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Team deliberate practice in medicine and related domains: a consideration of the issues

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Abstract

A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing individual expert performance in medicine and other domains. Highlighting these issues will inform the development of training for medical teams. The authors first describe team coordination and its critical role in medical teams. Presented next are the cognitive mechanisms that allow expert performers to accurately interpret the current situation via the creation of an accurate mental “model” of the current situation, known as a situation model. Following this, the authors propose that effective team performance depends at least in part on team members having similar models of the situation, known as a shared situation model. The authors then propose guiding principles for implementing team deliberate practice in medicine and describe how team deliberate practice can be used in an attempt to reduce barriers inherent in medical teams to the development of shared situation models. The paper concludes with considerations of limitations, and future research directions, concerning the implementation of team deliberate practice within medicine.

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Notes

  1. A reviewer suggested considering how the concept of situation awareness might augment our proposed model (e.g., see Crozier et al. 2015). While the situation awareness and situational model concepts have arisen within different literatures, their nature is quite comparable and so it is inappropriate to consider both concepts within the model proposed.

  2. A reviewer remarked that pathway “a” may rely too much on luck in healthcare training and pathway “b” should be prioritized during training; that is, that healthcare learners should be as explicit as possible whenever there is doubt concerning the situation model. We agree with this point but also recognize the value of training pathway “a” because, even if training pathway “b” is prioritized, the use of pathway “a” to establishing a shared situation model by teams is inevitable during performance.

References

  • Awad, S. S., Fagan, S. P., Bellows, C., Albo, D., Green-Rashad, B., De La Garza, M., & Berger, D. H. (2005). Bridging the communication gap in the operating room with medical team training. The American Journal of Surgery, 190(5), 770–774.

    Article  Google Scholar 

  • Burtscher, M. J., Wacker, J., Grote, G., & Manser, T. (2010). Managing nonroutine events in anesthesia: The role of adaptive coordination. Human Factors: The Journal of the Human Factors and Ergonomics Society, 52(2), 282–294.

    Article  Google Scholar 

  • Cades, D. M., Boehm-Davis, D. A., Trafton, J. G., & Monk, C. A. (2011). Mitigating disruptive effects of interruptions through training: What needs to be practiced? Journal of Experimental Psychology: Applied, 17(2), 97–109.

    Google Scholar 

  • Campitelli, G., & Gobet, F. (2011). Deliberate practice necessary but not sufficient. Current Directions in Psychological Science, 20, 280–285.

    Article  Google Scholar 

  • Carlson, J., Min, E., & Bridges, D. (2009). The impact of leadership and team behavior on standard of care delivered during human patient simulation: A pilot study for undergraduate medical students. Teaching and Learning in Medicine, 21(1), 24–32.

    Article  Google Scholar 

  • Chisholm, C. D., Dornfeld, A. M., Nelson, D. R., & Cordell, W. H. (2001). Work interrupted: A comparison of workplace interruptions in emergency departments and primary care offices. Annals of Emergency Medicine, 38(2), 146–151.

    Article  Google Scholar 

  • Cohen, E. R., Barsuk, J. H., Moazed, F., Caprio, T., Didwania, A., McGaghie, W. C., & Wayne, D. B. (2013). Making July safer: Simulation-based mastery learning during intern boot camp. Academic Medicine, 88(2), 233–239.

    Article  Google Scholar 

  • Crozier, M. S., Ting, H. Y., Boone, D. C., O’Regan, N. B., Bandrauk, N., Furey, A., & Hogan, M. P. (2015). Use of human patient simulation and validation of the team situation awareness global assessment technique (TSAGAT): A multidisciplinary team assessment tool in trauma education. Journal of Surgical Education, 72(1), 156–163.

    Article  Google Scholar 

  • Eccles, D. (2010). The coordination of labour in sports teams. International Review of Sport and Exercise Psychology, 3(2), 154–170.

    Article  Google Scholar 

  • Eccles, D. W., & Groth, P. T. (2007). Wolves, bees, and football: Enhancing coordination in sociotechnological problem solving systems through the study of human and animal groups. Computers in Human Behavior, 23(6), 2778–2790.

    Article  Google Scholar 

  • Eccles, D. W., & Tenenbaum, G. (2004). Why an expert team is more than a team of experts: A social-cognitive conceptualization of team coordination and communication in sport. Journal of Sport and Exercise Psychology, 26(4), 542–560.

    Article  Google Scholar 

  • Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10), S70–S81.

    Article  Google Scholar 

  • Ericsson, K. A., & Kintsch, W. (1995). Long-term working memory. Psychological Review, 102(2), 211–245.

