ORCID Profile
0000-0001-9103-2507
Current Organisations
Gold Coast University Hospital
,
University of Queensland
,
Bond University
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Publisher: Wiley
Date: 30-07-2023
DOI: 10.1002/AET2.10897
Abstract: Residents in emergency medicine have reported dissatisfaction with feedback. One strategy to improve feedback is to enhance learners’ feedback literacy—i.e., capabilities as seekers, processors, and users of performance information. To do this, however, the context in which feedback occurs needs to be understood. We investigated how residents typically engage with feedback in an emergency department, along with the potential opportunities to improve feedback engagement in this context. We used this information to develop a program to improve learners’ feedback literacy in context and traced the reported translation to practice. We conducted a year‐long design‐based research study informed by agentic feedback principles. Over five cycles in 2019, we interviewed residents and iteratively developed a feedback literacy program. Sixty‐six residents participated and data collected included qualitative evaluation surveys ( n = 55), educator‐written reflections ( n = 5), and semistructured interviews with residents ( n = 21). Qualitative data were analyzed using framework analysis. When adopting an agentic stance, residents reported changes to the frequency and tenor of their feedback conversations, rendering the interactions more helpful. Despite reporting overall shifts in their conceptions of feedback, they needed to adjust their feedback engagement depending on changing contextual factors such as workload. These microsocial adjustments suggest their feedback literacy develops through an interdependent process of in idual intention for feedback engagement—informed by an agentic stance—and dynamic adjustment in response to the environment. Resident feedback literacy is profoundly contextualized, so developing feedback literacy in emergency contexts is more nuanced than previously reported. While feedback literacy can be supported through targeted education, our findings raise questions for understanding how emergency medicine environments afford and constrain learner feedback engagement. Our findings also challenge the extent to which this contextual feedback know‐how can be “developed” purposefully outside of the everyday work.
Publisher: Wiley
Date: 30-03-2023
DOI: 10.1002/AET2.10852
Abstract: Emergency department (ED) teams frequently perform under conditions of high stress. Stress exposure simulation (SES) is specifically designed to train recognition and management of stress responses under these conditions. Current approaches to design and delivery of SES in emergency medicine are based on principles derived from other contexts and from anecdotal experience. However, the optimal design and delivery of SES in emergency medicine are not known. We aimed to explore participant experience to inform our approach. We performed an exploratory study in our Australian ED with doctors and nurses participating in SES sessions. We used a three‐part framework—sources of stress, the impacts of that stress, and the strategies to mitigate—to inform our SES design and delivery and to guide our exploration of participant experience. Data were collected through a narrative survey and participant interviews and analyzed thematically. There were 23 total participants (doctors n = 12, nurses n = 11) across the three sessions. Sixteen survey responses and eight interview transcripts were analyzed, each with equal numbers of doctors and nurses. Five themes were identified in data analysis: (1) experience of stress, (2) managing stress, (3) design and delivery of SES, (4) learning conversations, and (5) transfer to practice. We suggest that design and delivery of SES should follow health care simulation best practice, with stress adequately induced by authentic clinical scenarios and to avoid trickery or adding extraneous cognitive load. Facilitators leading learning conversations in SES sessions should develop a deep understanding of stress and emotional activation and focus on team‐based strategies to mitigate harmful impacts of stress on performance.
Publisher: Elsevier BV
Date: 2012
Publisher: Wiley
Date: 30-03-2018
Abstract: ED staff are subject to many stressors, but there are few descriptions of collective approaches to enhancing wellness in this setting. We aim to describe a programme developed to address these issues at department level, to report the feasibility and sustainability of the programme, and its impact on staff. The oneED programme was developed and delivered in a tertiary ED. The programme included a 1 day mindfulness workshop, followed by ongoing mindfulness activities embedded in clinical areas over the subsequent 12 months. A mixed-methods evaluation of the programme was conducted, which included quantitative validated psychological tools to measure anxiety, depression and emotional exhaustion, and pragmatic evaluation using surveys of participants and iterative appreciative inquiry. Eighty staff members attended the mindfulness workshop 66 from ED. Following the workshop, understanding and frequency of mindfulness practice increased significantly in 47% of participants. Free-text survey results demonstrated that staff found the programme to be acceptable (80% survey participants) and of perceived value to themselves (50%) and the ED (60%). Appreciative inquiry led to modification of the programme: the 4 min pause is now conducted weekly rather than daily, the pause consists of a variety of activities, and group activities are made more overtly optional. A departmental wellness programme embedding mindfulness practice is feasible and sustainable. Potential for success is enhanced by an approach that is open to modification according to each institution's culture.
