Definition, Measurement, Precursors, and Outcomes of Trust Within Health Care Teams: A Scoping Review.

PURPOSE: This scoping review aims to map the breadth of the literature examining how trust is defined in health care teams, describe what measurements of trust are used, and investigate the precursors and outcomes of trust. METHOD: Five electronic databases (Ovid MEDLINE, CINAHL, PsycInfo, Embase, and ASSIA [Applied Social Sciences Index and Abstracts]) were searched alongside sources of gray literature in February 2021. To be included, studies needed to discuss a health care team directly involved in managing patient care and one aspect of trust as a relational concept. A content count of the definitions of trust and tools used to measure trust and a deductive thematic analysis of the precursors and outcomes of trust in health care teams were conducted. RESULTS: Ultimately, 157 studies were included after full-text review. Trust was the main focus of 18 (11%) studies and was not routinely defined (38, 24%). Ability appeared to be key to the definition. Trust was measured in 34 (22%) studies, often using a bespoke measure (8/34, 24%). The precursors of trust within health care teams occur at the individual, team, and organizational levels. The outcomes of trust occur at the individual, team, and patient levels. Communication was a broad overarching theme that was present at all levels, both as a precursor and outcome of trust. Respect, as a precursor, influenced trust at the individual, team, and organizational levels, while trust influenced learning, an outcome, across the patient, individual, and team levels. CONCLUSIONS: Trust is a complex, multilevel construct. This scoping review has highlighted gaps in the literature, including exploration of the swift trust model, which may be applicable to health care teams. Furthermore, knowledge from this review may be integrated into future training and health care practices to optimize team processes and teamworking.

Twelve tips for using tactical decision games to teach non-technical skills.

Tactical decision games (TDGs) have been used in healthcare and other safety-critical industries to develop non-technical skills training (NTS). TDGs have been shown to be a realistic, feasible, and useful way of teaching NTS such as decision making, task prioritisation, situational awareness, and team working. Our 12-tips for using TDG to teach NTS are based on our experience of integrating them into an undergraduate medical and nursing programme. We cover how to design successful TDGs, how to facilitate and debrief them and how to integrate TDGs into curricula. We have found TDGs to be a cost-effective, low fidelity, and useful method of delivering NTS teaching, ideally as an adjunct to immersive simulation. Learners find them a useful way to be introduced to NTS in a safe and relaxed environment, with particular emphasis on critical decision making and prioritisation.

Exploring the feasibility and acceptability of using tactical decision games to develop final year medical students' non-technical skills.

INTRODUCTION: Clinical decision-making, situation awareness, task management, and teamwork are key non-technical skills (NTS) required by junior doctors. Tactical decision games (TDGs) are low-fidelity classroom-based activities designed to develop proficiency in NTS. This study aimed to explore the feasibility and acceptability of using TDGs as a novel teaching method for final year medical students. METHODS: Final year medical students at the University of Edinburgh participated in a single TDG session. Focus groups were then used to explore students' perceptions of participating in the TDG session and transcribed data from the focus groups was thematically analyzed. RESULTS: Six key themes emerged from the data: "the value of non-medical games"; "giving and receiving feedback"; "observing and reflecting"; "recognizing and understanding NTS"; "dealing with uncertainty and ambiguity", and "introducing TDGs into the curriculum". CONCLUSIONS: TDGs are an easy-to-use, low-fidelity method of teaching medical students about the importance of NTS. Medical students view TDGs as a valuable learning activity that appears to increase awareness and understanding of the importance of NTS.

The distracted intravenous access (DIVA) test.

BACKGROUND: The General Medical Council states that all medical graduates must be able to carry out practical procedures, including peripheral venous cannulation, safely and effectively. Teaching and assessments within primary medical training tend to focus on safety rather than 'effectiveness' or technical competence. This study aimed to develop and evaluate a test of automaticity of peripheral venous cannulation skill, appropriate to the level of a medical student. METHODS: Two researchers developed the distracted intravenous access (DIVA) test. Three components are assessed simultaneously: ability to cannulate a plastic arm manikin, performance in an arithmetic test and speed of completion. Volunteers were recruited from three groups: novices (fourth-year medical students), intermediates (foundation year-1 doctors) and experts (anaesthetic and emergency medicine consultants and trainees). Immediately following the test, volunteers completed a questionnaire. RESULTS: Mean scores differed between the three groups: novices (47.7%), intermediates (73.4%), experts (84.4%). Differences were statistically significant (p < 0.0005). The majority of participants found the test to be enjoyable (78%) and useful (76%). More students agreed that the test was fair (78%) than doctors (38%), but this difference was not statistically significant. DISCUSSION: This study presents a feasible method of testing medical students' automaticity when performing peripheral venous cannulation. It has provided evidence of the construct validity and acceptability of the test. The authors suggest that clinical tutors consider offering the test as a formative assessment to final-year medical students in order to familiarise them with the level of proficiency required to perform peripheral venous cannulation when distracted.