    Article  Google Scholar 

  • Ericsson, K. A., Krampe, R Th, & Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363–406.

    Article  Google Scholar 

  • Fiore, S. M., & Salas, E. (2004). Why we need team cognition. In E. Salas & S. M. Fiore (Eds.), Team cognition: Understanding the factors that drive process and performance (pp. 235–248). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Foushee, H. C. (1984). Dyads and triads at 35,000 feet: Factors affecting group process and aircrew performance. American Psychologist, 39(8), 885.

    Article  Google Scholar 

  • Gorman, J. C., & Cooke, N. J. (2011). Changes in team cognition after a retention interval: The benefits of mixing it up. Journal of Experimental Psychology: Applied, 17(4), 303.

    Google Scholar 

  • Green, D. M., & Swets, J. A. (1966). Signal detection theory and psychophysics. New York: Wiley.

    Google Scholar 

  • Greenberg, C. S., Regenbogen, S. E., Studdert, D. M., Lipsitz, S. R., Rogers, S. O., Zinner, M. J., & Gawande, A. A. (2007). Patterns of communication breakdowns resulting in injury to surgical patients. Journal of the American College of Surgeons, 204(4), 533–540.

    Article  Google Scholar 

  • Hambrick, D. Z., Oswald, F. L., Altmann, E. M., Meinz, E. J., Gobet, F., & Campitelli, G. (2014). Deliberate practice: Is that all it takes to become an expert? Intelligence, 45, 34–45.

    Article  Google Scholar 

  • Harris, K. R., Eccles, D. W., Ward, P., & Whyte, J. (2013). A theoretical framework for simulation in nursing: Answering Schiavento’s call. Journal of Nursing Education, 52(1), 6–16.

    Article  Google Scholar 

  • Harvey, A., Nathens, A. B., Bandiera, G., & Leblanc, V. R. (2010). Threat and challenge: Cognitive appraisal and stress responses in simulated trauma resuscitations. Medical Education, 44(6), 587–594.

    Article  Google Scholar 

  • Hayes, C. W., Rhee, A., Detsky, M. E., Leblanc, V. R., & Wax, R. S. (2007). Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: A survey of internal medicine residents. Critical Care Medicine, 35(7), 1668–1672.

    Article  Google Scholar 

  • Issenberg, S. B., Gordon, M. S., Gordon, D. L., Felner, J. M., Petrusa, E. R., & McGaghie, W. C. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher, 27(1), 10–28.

    Article  Google Scholar 

  • Kassab, E. S., King, D., Hull, L. M., Arora, S., Sevdalis, N., Kneebone, R. L., & Nestel, D. (2010). Actor training for surgical team simulations. Medical Teacher, 32(3), 256–258.

    Article  Google Scholar 

  • Katz, J. D. (2007). Conflict and its resolution in the operating room. Journal of Clinical Anesthesia, 19(2), 152–158.

    Article  Google Scholar 

  • Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To err is human: Building a safer health system. Institute of Medicine Reports. Washington, DC: National Academy Press.

  • Kulasegaram, K. M., Grierson, L. E., & Norman, G. R. (2013). The roles of deliberate practice and innate ability in developing expertise: Evidence and implications. Medical Education, 47, 979–989.

    Article  Google Scholar 

  • LeBlanc, V. R. (2009). The effects of acute stress in performance: Implications for health professions education. Academic Medicine, 84(10), S25–S33.

    Article  Google Scholar 

  • Lee, A. (2006). Learning and transfer in two web-based and distance applications. In H. F. O’Neil & R. S. Perez (Eds.), Web-based learning: Theory, research, and practice (pp. 221–228). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Lingard, L., Reznick, R., DeVito, I., & Espin, S. (2002). Forming professional identities on the health care team: Discursive constructions of the ‘other’ in the operating room. Medical Education, 36(85), 728–734.

    Article  Google Scholar 

  • Makary, M. A., Sexton, J. B., Freischlag, J. A., Holzmueller, C. G., Millman, E. A., Rowen, L., & Pronovost, P. J. (2006). Operating room teamwork among physicians and nurses: Teamwork in the eye of the beholder. Journal of the American College of Surgeons, 202(5), 746–752.

    Article  Google Scholar 

  • Mannion, R., & Thompson, C. (2014). Systematic biases in group decision-making: Implications for patient safety. International Journal for Quality in Health Care, 26(6), 606–612.

    Article  Google Scholar 

  • Marteau, T. M., Wynne, G., Kaye, W., & Evans, T. R. (1990). Resuscitation: Experience without feedback increases confidence but not skill. British Medical Journal, 300(6728), 849–850.