Publisher: Wiley
Date: 12-2008
Publisher: Wiley
Date: 14-07-2014
DOI: 10.1111/TCT.12170
Abstract: To investigate how clinical supervisors of junior doctors provide feedback and assessment on cultural competence, one of several professionalism skills outlined in the Australian Curriculum Framework for Junior Doctors. Twenty clinical supervisors were recruited to a qualitative study in a regional hospital in Queensland, Australia. Data from semi-structured interviews (June-August 2011) were thematically analysed. Interviews revealed that cultural competence was interpreted by the supervising clinicians as a vague concept, and that junior doctors were not assessed in this area. Additional themes related to the cultural competence of junior doctors, as reported by their supervisors, included: limited direct supervision of, and feedback to, junior doctors variations in approaches to assessment clinicians' communication focuses on clinical aspects of disease process perceived lack of cultural ersity among staff and patients acceptance of laypersons as English interpreters language barriers with international medical graduates and patients' low levels of health literacy. Supervisors were unable to define cultural competence in ways that enable them to apply the concept to clinical training for junior doctors. Specific training in cultural competence, and guidelines for its assessment, is therefore recommended for clinical supervisors and junior doctors to improve their approaches to patient care and health outcomes.
Publisher: Wiley
Date: 22-05-2018
Abstract: There is a paucity of any long-term follow up of trainees' career pathways or organisational outcomes from medical education registrar posts in emergency medicine training. We report on the experience of a selected group of medical education trainees during and subsequent to their post and reflect on the value added to emergency medical education at three institutions. We conducted an online survey study, examining quantitative outcomes and qualitative reflections, of emergency physicians who had previously undertaken a medical education registrar post. Descriptive statistics were used to summarise responses to Likert items. The authors independently analysed and interpreted the reflective responses to identify key themes and sub-themes. Nineteen of 21 surveys were completed. Most respondents were in formal educational roles, in addition to clinical practice. The thematic analysis revealed that the medical education registrar experience, and the subsequent contribution of these trainees to medical education, is significantly shaped by external factors. These include the extent of faculty support, and the value placed on medical education by hospitals/departments/leaders. Acquisition of knowledge and skills in medical education was only part of a broader developmental journey and transitioning of identity for the trainees. Our findings suggest that medical education trainees in emergency medicine progress to educational roles, and most respondents attribute their career progression to the medical education training experience. We recommend that medical education registrar programmes need to be valued within the clinical service, supported by faculty and a 'community of practice', to support trainees' transition to clinician educator leadership roles.
Publisher: Wiley
Date: 08-09-1999
Publisher: Springer Science and Business Media LLC
Date: 24-01-2022
DOI: 10.1186/S41077-022-00200-9
Abstract: Healthcare simulation may present risks to safety, especially when delivered ‘in situ’—in real clinical environments—when lines between simulated and real practice may be blurred. We felt compelled to develop a simulation safety policy (SSP) after reading reports of adverse events in the healthcare simulation literature, editorials highlighting these safety risks, and reflecting on our own experience as a busy translational simulation service in a large healthcare institution. The process for development of a comprehensive SSP for translational simulation programs is unclear. Personal correspondence with leaders of simulation programs like our own revealed a piecemeal approach in most institutions. In this article, we describe the process we used to develop the simulation safety policy at our health service, and crystalize principles that may provide guidance to simulation programs with similar challenges.
Publisher: AMPCo
Date: 06-2013
DOI: 10.5694/MJA12.11573
Publisher: Wiley
Date: 28-09-2016
Publisher: AMPCo
Date: 03-2017
DOI: 10.5694/MJA16.01254
Publisher: AMPCo
Date: 04-2013
DOI: 10.5694/MJA13.10176
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-05-2022
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOQ-2019-000749
Abstract: Trauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation and coordination across erse groups. We aimed to define and improve relational aspects of trauma care at Gold Coast University Hospital. We conducted a mixed-methods collaborative ethnography using the relational coordination survey—an established tool to analyse the relational dimensions of multidisciplinary teamwork—participant observation, interviews and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation programme in contributing positively to team culture and relational ties. A range of 16 interventions—focusing on structural, process and relational dimensions—were co-created with participants and are now being implemented and evaluated by various trauma care providers. Through engagement of clinicians spanning organisational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage healthcare leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
Publisher: BMJ
Date: 16-12-2021
DOI: 10.1136/BMJSTEL-2020-000645
Abstract: Peer-assisted learning (PAL) is well described in medical education but there has been little research on its application in simulation-based education (SBE). This exploratory study aimed to determine the perceptions of senior medical students at two universities to teaching and learning in SBE using PAL (PAL-SBE). Ninety-seven medical students at two universities working in small groups with facilitator oversight wrote, ran and debriefed a simulation scenario for their peers. This was a mixed-methods study. Participants completed a written free-text and Likert survey instrument, and participated in a facilitated focus group immediately after the scenario. Thematic analysis was performed on the free-text and focus group transcripts. Student-led scenarios ran without major technical issues. Instructor presence was required throughout scenario delivery and debrief, making the exercise resource intensive. Participant responses were more positive regarding learning as peer teachers in simulation than they were regarding participation as a peer learner. Five themes were identified: learning in the simulated environment teaching in the simulated environment teaching peers and taking on an educator role learning from peers and time and effort expended. Perceived benefits included learning in depth through scenario writing, improved knowledge retention, understanding the patient’s perspective and learning to give feedback through debriefing. PAL in SBE is feasible and was perceived positively by students. Perceived benefits appear to be greater for the peer teachers than for peer learners.
