Patient Care Team
Conditions
Keywords
Teamwork, Resuscitation, Team training
Brief summary
It is challenging for healthcare team to manage emergency patient effectively. Most of these critical patients have medical conditions and need complex medical managements. Research findings have shown that poor healthcare teamwork would result in poor communication, missing information, and insufficient situation monitoring and thus compromise patient safety. Simulation has been proved as an effective method to develop teamwork competency. However, comparing to traditional training model, simulation requires more resources such as funding, spaces, time, administration staffs, schedule, facilitators, and equipment. It would not be easy to delivery in various professional departments. Game-based learning was a known effective and learner-centered learning model which required less resources. Researchers have shown that game-based learning has higher acceptance for the learners and can improve learners' knowledge, attitude, motivation, and performance. Therefore, the aim of this study was to explore the learning effectiveness of resuscitation teamwork training of board game-based learning, simulation-based learning and lecture-based learning in PGY doctors and nurses.
Detailed description
This will be a prospective, longitudinal, and randomized controlled trial design. A total number of 180 PGY doctors and nurses will be enrolled from a teaching hospital in northern Taipei City. They will be randomized into board game-based learning group, simulation-based learning group, and lecture-based learning group. Three groups will receive Emergency Medical Response Teamwork training and all of these contents were developed according to America Heart Association Guidelines for Cardiopulmonary Resuscitation and ECC and TeamSTEPPS curriculum from Agency for Healthcare Research and Quality. We will collect the professional demography, the professional medical knowledge for medical management, the concept of knowledge for teamwork, team performance, team attitude, medical management, course survey, and cognitive load scales. We will compare the learning effectiveness between three groups in pretest, posttest, and three-months follow up. Statistical methods used included descriptive and inferential statistics, χ2 chi-square tests, Kruskal-Wallis H test, Friedman test, Wilcoxon test, generalized estimating equations, and text mining.
Interventions
BEHAVIORALBoard game-based learning
The team of PGY doctors and nurses received 3 hours training intervention in resuscitation teamwork skills through a board game-based teaching approach.
BEHAVIORALSimulation-based learning
The team of PGY doctors and nurses received 3 hours training intervention in resuscitation teamwork skills through a simulation-based teaching approach.
BEHAVIORALLecture-based learning
The team of PGY doctors and nurses received 3 hours training intervention in resuscitation teamwork skills through an interactive lecture-based approach.
Sponsors
Taipei Medical University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
two assessors using video to evaluate outcomes.
Intervention model description
three arms
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. Postgraduate Year doctors who is 20 years old and work in primary care. 2. Postgraduate Year nurses who is 20 years old and work in primary care
Exclusion criteria
1. Participant do not work in primary care provide. 2. Healthcare provider do not delivery in relative adult care department, such as pediatric department, obstetrics department, and psychiatry department so on.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Team Performance Observation Tool | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. | The assessment of the medical team's teamwork performance was conducted using the Team Performance Observation Tool, which includes a 23-item rating checklist. This checklist is divided into five categories: team structure (four items), leadership (six items), communication (four items), situation monitoring (five items), and mutual support (four items). Scores for each item range from 1 (Very Poor) to 5 (Excellent), resulting in a cumulative score between 23 and 115. A higher score indicates better teamwork performance. |
