care Students: Assessment of a Training Program.

Introduction: Interprofessional communication failures are estimated to be a factor in two-thirds of serious health care-related accidents. Using a standardized communication protocol during transfer of patient information between providers improves patient safety. An interprofessional education (IPE) event for first-year health professions students was designed using the Situation, Background, Assessment, Recommendation (SBAR) tool as a structured communication framework. IPE literature, including a valid measurement tool specifically tailored for SBAR, was utilized to design the Interprofessional Team Training Day (ITTD) and evaluate learner gains in SBAR skills. Methods: Learners from six educational programs participated in ITTD, which consisted of didactics, small-group discussion, and role-play using the SBAR protocol. Individual learners were assessed using the SBAR Brief Assessment Rubric for Learner Assessment (SBAR-LA) on SBAR communication skills before and after the ITTD event. Learners received a written clinical vignette and submitted video recordings of themselves simulating the use of SBAR to communicate to another health care professional. Pre- and postrecordings were scored using the SBAR-LA rubric. Normalized gain scores were calculated to estimate the improvement attributable to ITTD. Results: SBAR-LA scores increased for 60% of participants. For skills not demonstrated before the event, the average learner acquired 44% of those skills from ITTD. Learners demonstrated statistically significant increases for five of 10 SBAR-LA skills. Discussion: The value to patient safety of utilizing structured communication between health care providers is proven; however, evaluating IPE teaching of communication skills effectiveness is challenging. Using SBAR-LA, communication skills were shown to improve following ITTD.

SBAR-LA: SBAR Brief Assessment Rubric for Learner Assessment.

Introduction: Structured communication tools are associated with improvement in information transfer and lead to improved patient safety. Situation, Background, Assessment, Recommendation (SBAR) is one such tool. Because there is a paucity of instruments to measure SBAR effectiveness, we developed and validated an assessment tool for use with prepractice health professions students. Methods: We developed the SBAR Brief Assessment Rubric for Learner Assessment (SBAR-LA) by starting with a preliminary list of items based on the SBAR framework. During an interprofessional team training event, students were trained in the use of SBAR. Subsequently, they were assigned to perform a simulated communication scenario demonstrating use of SBAR principles. We used 10 videos from these scenarios to refine the items and scales over two rounds. Finally, we applied the instrument on another subset of 10 students to conduct rater calibration and measure interrater reliability. Results: We used a total of 20 out of 225 videos of student performance to create the 10-item instrument. Interrater reliability was .672, and for eight items, the Fleiss' kappa was considered good or fair. Discussion: We developed a scoring rubric for teaching SBAR communication that met criteria for validity and demonstrated adequate interrater reliability. Our development process provided evidence of validity for the content, construct, and response process used. Additional evidence from the use of SBAR-LA in settings where communication skills can be directly observed, such as simulation and clinical environments, may further enhance the instrument's accuracy. The SBAR-LA is a valid and reliable instrument to assess student performance.

"Disbelief and Sadness": First-Year Health Profession Students' Perspectives on Medical Errors.

OBJECTIVES: The aims of the study were to examine the reactions of first-year health profession students to medical errors and determine whether differences exist between disciplines. METHODS: After viewing the Team STEPPS Program's Susan Sheridan video that describes two separate medical errors, students from anesthesia assistant, medical imaging, medicine, nursing, physical therapy, and physician assistant programs provided unstructured open responses reflecting on initial impressions of medical errors depicted in the film. Student responses were assessed via inductive coding techniques and thematic analysis and stratified by discipline. Frequencies of key themes were calculated. Descriptive analyses characterized respondents and χ2 tests compared responses between disciplines. RESULTS: In a review of 373 student responses (80% response rate), 255 students expressed an emotion-based reply, of which 93.75 were negative with such comments as they felt horrified, appalled, and disappointed by the patient's experience. Of the 227 students who commented on blame or fault, 70% felt that a system error was at fault, 45% felt that it was the provider and only 1.3% stated that it was the patient's fault. Of the students who mentioned the context or situation, just more than half felt that the episode was preventable and there was a causal relationship between clinic workers' actions and the medical error. Finally, a high percentage of students had a solutions-oriented response, noting the importance of teamwork and communication in the avoidance of medical errors. CONCLUSIONS: First-year health profession students responded to medical error with strong emotion and distress. Their responses largely represent an individualistic view of healthcare in both the causes and solutions to medical errors. No differences in response themes were observed by discipline. This study represents our students' emotional responses to a medical error scenario. The qualitative responses and reactions of students to the Sheridan video offered opportunities to tease out nuances that would otherwise be unavailable in a typical attitudes survey. We noted a individualistic view of healthcare in both the causes and solutions to medical errors. We view these results as an opportunity for interprofessional education in systems-level approaches to improve patient safety. Curricular efforts in interprofessional education, collaborative practice, and patient safety should be driven by these results.

Interprofessional simulation training's impact on process and outcome team efficacy beliefs over time.

Introduction: Recent findings suggest that process and outcome-based efficacy beliefs are factorially distinct with differential effects for team performance. This study extends this work by examining process and outcome efficacy (TPE, TOE) of interprofessional (IP) care teams over time. Methods: A within-team, repeated measures design with survey methodology was implemented in a sample of prelicensure IP care teams performing over three consecutive clinical simulation scenarios. TPE and TOE were assessed before and after each performance episode. Results: Initial baseline results replicated the discriminant validity for TPE and TOE separate factors. Further findings from multilevel modelling indicated significant time effects for TPE convergence, but not TOE convergence. However, a cross-level interaction effect of 'TOE(Start-Mean)×Time' strengthened TOE convergence over time. A final follow-up analysis of team agreement's substantive impact was conducted using independent faculty-observer ratings of teams' final simulation. Conclusion: Independent sample t-tests of high/low-agreement teams indicated support for agreement's substantive impact, such that high-agreement teams were rated as significantly better performers than low-agreement teams during the final simulation training. We discuss the substantive merit of methodological within-team agreement as an indicator of team functionality within IP and greater healthcare-simulation trainings at-large.

Teaching the teachers: faculty development in inter-professional education.

AIMS: The purpose of this study is to evaluate changes in self-concept for the knowledge, skills and attitudes toward inter-professional teamwork of facilitators who participated in training and an inter-professional team training event. BACKGROUND: Inter-professional education requires dedicated and educated faculty. METHODS: A pretest posttest quasi-experimental design was used for the evaluation. Fifty-three facilitators were asked to complete pre-post questionnaires to measure inter-professional team self-concept (IPTSC), assessing self-concept for the knowledge, skills, and attitudes required for performing in an inter-professional team. RESULTS: Post-session scores on inter-professional team knowledge, skills and attitudes were significantly higher (F(1, 31) = 5.59, p = .02). CONCLUSION: A facilitator development course and participation in the teaching event had a positive impact on perceived knowledge, skills and attitudes toward inter-professional teamwork.