Publisher: SAGE Publications
Date: 15-07-2020
Abstract: This article adds to the repertoire of field research methods through developing the technique of “participant deconstruction.” This technique involves research participants challenging and reinterpreting organizational texts through the application of orienting, disorienting, and reorienting deconstructive questions. We show how participant deconstruction complements existing strategies for “getting on” with field research—cultivating relationships, developing outsider knowledge, and mobilizing insider knowledge—by facilitating research participants’ questioning and challenging of organizational texts and thus opening up alternative latent understandings, illuminating concealed meanings, supporting reflexivity for participants and researchers, and suggesting fruitful lines of inquiry. We illustrate the application of the technique with ex les drawn from health care research projects. Through gathering further practitioner feedback from a variety of alternative contexts, we go on to demonstrate the potential application of participant deconstruction in a range of field contexts, by different types of practitioners undertaking deconstructive readings of a wide variety of organizational texts. We also offer suggestions for further research to extend the technique.
Publisher: AMPCo
Date: 06-2017
DOI: 10.5694/MJA17.00113
Publisher: Informa UK Limited
Date: 04-07-2022
Publisher: Cambridge University Press
Date: 11-01-2023
Abstract: Historically simulation was used as an education and training technique in healthcare, but now has an emerging role in improving quality and safety. Simulation-based techniques can be applied to help understand healthcare settings and the practices and behaviours of those who work in them. Simulation-based interventions can help to improve care and outcomes – for ex le, by improving readiness of teams to respond effectively to situations or to improve skill and speed. Simulation can also help test planned interventions and infrastructural changes, allowing possible vulnerabilities and risks to be identified and addressed. Challenges include cost, resources, training, and evaluation, and the lack of connection between the simulation and improvement fields, both in practice and in scholarship. The business case for simulation as an improvement technique remains to be established. This Element concludes by offering a way forward for simulation in practice and for future scholarly directions to improve the approach. This title is also available as Open Access on Cambridge Core.
Publisher: Wiley
Date: 17-09-2021
Publisher: Informa UK Limited
Date: 31-01-2017
DOI: 10.1080/13561820.2016.1254164
Abstract: Prescribing in acute healthcare settings is a complex interprofessional process with a high incidence of medication errors. Opportunities exist to improve prescribing learning through collaborative practice. This qualitative interview-based study aimed to investigate the development of junior doctors' prescribing capacity and how pharmacists contribute interprofessionally to this development and the prescribing practices of a medical community. The setting for this study was a large teaching hospital in Australia where ethical approval was gained before commencing the study. A constructionist approach was adopted and the interviews were held with a purposive s le of 34 participants including junior doctors (n = 11), clinical supervisors (medical n = 10), and pharmacists (n = 13). Informed by workplace learning theory, interview data were thematically analysed. Three key themes related to pharmacists' contributions to prescribing practices emerged: building prescribing capacities of junior doctors through guidance and instruction sustaining safe prescribing practices of the community in response to junior doctor rotations and transforming prescribing practices of the community through workplace learning facilitation and team integration. These findings emphasize the important contributions made by pharmacists to building junior doctors' prescribing capacities that also assist in transforming the practices of that community. These findings suggest that rather than developing more conventional education programs for prescribing, further consideration should be given to interprofessional collaboration in everyday activities and interactions as a means to promote both effective learning for in iduals and advancing the enactment of effective prescribing practice.
Publisher: Wiley
Date: 28-04-2022
DOI: 10.1111/AJO.13528
Abstract: Laparoscopy is the gold standard approach for many surgical procedures, but it is a complex skill to learn. Laparoscopic simulation training may help, but it is unclear how to best engage trainees in these programs. Test‐enhanced learning (TEL) uses regular, well‐defined assessments of performance throughout the training phase of learning. The aim of this study was to assess the effects of TEL on a laparoscopic simulation program involving a cohort of medical student volunteers. A prospective cohort study was performed with a convenience s le of 40 medical students. Students were recruited to participate in a ten‐week laparoscopic simulation program. Twenty students participated in a laparoscopic surgical program with TEL (‘TEL group’), and 20 students participated in a standard laparoscopic simulation program (‘control group’). Attendance in the TEL group was significantly higher than in the standard group (71 vs 51.5%, P = 0.03). There was no difference between groups in mean time scores. Four themes were identified in qualitative data drawn from student surveys – personal traits and motivators, training context, clear goals and feedback enabling understanding of one's own performance. Testing laparoscopic skills throughout a learning program, in conjunction with in idualised feedback and tracking of learning trajectory, increases trainee attendance. Laparoscopic simulation training programs are encouraged to reflect on the pedagogic framework in which their procedural skills training operates.