| Knowledge of Teamwork Assessment | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. | The Knowledge of Teamwork assessment, aimed at evaluating healthcare professionals' understanding of teamwork knowledge, consists of 23 multiple-choice items based on the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) Learning Benchmarks provided by the Agency for Healthcare Research and Quality. Each item is formulated as a statement that participants must evaluate as true or false, choosing from five available answer options, of which only one is correct. Participants earn one point for each correct response, with no points awarded for incorrect answers, resulting in a total possible score of 0 to 23. A higher score signifies a more comprehensive understanding of the principles of teamwork knowledge. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Interprofessional Collaboration Scale | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. | The attitudes of healthcare professionals toward interprofessional collaboration were assessed using the 'Interprofessional Collaboration Scale' (IPC), which consists of 26 items. The Interprofessional Collaboration Scale covers three main aspects: communication, accommodation, and isolation. We adopted the first 13 items because they are relevant to medical and nursing professional backgrounds. The scale ranges from 1 (strongly disagree) to 4 (strongly agree), with total scores ranging from 13 to 52. A higher score indicates a more positive attitude toward interprofessional collaboration. |
| Resuscitation Knowledge Scale | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. | The healthcare professionals' resuscitation medical knowledge was assessed using the 'Adavance Cardiac Life Support Precourse Self-Assessment,' which consisted of 60 items. The assessment covered three main aspects: rhythm identification, pharmacology, and practical application. We selected 20 items related to resuscitation medical management (ventricular tachycardia, ventricular fibrilation, asystole, pulseless electrical activity). The total score ranged from 0 (minimum) to 20 (maximum), with higher scores indicating a better understanding of resuscitation medical knowledge. |
| Medical Task Performance | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. | The medical team's resuscitation management performance was assessed using the Medical Task Performance checklist. The checklist items were referenced from the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Twenty items were identified by an expert panel based on the resuscitation guidelines, including applying adequate oxygen according to the patient's dynamic condition, timely identification of cardiac arrest and provision of high-quality cardiopulmonary resuscitation, identification of shockable rhythms and delivery of timely and correct shocks, and correct administration of resuscitation medication. The checklist was rated on a dichotomous scale with scores of 2 (complete), 1 (partial), and 0 (incomplete). The total score ranged from 0 (minimum) to 40 (maximum), with higher scores indicating better resuscitation management performance by the medical team. |
| Learning Cognitive Load | The posttest right after intervention at the 4 weeks. | The learning cognitive load of healthcare professionals was assessed using the 'Chinese Version of the Learning Cognitive Load Questionnaire,' which consists of 8 items. The questionnaire encompasses two main aspects: mental load and mental effort. The scale ranges from 1 (Strongly Disagree) to 6 (Strongly Agree), with a total score from 6 (minimun) to 48 (maximun). A higher score indicates a higher learning cognitive load. |
Countries
Taiwan
Participant flow
Pre-assignment details
The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48.
Participants by arm
| Arm | Count |
|---|---|
| Board-game Based Learning The team of PGY doctors and nurses received training in resuscitation teamwork skills through a board game-based teaching approach. | 32 |
| Simulation-based Learning The team of PGY doctors and nurses received training in resuscitation teamwork skills through a simulation-based teaching approach. | 32 |
| Lecture-based Learning The team of PGY doctors and nurses received training in resuscitation teamwork skills through an interactive lecture-based learning approach. | 32 |
| Total | 96 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Posttest to Three Months Follow-up | Lost to Follow-up | 16 | 16 | 16 |
| Pretest to Posttest | Lost to Follow-up | 12 | 8 | 8 |
Baseline characteristics
| Characteristic | Board-game Based Learning | Total | Lecture-based Learning | Simulation-based Learning |
|---|---|---|---|---|
| ACLS/BLS certification No | 8 Participants | 14 Participants | 4 Participants | 2 Participants |
| ACLS/BLS certification Yes | 24 Participants | 82 Participants | 28 Participants | 30 Participants |
| Age, Continuous | 25.63 years STANDARD_DEVIATION 4.16 | 24.97 years STANDARD_DEVIATION 3.3 | 24.97 years STANDARD_DEVIATION 3.04 | 24.31 years STANDARD_DEVIATION 2.49 |
| Education Associate or below | 2 Participants | 4 Participants | 1 Participants | 1 Participants |