    Article  Google Scholar 

  • Massiello, I. (2011). Why simulation-based team training has not been used effectively and what can be done about it. Advances in Health Sciences Education, 17(2), 10–28.

    Google Scholar 

  • Mazzocco, K., Petitti, D. B., Fong, K. T., Bonacum, D., Brookey, J., Graham, S., et al. (2009). Surgical team behaviors and patient outcomes. The American Journal of Surgery, 197(5), 678–685.

    Article  Google Scholar 

  • McDonald, R., Waring, J., Harrison, S., Walshe, K., & Boaden, R. (2005). Rules and guidelines in clinical practice: A qualitative study in operating theatres of doctors’ and nurses’ views. Quality and Safety in Health Care, 14, 290–294.

    Article  Google Scholar 

  • McGaghie, W. C., Issenberg, S. B., Cohen, M. E. R., Barsuk, J. H., & Wayne, D. B. (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic Medicine, 86(6), 706.

    Article  Google Scholar 

  • Nestel, D. F., Black, S. A., Kneebone, R. L., Wetzel, C. M., Thomas, P., Wolfe, J. H., & Darzi, A. W. (2008). Simulated anaesthetists in high fidelity simulations for surgical training: Feasibility of a training programme for actors. Medical Teacher, 30(4), 407–413.

    Article  Google Scholar 

  • Paige, J. T. (2010). Surgical team training: Promoting high reliability with nontechnical skills. Surgical Clinics of North America, 90(3), 569–581.

    Article  Google Scholar 

  • Paige, J. T., Kozmenko, V., Yang, T., Gururaja, R. P., Hilton, C. W., Cohn, I., & Chauvin, S. W. (2009). High-fidelity, simulation-based, interdisciplinary operating room team training at the point of care. Surgery, 145(2), 138–146.

    Article  Google Scholar 

  • Shapiro, M. J., Gardner, R., Godwin, S. A., Jay, G. D., Lindquist, D. G., Salibury, M. L., & Salas, E. (2008). Defining team performance for simulation-based training: Methodology, metrics, and opportunities for emergency medicine. Academic Emergency Medicine, 15(11), 1088–1097.

    Article  Google Scholar 

  • Stahl, K., Palileo, A., Schulman, C. I., Wilson, K., Augenstein, J., Kiffin, C., & McKenney, M. (2009). Enhancing patient safety in the trauma/surgical intensive care unit. Journal of Trauma and Acute Care Surgery, 67(3), 430–435.

    Article  Google Scholar 

  • Ten Eyck, R. P., Tews, M., Ballester, J. M., & Hamilton, G. C. (2010). Improved fourth-year medical student clinical decision-making performance as a resuscitation team leader after a simulation-based curriculum. Simulation in Healthcare, 5(3), 139–145.

    Article  Google Scholar 

  • Thomas, E. J., Sexton, B. J., & Helmreich, R. L. (2003). Discrepant attitudes about teamwork among critical care nurses and physicians. Critical Care Medicine, 31, 956–959.

    Article  Google Scholar 

  • Tsuda, S., Scott, D., Doyle, J., & Jones, D. B. (2009). Surgical skills training and simulation. Current Problems in Surgery, 46(4), 271–370.

    Article  Google Scholar 

  • Undre, S., Koutantji, M., Sevdalis, N., Gautama, S., Selvapatt, N., Williams, S., et al. (2007). Multidisciplinary crisis simulations: The way forward for training surgical teams. World Journal of Surgery, 31(9), 1843–1853.

    Article  Google Scholar 

  • Undre, S., Sevdalis, N., Healey, A. N., Darzi, S. A., & Vincent, C. A. (2006). Teamwork in the operating theatre: Cohesion or confusion? Journal of Evaluation in Clinical Practice, 12(2), 182–189.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Psychological Science and Counseling, Austin Peay State University, 4537, Clarksville, TN, 37044-4594, USA

    Kevin R. Harris

  2. School of Applied Social Sciences, Durham University, Durham, DH1 3HN, UK

    David W. Eccles

  3. Vanderbilt University School of Medicine, Nashville, TN, 37232, USA

    John H. Shatzer

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  1. Kevin R. Harris
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  2. David W. Eccles
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Correspondence to Kevin R. Harris.

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Harris, K.R., Eccles, D.W. & Shatzer, J.H. Team deliberate practice in medicine and related domains: a consideration of the issues. Adv in Health Sci Educ 22, 209–220 (2017). https://doi.org/10.1007/s10459-016-9696-3

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