Publisher: AMPCo
Date: 02-2011
DOI: 10.5694/J.1326-5377.2011.TB03763.X
Abstract: To evaluate an intern educational project, the More Learning for Interns in Emergency (MoLIE) project, designed to increase intern placements in the emergency department (ED). The study was conducted in the ED of the Royal Brisbane and Women's Hospital, Queensland, in 2008. As well as the usual direct contact with patients, interns had 8 hours per week of "off the floor" structured learning time supervised by consultants. This allowed for an increased number of interns to complete a term in the ED over a 1-year period. The study was evaluated by an intern exit feedback survey and a senior staff survey. Numbers of intern placements in the ED intern satisfaction with the project senior medical staff satisfaction with interns' skills and performance assessments. The number of interns completing a term in the ED increased from 65 in 2007 to 90 in 2008. Overall, the 90 interns surveyed were highly satisfied with their training. Most agreed or strongly agreed that the sessions were relevant and covered the right mix of clinical and professional issues. Most of the 12 senior staff surveyed felt that the participating interns performed slightly or much better than interns in previous years, and that their experience as supervisors and overall patient care were improved. The project successfully combined increased intern numbers with educational outcomes that were well perceived by interns and senior staff, without adversely affecting service delivery or supervision workload in the ED.
Publisher: Springer New York
Date: 2013
Publisher: BMJ
Date: 18-07-2019
Publisher: Cambridge University Press
Date: 26-05-2005
Publisher: Wiley
Date: 08-2004
Publisher: BMJ
Date: 07-08-2020
Publisher: Wiley
Date: 02-2014
Publisher: Springer Science and Business Media LLC
Date: 25-11-2019
DOI: 10.1017/CEM.2019.427
Abstract: Podcasts are increasingly being used for medical education. A deeper understanding of usage patterns would inform both producers and researchers of medical podcasts. We aimed to determine how and why podcasts are used by emergency medicine and critical care clinicians. An international interprofessional s le (medical students, residents, physicians, nurses, physician assistants, and paramedics) was recruited through direct contact and a multimodal social media (Twitter and Facebook) c aign. Each participant completed a survey outlining how and why they utilize medical podcasts. Recruitment materials included an infographic and study website. 390 participants from 33 countries and 4 professions (medicine, nursing, paramedicine, physician assistant) completed the survey. Participants most frequently listened to medical podcasts to review new literature (75.8%), learn core material (75.1%), and refresh memory (71.8%). The majority (62.6%) were aware of the ability to listen at increased speeds, but most (76.9%) listened at 1.0 x (normal) speed. All but 25 (6.4%) participants concurrently performed other tasks while listening. Driving (72.3%), exercising (39.7%), and completing chores (39.2%) were the most common. A minority of participants used active learning techniques such as pausing, rewinding, and replaying segments of the podcast. Very few listened to podcasts multiple times. An international cohort of emergency clinicians use medical podcasts predominantly for learning. Their listening habits (rarely employing active learning strategies and frequently performing concurrent tasks) may not support this goal. Further exploration of the impact of these activities on learning from podcasts is warranted.
Publisher: Cambridge University Press
Date: 10-04-2012
Publisher: No publisher found
Date: 2020
Publisher: Wiley
Date: 04-2007
Publisher: Wiley
Date: 21-06-2015
Publisher: Informa UK Limited
Date: 08-10-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2018
DOI: 10.1097/SIH.0000000000000284
Abstract: Professional development opportunities are not readily accessible for most simulation educators, who may only connect with simulation experts at periodic and costly conferences. Virtual communities of practice consist of in iduals with a shared passion who communicate via virtual media to advance their own learning and that of others. A nascent virtual community of practice is developing online for healthcare simulation on social media platforms. Simulation educators should consider engaging on these platforms for their own benefit and to help develop healthcare simulation educators around the world. Herein, we describe this developing virtual community of practice and offer guidance to assist educators to engage, learn, and contribute to the growth of the community.
Publisher: Springer Science and Business Media LLC
Date: 06-2022
Publisher: F1000 Research Ltd
Date: 03-05-2023
DOI: 10.12688/HRBOPENRES.13727.1
Abstract: Background : Over 70% of the general population have experienced at least one psychologically traumatic event in their lifetime, with 30.5% experiencing four or more events. Recognising the prevalence and potentially injurious effects of psychological trauma among healthcare workers and patients alike is considered important to ensure patient engagement, quality of care, positive health outcomes, as well as improved staff wellness, and more resilient health systems. Aim: The current project aims to improve the experience of both patients and staff in two acute hospital settings in St James’ Hospital (SJH): the Emergency Department (ED) and Acute Medical Assessment Unit (AMAU). This will be achieved through the development of a translational simulation improvement programme for trauma-informed care (TS4TIC). The objective of trauma-informed care (TIC) in the acute hospital setting is to reduce the impact of previous trauma on the care experience. Methods : Underpinned the Institute for Healthcare Improvement (IHI) Model for Improvement we will (i) co-design a TIC improvement programme for use in acute hospital settings using translational simulation (TS) approaches, (ii) implement TS4TIC in two acute hospital settings, and (iii) co-evaluate the effectiveness and acceptability of TS4TIC using co-defined outcome, process, and balancing indicators measured across iterative Plan, Do, Study, Act (PDSA) cycles. Expected Outcome : The project’s completion will result in a co-designed, open access TS4TIC Toolkit , consisting of a suite of TS scenarios and accompanying monitoring and training resources to guide the adaptation of this approach for use in other acute healthcare settings nationally and internationally.