| Education Bachelor or above | 30 Participants | 92 Participants | 31 Participants | 31 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 32 Participants | 96 Participants | 32 Participants | 32 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Resuscitation experience (times after work) 1 | 6 Participants | 13 Participants | 2 Participants | 5 Participants |
| Resuscitation experience (times after work) ≤ 5 | 9 Participants | 24 Participants | 7 Participants | 8 Participants |
| Resuscitation experience (times after work) ≥5 | 4 Participants | 6 Participants | 1 Participants | 1 Participants |
| Resuscitation experience (times after work) No | 13 Participants | 53 Participants | 22 Participants | 18 Participants |
| Sex: Female, Male Female | 26 Participants | 77 Participants | 24 Participants | 27 Participants |
| Sex: Female, Male Male | 6 Participants | 19 Participants | 8 Participants | 5 Participants |
| Units Medical Ward | 4 Participants | 18 Participants | 6 Participants | 8 Participants |
| Units Operating Room | 3 Participants | 22 Participants | 10 Participants | 9 Participants |
| Units Others | 8 Participants | 20 Participants | 7 Participants | 5 Participants |
| Units Special Unit | 8 Participants | 18 Participants | 2 Participants | 8 Participants |
| Units Surgical Ward | 9 Participants | 18 Participants | 7 Participants | 2 Participants |
| Working experience (months) 0-6 months | 6 Participants | 34 Participants | 13 Participants | 15 Participants |
| Working experience (months) 13-18 months | 7 Participants | 13 Participants | 4 Participants | 2 Participants |
| Working experience (months) 19-24 months | 8 Participants | 14 Participants | 4 Participants | 2 Participants |
| Working experience (months) 7-12 months | 11 Participants | 35 Participants | 11 Participants | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 32 | 0 / 32 | 0 / 32 |
| other Total, other adverse events | 0 / 32 | 0 / 32 | 0 / 32 |
| serious Total, serious adverse events | 0 / 32 | 0 / 32 | 0 / 32 |
Outcome results
Primary
Knowledge of Teamwork Assessment
The Knowledge of Teamwork assessment, aimed at evaluating healthcare professionals' understanding of teamwork knowledge, consists of 23 multiple-choice items based on the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) Learning Benchmarks provided by the Agency for Healthcare Research and Quality. Each item is formulated as a statement that participants must evaluate as true or false, choosing from five available answer options, of which only one is correct. Participants earn one point for each correct response, with no points awarded for incorrect answers, resulting in a total possible score of 0 to 23. A higher score signifies a more comprehensive understanding of the principles of teamwork knowledge.
Time frame: Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks.
Population: The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Board Game-based Learning | Knowledge of Teamwork Assessment | Posttest | 19.00 score on a scale |
| Board Game-based Learning | Knowledge of Teamwork Assessment | Pretest | 18.00 score on a scale |
| Board Game-based Learning | Knowledge of Teamwork Assessment | Three months follow-up | 19.00 score on a scale |
| Simulation-based Learning | Knowledge of Teamwork Assessment | Posttest | 18.00 score on a scale |
| Simulation-based Learning | Knowledge of Teamwork Assessment | Pretest | 17.00 score on a scale |
| Simulation-based Learning | Knowledge of Teamwork Assessment | Three months follow-up | 19.00 score on a scale |
| Lecture-based Learning | Knowledge of Teamwork Assessment | Pretest | 17.00 score on a scale |
| Lecture-based Learning | Knowledge of Teamwork Assessment | Three months follow-up | 19.50 score on a scale |
| Lecture-based Learning | Knowledge of Teamwork Assessment | Posttest | 20.00 score on a scale |
Comparison: For pretest at the 0 weekp-value: <0.05Kruskal-Wallis
Comparison: For posttest right after intervention at the 4 weeks.p-value: 0.05Kruskal-Wallis
Comparison: For follow-up test at the 16 weeks.p-value: 0.05Kruskal-Wallis
Primary
Team Performance Observation Tool
The assessment of the medical team's teamwork performance was conducted using the Team Performance Observation Tool, which includes a 23-item rating checklist. This checklist is divided into five categories: team structure (four items), leadership (six items), communication (four items), situation monitoring (five items), and mutual support (four items). Scores for each item range from 1 (Very Poor) to 5 (Excellent), resulting in a cumulative score between 23 and 115. A higher score indicates better teamwork performance.
