Simulation is a powerful teaching tool and psychological safety and high-quality facilitation are important. We deliberately aimed at establishing a faculty team of experienced simulation educators (rather than student teachers) who are able to guide students meaningfully and respectfully through challenging simulation exercises, debriefings and deal with difficult situations.
TeamSIM is designed as week-long simulation training and is open to all third-year medical students. We invite students to “walk the talk” of teamwork by training medical teamwork in teams.
Organized in teams of 11-12 students, they remain in their respective team for the full week and participate in eight, in-person, four-hour-simulation sessions representing different clinical situations with varying degrees of complexity (e.g., deteriorating patient in ward; trauma; labour and delivery. Guided by an interprofessional clinical faculty with simulation-based instructor training, each of the teams follows a slightly different schedule.
Each of the eight simulation sessions includes participation in two to three rounds of briefing, simulated case, and debriefing. We introduce all students to the course during the formal TeamSIM briefing on Monday morning. Using Zoom, we discuss expectations, course of events, learning objectives, confidentiality, roles, and logistic details to provide orientation and contribute to a psychologically safe learning environment. We introduce simulation as a teaching tool, reflect on its advantages and limitations, provide recommendations for how to engage in simulation and demonstrate our commitment to respecting students and their perspective. We then invite students into breakout groups in their respective teams to brief themselves and ask them to develop a set of guiding principles for their team. In-person simulation sessions start Monday afternoon and end Friday morning. TeamSIM ends with a formal TeamSIM debriefing on Friday afternoon.
The main course objectives are to practice essential teamwork skills and to experience the translational effects of psychological safety.
Encourage Student Engagement
We engage students teams to practice teamwork skills from three different perspectives: For example, when training how to lead, students can actively lead the team (1st-person practice), are led by a team member (2nd-person practice) and observe team leadership and followership from the outside (3rd-person practice). Depending on the simulated case, four to six of the students actively participate (1st and 2nd-person perspective) while their peers observe them (3rd-person perspective); roles are switched in the subsequent case. In each case, students were guided by clinicians with lots of work experience.
Innovative elements on student learning
According to the evaluation data, the students appreciated the teaching, coaching, and facilitation by the interdisciplinary and interprofessional simulation faculty whom they perceived as very engaged and committed. In response to what the students particularly liked, the three most frequently mentioned topics were the simulation method as such, specific simulation sessions, and the way the faculty engaged with them. In response to what they did not like about TeamSIM, the three most frequently mentioned topics were “nothing”, “long, repetitive debriefings”, and specific simulation session. As their most important learning experience, students reported in particular communication such as closed-loop communication and speaking up, teamwork and leadership, role distribution, and a variety of other insights such as “not yet knowing is okay if one knows how to get help,” “thinking out loud,” “admitting one’s fallibility,” or “asking for help is a strength”.
Feedback and debriefing approaches
For the multiple feedback and debriefing conversations (Figure 1), the faculty follows feedback and debriefing approaches in which they hold students in high regard and discuss their actions based on honesty and curiosity. They use their observations of the students’ actions during the scenarios to provide feedback, inquire their perspectives, and discuss different approaches with all team members. During both briefing and debriefing faculty focuses on selected learning objectives. For example, during the session “managing trauma as team,” the faculty introduces and discusses
- tools developing & applying strategies for using colleagues’ knowledge and experience in clinical situations (learning objective #2),
- for teaming up spontaneously and effectively and clarify roles and responsibilities (learning objective #3),
- how to realize and manage when they are stretched to their limits with respect to knowledge, skills, attitude (learning objective #10 & #11).
- The faculty adapts their focus depending on the students’ needs (e.g., inviting them to re-do or practice certain team actions). Students’ actions are not graded. To pass the course, 90%, attendance of the sessions is required.
Recommendations
Based on the students’ feedback paintand our experience as faculty, we would recommend if possible, to allow students
1. To allow students to act as if (they were already doctors)
2. To practice skills from three different perspectives (1st, 2nd, and 3rd-person perspective)
3. To deeply reflect as faculty on the psychology safety of both faculty and learners
Course Description
- Name:
- Teamwork, Interprofessionality & Own Career
- Description:
- The module «interprofessional teamwork and career” will provide students with the possibility to learn principles of working together efficiently, effectively and safely in interprofessional healthcare teams. Consequences of teamwork for patient care & safety and implications for career management will be discussed. Applying experience-based learning, in simulations of clinical situation with varying degrees of complexity students will learn, which competencies are required in addition to clinical knowledge and skills. Teamwork and communication will be centerstage. Students will encounter simulated clinical situations (e.g., deteriorating patient in ward; trauma; resuscitation; board/colloquium) and reflect on their shared experience in structured debriefings. Particularly essential skills such as handover communication and speaking up will be deliberately practiced. Short lectures will present background and research findings.
- Objective:
- Learning objective #1: Students are able to describe the importance of colleagues’ knowledge and experience.
Learning objective #2: Students develop strategies for using colleagues’ knowledge and experience in clinical situations and are able to apply these strategies.
Learning objective #3: Students are able to team up spontaneously and effectively and clarify roles and responsibilities.
Learning objective #4: Students can describe the importance of respect and appreciation for collaboration and performance.
Learning objective #5: Students are able to communicate respectfully and in an appreciative manner.
Learning objective #6: Students are able to describe benefits and risks of diverse opinions and conflicts in interprofessional teams and can apply strategies for managing them effectively.
Learning objective #7: Students can identify success factors of teamwork and adapt their own interests accordingly.
Learning objective #8: Students are able to recognize situations which require speaking up.
Learning objective #9: Students develop strategies for speaking up and listening effectively.
Learning objective #10: Students are able to realize when they are stretched to their limits with respect to knowledge, skills, attitude.
Learning objective #11: Students are able to apply strategies managing their own subject-specific limits.
Learning objective #12: Students use self-reflection as a tool to reflect on their actions and related consequences for
- Department:
- D-HEST
- Level:
- 3rd year
- Format:
- week-long simulation practice
- Size:
- 100 students
- Assessment:
- Students’ actions are not graded. To pass the course, 90%, attendance of the sessions is required.