Publisher: Wiley
Date: 17-07-2017
DOI: 10.1111/TCT.12551
Abstract: During their training, medical students often undertake a rotation in an emergency department (ED), where they are exposed to a wide variety of patient presentations. Simulation can be an effective teaching strategy to help prepare learners for the realities of the clinical environment. Simulating an ED shift can provide students with the opportunity to perform a range of clinical activities, within their scope of practice, in a supervised and supportive learning environment. Medical students often undertake a rotation in an emergency department CONTEXT: There is limited literature describing the structure, syllabus, feasibility and perceived usefulness of simulating a typical ED for medical student training. We developed a simulated ED (simED) teaching session for medical students at our university. Students were informed of the purpose and learning tasks of the session prior to attendance. At the start of their 2-hour simED shift students were allocated 'patients' by the Triage nurse. At the completion of their shift, students attended a debriefing discussion. Student feedback indicated that they felt that the simED: provided a good opportunity to practise skills and apply theory to practice was realistic and challenging highlighted the importance of teamwork and enabled them to identify skills requiring further practise. Suggestions for improvements included a longer time spent in the simED and the opportunity to see more patients. The simED approach seemed to be well received and perceived by medical students as useful preparation for the ED. An overview of the structure, materials and resources used is provided to assist educators seeking to implement similar ED clinical scenarios in their curriculum.
Publisher: Springer Science and Business Media LLC
Date: 21-05-2019
Publisher: The Korean Society of Emergency Medicine
Date: 31-03-2020
DOI: 10.15441/CEEM.19.021
Publisher: Springer Science and Business Media LLC
Date: 03-06-2020
DOI: 10.1186/S41077-020-00127-Z
Abstract: Healthcare simulation has significant potential for helping health services to deal with the COVID-19 pandemic. Rapid changes to care pathways and processes needed for protection of staff and patients may be facilitated by a translational simulation approach—diagnosing changes needed, developing and testing new processes and then embedding new systems and teamwork through training. However, there are also practical constraints on running in situ simulations during a pandemic—the need for physical distancing, rigorous infection control for manikins and training equipment and awareness of heightened anxiety among simulation participants. We describe our institution’s simulation strategy for COVID-19 preparation and reflect on the lessons learned—for simulation programs and for health services seeking to utilise translational simulation during and beyond the COVID-19 pandemic. We offer practical suggestions for a translational simulation strategy and simulation delivery within pandemic constraints. We also suggest simulation programs develop robust strategies, governance and relationships for managing change within institutions—balancing clinician engagement, systems engineering expertise and the power of translational simulation for diagnosing, testing and embedding changes.
Publisher: SAGE Publications
Date: 14-01-2016
Abstract: Evidence-based management (EBMgt) is a growing literature stream in management education which contends that management decision making should be informed by the best available scientific evidence (Rousseau, 2006). Encouraged by the success of evidence-based practice in the field of medicine, advocates of EBMgt have increasingly called for management educators to develop graduates into evidence-based practitioners who—like physicians—value and use evidence in their daily practice in organizations. In this essay, we contribute to these debates by exploring three strategies that are used in medicine to train physicians to engage with evidence: embedding the normative foundation of evidence in problem-solving routines, role modelling being a reflective research consumer, and creating teachable moments through lived experience of research. We consider whether and how these strategies can be adapted to inform teaching the teaching of EBMgt. Drawing on these insights from physician training, we suggest a range of methods and techniques that management educators can implement in their teaching to facilitate student learning about evidence-based practice. We also consider the challenge of developing evidence-based cultures in organizations.
Publisher: BMJ
Date: 07-08-2015
DOI: 10.1136/EMERMED-2015-205024
Abstract: Social media has been viewed by some as a threat to traditional medical education. In emergency care, the underpinning educational principles of social media, while sometimes innovative in their delivery, are often no different than long-standing techniques and methods. This article aims to encourage discussion and debate that reduces the ide between these two communities of practice.
Publisher: Informa UK Limited
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 05-02-2022
DOI: 10.1186/S41077-022-00201-8
Abstract: Simulation facilitators strive to ensure the psychological safety of participants during simulation events however, we have limited understanding of how antecedent levels of psychological safety impact the simulation experience or how the simulation experience impacts real-world psychological safety. We explored the experience of participants in an embedded, interprofessional simulation program at a large tertiary emergency department (ED) in Australia. We engaged in theoretical thematic analysis of sequential narrative surveys and semi-structured interviews using a previously derived framework of enablers of psychological safety in healthcare. We sought to understand (1) how real-world psychological safety impacts the simulation experience and (2) how the simulation experience influences real-world psychological safety. We received 74 narrative responses and conducted 19 interviews. Simulation experience was both influenced by and impacted psychological safety experienced at the in idual, team, and organizational levels of ED practice. Most strikingly, simulation seemed to be an incubator of team familiarity with direct impact on real-world practice. We present a model of the bidirectional impact of psychological safety and simulation within healthcare environments. Our model represents both opportunity and risk for facilitators and organizations engaging in simulation. It should inform objectives, design, delivery, debriefing, and faculty development and firmly support the situation of simulation programs within the broader cultural ethos and goals of the departments and organizations.