Time frame: Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks.
Population: The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Board Game-based Learning | Team Performance Observation Tool | Posttest | 57.75 score on a scale |
| Board Game-based Learning | Team Performance Observation Tool | Pretest | 53.00 score on a scale |
| Board Game-based Learning | Team Performance Observation Tool | Three months follow-up | 62.50 score on a scale |
| Simulation-based Learning | Team Performance Observation Tool | Posttest | 56.50 score on a scale |
| Simulation-based Learning | Team Performance Observation Tool | Pretest | 39.00 score on a scale |
| Simulation-based Learning | Team Performance Observation Tool | Three months follow-up | 56.75 score on a scale |
| Lecture-based Learning | Team Performance Observation Tool | Pretest | 39.25 score on a scale |
| Lecture-based Learning | Team Performance Observation Tool | Three months follow-up | 57.25 score on a scale |
| Lecture-based Learning | Team Performance Observation Tool | Posttest | 51.50 score on a scale |
Comparison: For the pretest at week 0.p-value: <0.05Kruskal-Wallis
Comparison: For posttest right after intervention at the 4 weeks.p-value: 0.05Kruskal-Wallis
Comparison: For follow-up test at the 16 weeks.p-value: 0.05Kruskal-Wallis
Secondary
Interprofessional Collaboration Scale
The attitudes of healthcare professionals toward interprofessional collaboration were assessed using the 'Interprofessional Collaboration Scale' (IPC), which consists of 26 items. The Interprofessional Collaboration Scale covers three main aspects: communication, accommodation, and isolation. We adopted the first 13 items because they are relevant to medical and nursing professional backgrounds. The scale ranges from 1 (strongly disagree) to 4 (strongly agree), with total scores ranging from 13 to 52. A higher score indicates a more positive attitude toward interprofessional collaboration.
Time frame: Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks.
Population: The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Board Game-based Learning | Interprofessional Collaboration Scale | Posttest | 41.00 score on a scale |
| Board Game-based Learning | Interprofessional Collaboration Scale | Pretest | 36.00 score on a scale |
| Board Game-based Learning | Interprofessional Collaboration Scale | Three months follow-up | 40.00 score on a scale |
| Simulation-based Learning | Interprofessional Collaboration Scale | Posttest | 45.00 score on a scale |
| Simulation-based Learning | Interprofessional Collaboration Scale | Pretest | 40.00 score on a scale |
| Simulation-based Learning | Interprofessional Collaboration Scale | Three months follow-up | 43.00 score on a scale |
| Lecture-based Learning | Interprofessional Collaboration Scale | Pretest | 38.00 score on a scale |
| Lecture-based Learning | Interprofessional Collaboration Scale | Three months follow-up | 38.50 score on a scale |
| Lecture-based Learning | Interprofessional Collaboration Scale | Posttest | 39.00 score on a scale |
Comparison: For the pretest at week 0.p-value: <0.05Kruskal-Wallis
Comparison: For posttest right after intervention at the 4 weeks.p-value: 0.05Kruskal-Wallis
Comparison: For follow-up test at the 16 weeks.p-value: 0.05Kruskal-Wallis
Secondary
Learning Cognitive Load
The learning cognitive load of healthcare professionals was assessed using the 'Chinese Version of the Learning Cognitive Load Questionnaire,' which consists of 8 items. The questionnaire encompasses two main aspects: mental load and mental effort. The scale ranges from 1 (Strongly Disagree) to 6 (Strongly Agree), with a total score from 6 (minimun) to 48 (maximun). A higher score indicates a higher learning cognitive load.
Time frame: The posttest right after intervention at the 4 weeks.