Publisher: Wiley
Date: 10-2003
Publisher: Wiley
Date: 10-2013
Publisher: Wiley
Date: 28-02-2016
Publisher: Springer Science and Business Media LLC
Date: 19-10-2017
Publisher: Informa UK Limited
Date: 02-09-2019
Publisher: Wiley
Date: 19-04-2015
Publisher: Wiley
Date: 20-12-2013
Abstract: To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. A retrospective review of intern assessment forms from a 2 year period (2009-2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as 'requiring substantial assistance' and/or 'requires further development' on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5-3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (P < 0.01). Interns predominantly had difficulty with 'clinical judgment and decision-making skills', 'time management skills' and 'teamwork and colleagues' (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2-19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations.
Publisher: Springer Singapore
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 09-2022
DOI: 10.1186/S12913-022-08463-8
Abstract: Post-partum haemorrhage (PPH) is an obstetric emergency that requires effective teamwork under complex conditions. We explored healthcare team performance for women who suffered a PPH, focusing on relationships and culture as critical influences on teamwork behaviours and outcomes. In collaboration with clinical teams, we implemented structural, process and relational interventions to improve teamwork in PPH cases. We were guided by the conceptual framework of Relational Coordination and used a mixed methods approach to data collection and analysis. We employed translational simulation as a central, but not singular, technique for enabling exploration and improvement. Key themes were identified from surveys, focus groups, simulation sessions, interviews, and personal communications over a 12-month period. Four overarching themes were identified: 1) Teamwork, clear roles and identified leadership are critical. 2) Relational factors powerfully underpin teamwork behaviours—shared goals, shared knowledge, and mutual respect. 3) Conflict and poor relationships can and should be actively explored and addressed to improve performance. 4) Simulation supports improved team performance through multifaceted mechanisms. One year after the project commenced, significant progress had been made in relationships and systems. Clinical outcomes have improved despite unprecedented increase in labour ward activity, there has not been any increase in large PPHs. Teamwork, relationships, and the context of care can be actively shaped in partnership with clinicians to support high performance in maternity care. We present our multifaceted approach as a guide for leaders and clinicians in maternity teams, and as an exemplar for others enacting quality improvement in healthcare.
Publisher: Wiley
Date: 16-05-2021
DOI: 10.1002/AET2.10601
Abstract: Free Open‐Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. We assessed the AAT’s usability in a erse population of practicing emergency medicine (EM) physicians, residents, and medical students solicited feedback and developed a revised tool. As part of the Medical Education Translational Resources: Impact and Quality (METRIQ) study, we recruited medical students, EM residents, and EM attendings to evaluate five FOAM posts with the AAT and provide quantitative and qualitative feedback via an online survey. Two independent analysts performed a qualitative thematic analysis with discrepancies resolved through discussion and negotiated consensus. This analysis informed development of an initial revised AAT, which was then further refined after pilot testing among the author group. The final tool was reassessed for reliability. Of 330 recruited international participants, 309 completed all ratings. The Best Evidence in Emergency Medicine (BEEM) score was the component most frequently reported as difficult to use. Several themes emerged from the qualitative analysis: for ease of use—understandable, logically structured, concise, and aligned with educational value. Limitations include deviation from questionnaire best practices, validity concerns, and challenges assessing evidence‐based medicine. Themes supporting its use include evaluative utility and usability. The author group pilot tested the initial revised AAT, revealing a total score average measure intraclass correlation coefficient (ICC) of moderate reliability (ICC = 0.68, 95% confidence interval [CI] = 0 to 0.962). The final AAT’s average measure ICC was 0.88 (95% CI = 0.77 to 0.95). We developed the final revised AAT from usability feedback. The new score has significantly increased usability, but will need to be reassessed for reliability in a broad population.
Publisher: Wiley
Date: 27-02-2019
DOI: 10.1002/AET2.10325
Publisher: BMJ
Date: 23-05-2020
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.ANNEMERGMED.2018.05.003
Abstract: Online educational resources such as blogs are increasingly used for education by emergency medicine clinicians. The Social Media Index was developed to quantify their relative impact. The Medical Education Translational Resources: Indicators of Quality (METRIQ) study was conducted in part to determine the association between the Social Media Index score and quality as measured by gestalt and previously derived quality instruments. Ten blogs were randomly selected from a list of emergency medicine and critical care Web sites. The 2 most recent clinically oriented blog posts published on these blogs were evaluated with gestalt, the Academic Life in Emergency Medicine Approved Instructional Resources (ALiEM AIR) score, and the METRIQ-8 score. Volunteer raters (including medical students, emergency medicine residents, and emergency medicine attending physicians) were identified with a multimodal recruitment methodology. The Social Media Index was calculated in February 2016, November 2016, April 2017, and December 2017. Pearson's correlations were calculated between the Social Media Index and the average rater gestalt, ALiEM AIR score, and METRIQ-8 score. A total of 309 of 330 raters completed all ratings (93.6%). The Social Media Index correlated moderately to strongly with the mean rater gestalt ratings (range 0.69 to 0.76) and moderately with the mean rater ALiEM AIR score (range 0.55 to 0.61) and METRIQ-8 score (range 0.53 to 0.57) during the month of the blog post's selection and for 2 years after. The Social Media Index's correlation with multiple quality evaluation instruments over time supports the hypothesis that it is associated with overall Web site quality. It can play a role in guiding in iduals to high-quality resources that can be reviewed with critical appraisal techniques.
Publisher: Springer Science and Business Media LLC
Date: 27-05-2020
DOI: 10.1186/S41077-020-00122-4
Abstract: Virtual Communities of Practice (vCoP) is a nascent approach to professional development for simulation educators (Thoma et al., Simul Healthc. 2018 (2):124-30). vCoPs overcome geographic barriers to accessing expertise and professional networks and may promote ‘democratisation’ of voices in the simulation community. However, the optimal process for creating, nurturing and joining vCoPs in healthcare simulation is not well understood. We report on the establishment of our healthcare simulation hybrid podcast/blog— Simulcast ( www.simulationpodcast.com )—utilising the conceptual framework of Wenger’s three dimensions of Communities of Practice. In exploring these dimensions—joint enterprise, mutual engagement and shared repertoire—we hope to contextualise vCoP within professional development approaches for simulation faculty and invite readers to engage with our existing community.
Publisher: Wiley
Date: 09-07-2020
DOI: 10.1111/AJO.13185
Publisher: Wiley
Date: 22-01-2018
DOI: 10.1111/MEDU.13505
Publisher: Wiley
Date: 15-03-2016
Abstract: Patient safety has emerged as an important topic for inclusion in medical curricula. However, there is limited literature describing how medical students are taught, learn and self-assess patient safety skills. The present study aimed to seek pre-clinical medical students' perceptions of (i) their in idual performance at a range of safety skills and (ii) how they define patient safety in a simulated ED. Data were collected in the form of questionnaire responses at the end of the Bond University Simulated ED activity in October 2014. The simulated ED is a session for pre-clinical medical students prior to their clinical rotations, aimed at preparing them for the clinical environment. Likert scale and short answer responses were used to describe students' perceptions of their safety skills and to identify themes related to patient safety. Seventy-eight out of 92 students completed the questionnaires (85% response rate). The majority of students thought their patients were safe from adverse events during their shift. However, students' perception of patient safety was wide-ranging and demonstrated a number of misconceptions. The most frequent strategies employed by students to ensure patient safety were asking for help from nursing staff or senior doctors, ensuring good communication with the patient and checking allergies before administering medication. Students had a favourable opinion of their own safety skills. However, answers to free text question revealed misconceptions about the nature of patient safety despite significant teaching on this topic.
Publisher: Wiley
Date: 14-01-2028
Abstract: Team culture underpins team performance. Psychological safety – ‘a shared belief held by members of a team that the team is safe for interpersonal risk taking’ – is a critical component of team culture for high‐performing teams across contexts. However, psychological safety in ED teams has not been well explored. We aimed to explore this core teamwork concept in the ED. This was a sequential mixed‐methods study of nursing and medical staff at a large tertiary care ED in Australia from October 2020 to March 2021. First, participants completed the ‘Team Learning and Psychological Safety Survey’ and a narrative questionnaire. These findings informed semi‐structured interviews. We determined median psychological safety and compared results across role and length of time working in the department. Qualitative results were analysed using a deductive thematic analysis using a previously generated framework for enablers of psychological safety at the in idual, team and organisational levels. The survey was completed by 72/410 participants and 19 interviews were conducted. The median psychological safety score was 37/49 (IQR 13). Psychological safety was not experienced universally, with nurses and new staff experiencing lower levels. In idual, team and organisational factors impacted psychological safety. The primary force shaping psychological safety was familiarity with colleagues and leaders. Familiarity of team members and leaders was critical to the development of psychological safety within the ED. Fostering familiarity should be a focus for frontline leadership each shift and a priority in broader departmental decisions for those seeking to enhance the psychological safety of their teams.