Population: The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Board Game-based Learning | Learning Cognitive Load | 22.00 score on a scale |
| Simulation-based Learning | Learning Cognitive Load | 22.00 score on a scale |
| Lecture-based Learning | Learning Cognitive Load | 21.00 score on a scale |
Comparison: For posttest right after intervention at the 4 weeks.p-value: <0.05Kruskal-Wallis
Secondary
Medical Task Performance
The medical team's resuscitation management performance was assessed using the Medical Task Performance checklist. The checklist items were referenced from the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Twenty items were identified by an expert panel based on the resuscitation guidelines, including applying adequate oxygen according to the patient's dynamic condition, timely identification of cardiac arrest and provision of high-quality cardiopulmonary resuscitation, identification of shockable rhythms and delivery of timely and correct shocks, and correct administration of resuscitation medication. The checklist was rated on a dichotomous scale with scores of 2 (complete), 1 (partial), and 0 (incomplete). The total score ranged from 0 (minimum) to 40 (maximum), with higher scores indicating better resuscitation management performance by the medical team.
Time frame: Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks.
Population: The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Board Game-based Learning | Medical Task Performance | Three months follow-up | 29.25 score on a scale |
| Board Game-based Learning | Medical Task Performance | Posttest | 29.00 score on a scale |
| Board Game-based Learning | Medical Task Performance | Pretest | 23.00 score on a scale |
| Simulation-based Learning | Medical Task Performance | Posttest | 27.25 score on a scale |
| Simulation-based Learning | Medical Task Performance | Pretest | 13.25 score on a scale |
| Simulation-based Learning | Medical Task Performance | Three months follow-up | 28.50 score on a scale |
| Lecture-based Learning | Medical Task Performance | Pretest | 22.00 score on a scale |
| Lecture-based Learning | Medical Task Performance | Three months follow-up | 22.00 score on a scale |
| Lecture-based Learning | Medical Task Performance | Posttest | 27.00 score on a scale |
Comparison: For the pretest at week 0.p-value: <0.05Kruskal-Wallis
Comparison: For posttest right after intervention at the 4 weeks.p-value: 0.05Kruskal-Wallis
Comparison: For follow-up test at the 16 weeks.p-value: 0.05Kruskal-Wallis
Secondary
Resuscitation Knowledge Scale
The healthcare professionals' resuscitation medical knowledge was assessed using the 'Adavance Cardiac Life Support Precourse Self-Assessment,' which consisted of 60 items. The assessment covered three main aspects: rhythm identification, pharmacology, and practical application. We selected 20 items related to resuscitation medical management (ventricular tachycardia, ventricular fibrilation, asystole, pulseless electrical activity). The total score ranged from 0 (minimum) to 20 (maximum), with higher scores indicating a better understanding of resuscitation medical knowledge.
Time frame: Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks.
Population: The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Board Game-based Learning | Resuscitation Knowledge Scale | Posttest | 11.00 score on a scale |
| Board Game-based Learning | Resuscitation Knowledge Scale | Pretest | 7.00 score on a scale |
| Board Game-based Learning | Resuscitation Knowledge Scale | Three months follow-up | 8.50 score on a scale |
| Simulation-based Learning | Resuscitation Knowledge Scale | Posttest | 11.00 score on a scale |
| Simulation-based Learning | Resuscitation Knowledge Scale | Pretest | 8.00 score on a scale |
| Simulation-based Learning | Resuscitation Knowledge Scale | Three months follow-up | 7.00 score on a scale |
| Lecture-based Learning | Resuscitation Knowledge Scale | Pretest | 7.00 score on a scale |
| Lecture-based Learning | Resuscitation Knowledge Scale | Three months follow-up | 7.50 score on a scale |
| Lecture-based Learning | Resuscitation Knowledge Scale | Posttest | 11.00 score on a scale |
Comparison: For the pretest at week 0.p-value: <0.05Kruskal-Wallis
Comparison: For posttest right after intervention at the 4 weeks.p-value: 0.05Kruskal-Wallis
Comparison: For follow-up test at the 16 weeks.p-value: 0.05Kruskal-Wallis