Publisher: Wiley
Date: 05-2021
DOI: 10.1111/AJO.13346
Publisher: Wiley
Date: 31-08-2021
Publisher: Wiley
Date: 04-2010
Publisher: Wiley
Date: 11-01-2018
Publisher: Wiley
Date: 28-11-2012
DOI: 10.1111/J.1742-6723.2011.01506.X
Abstract: Endotracheal intubation is a challenging procedure in emergency medicine. Junior doctors lack experience and confidence in this task. The use of a gum elastic bougie (GEB) to facilitate intubation may improve success rates, especially in difficult situations. Junior doctors working in the ED were studied. Endotracheal intubation was simulated using part-task trainers in "easy" positioning and "difficult" positioning modes. Intubation was attempted in both positions using either an endotracheal tube, with re-enforcing stylet (ETT-S), or insertion of a gum elastic bougie (GEB), with subsequent passage of the endotracheal tube over the bougie. Success rates and time to complete intubation were measured with GEB, and with ETT-S. Participants were asked to record the perceived ease of intubation. One hundred and four intubations were performed by 26 study subjects. Overall, mean time to intubation with ETT-S technique was 16.14 s (14.49-17.98 95% CI), and was faster than with GEB 24.18 (21.45-27.25 95% CI) in both airway difficulty grades (P < 0.01). The success rate for intubation using the GEB was 100%, compared with 92.9% with ETT-S. This difference was not statistically significant. Perceived ease of intubation was similar for GEB and ETT-S (VAS 6.808 vs 6.904). The use of a GEB marginally increases the time taken to perform endotracheal intubation. Success rates for junior doctors attempting endotracheal intubation were not significantly different between the two techniques. Success rates for novice practitioners using a GEB were high after even limited instruction and practice.
Publisher: Wiley
Date: 28-08-2013
DOI: 10.1111/MEDU.12294
Publisher: Wiley
Date: 25-06-2019
Publisher: Springer Science and Business Media LLC
Date: 31-03-2023
DOI: 10.1186/S41077-023-00250-7
Abstract: There have been increasing calls for awareness and action related to equity, ersity, and inclusion (EDI) in simulation but a lack of practical guidance for how simulation delivery teams (SDTs) might move towards meaningful transformation. The gap between academic conversations about EDI and how to practically impact SDT attitudes, behaviors, and performance remains considerable. We designed a conversational tool, the SIM-EDI, to bridge the gap between theory and practice for SDTs by enhancing reflexivity and studied its impact locally. We engaged in a collaborative autoethnography to explore EDI within our emergency department SDT shortly after implementing the SIM-EDI. The 12-month ethnography is informed by our team’s collection and analysis of data about ourselves and our own experiences using the tool. Data included serial interviews, field notes from simulations and SDT meetings, SDT documents, and self-reflections. We found the SIM-EDI tool could be implemented with a team with a high level of readiness. Use of the tool had several meaningful impacts including enhanced team reflexivity, normalization of conversations related to EDI and increased confidence to engage in EDI conversations with participants. Key themes throughout the process included (1) in idual and team growth, (2) fear of “getting it wrong”, and (3) tension between bias towards action and need for slow reflection. The SIM-EDI tool can effectively promote reflexivity among faculty in an emergency department simulation program. The tool is easy to use and implement, impacts attitudes and behaviors, and facilitates in idual and team growth.
Publisher: Springer Science and Business Media LLC
Date: 27-10-2022
DOI: 10.1186/S41077-022-00229-W
Abstract: Many clinicians working in healthcare simulation struggle with competing dual identities of clinician and educator, whilst those who harmonise these identities are observed to be highly effective teachers and clinicians. Professional identity formation (PIF) theories offer a conceptual framework for considering this dilemma. However, many clinician simulation educators lack practical guidance for translating these theories and are unable to develop or align their dual identities. An unusual experience involving the first author’s suspension of disbelief as a simulation facilitator sparked a novel reflection on his dual identity as a clinician and as a simulation educator. He re-framed his clinician and simulation ‘hats’ as cooperative and fluid rather than competing and compartmentalised. He recognised that these dual identities could flow between clinical and simulation environments through leaky ‘blended boundaries’ rather than being restricted by environmental demarcations. This personal story is shared and reflected upon to offer a practical ‘hats and boundaries’ model. Experimenting with the model in both clinical and simulation workplaces presents opportunities for PIF and alignment of dual identities. The model may help other clinician simulation educators navigate the complexities of merging their dual identities.
Publisher: BMJ
Date: 03-04-2021
DOI: 10.1136/BMJSTEL-2020-000582
Abstract: Medical students will have future roles as clinician educators, and need to develop knowledge and skills for that role. Specific skills in simulation-based education (SBE) may be valuable in many educational settings. We aimed to understand the impact of a 7-week placement in SBE on the development of medical students’ knowledge, skills and perspectives as educators. We reviewed the experience of three graduated students (also coauthors of this article) who participated in the rotation in 2018. This case study includes analysis of the students’ electronic portfolios, rotation reports and subsequent reflections of the student coauthors. Five themes were identified:—‘Development as a professional’, ‘Active participation in an educator team’, ‘Diverse experience in simulation skills and techniques’, ‘Role models and mentoring’ and ‘Rethinking feedback’. Students describe the development of practical knowledge and skills, and more fundamental reflections on the nature of learning, feedback and their personal professional development. We suggest that integration of a simulation education elective within a medical school curriculum helps build capacity for effective SBE delivery, and has positive impacts on students for their future roles as doctors, educators and lifelong learners.
Publisher: Informa UK Limited
Date: 26-02-2014
Publisher: Wiley
Date: 22-07-2020
DOI: 10.1111/ANAE.15219
Publisher: No publisher found
Date: 2013
No related grants have been discovered for Victoria Brazil.