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Publikation TEAMs go VR - validating the TEAM in a virtual reality (VR) medical team training(BioMed Central, 2024) Wespi, Rafael; Schwendimann, Lukas; Neher, Andrea; Birrenbach, Tanja; Schauber, Stefan K.; Manser, Tanja; Sauter, Thomas C.; Kämmer, Juliane E.Abstract Background Inadequate collaboration in healthcare can lead to medical errors, highlighting the importance of interdisciplinary teamwork training. Virtual reality (VR) simulation-based training presents a promising, cost-effective approach. This study evaluates the effectiveness of the Team Emergency Assessment Measure (TEAM) for assessing healthcare student teams in VR environments to improve training methodologies. Methods Forty-two medical and nursing students participated in a VR-based neurological emergency scenario as part of an interprofessional team training program. Their performances were assessed using a modified TEAM tool by two trained coders. Reliability, internal consistency, and concurrent validity of the tool were evaluated using intraclass correlation coefficients (ICC) and Cronbach’s alpha. Results Rater agreement on TEAM’s leadership, teamwork, and task management domains was high, with ICC values between 0.75 and 0.90. Leadership demonstrated strong internal consistency (Cronbach’s alpha = 0.90), while teamwork and task management showed moderate to acceptable consistency (alpha = 0.78 and 0.72, respectively). Overall, the TEAM tool exhibited high internal consistency (alpha = 0.89) and strong concurrent validity with significant correlations to global performance ratings. Conclusion The TEAM tool proved to be a reliable and valid instrument for evaluating team dynamics in VR-based training scenarios. This study highlights VR’s potential in enhancing medical education, especially in remote or distanced learning contexts. It demonstrates a dependable approach for team performance assessment, adding value to VR-based medical training. These findings pave the way for more effective, accessible interdisciplinary team assessments, contributing significantly to the advancement of medical education.01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Video analysis of real‐life shoulder dystocia to assess technical and non‐technical performance(Wiley, 2024) Roed Hjorth‐Hansen, Kristiane; Rosvig, Lena; Hvidman, Lone; Kierkegaard, Ole; Uldbjerg, Niels; Manser, Tanja; Brogaard, LiseIntroduction Managing obstetric shoulder dystocia requires swift action using correct maneuvers. However, knowledge of obstetric teams' performance during management of real‐life shoulder dystocia is limited, and the impact of non‐technical skills has not been adequately evaluated. We aimed to analyze videos of teams managing real‐life shoulder dystocia to identify clinical challenges associated with correct management and particular non‐technical skills correlated with high technical performance. Material and Methods We included 17 videos depicting teams managing shoulder dystocia in two Danish delivery wards, where deliveries were initially handled by midwives, and consultants were available for complications. Delivery rooms contained two or three cameras activated by Bluetooth upon obstetrician entry. Videos were captured 5 min before and after activation. Two obstetricians assessed the videos; technical performances were scored as low (0–59), average (60–84), or high (85–100). Two other assessors evaluated non‐technical skills using the Global Assessment of Team Performance checklist, scoring 6 (poor) to 30 (excellent). We used a spline regression model to explore associations between these two score sets. Inter‐rater agreement was assessed using interclass correlation coefficients. Results Interclass correlation coefficients were 0.71 (95% confidence interval 0.23–0.89) and 0.82 (95% confidence interval 0.52–0.94) for clinical and non‐technical performances, respectively. Two teams had low technical performance scores; four teams achieved high scores. Teams adhered well to guidelines, demonstrating limited head traction, McRoberts maneuver, and internal rotation maneuvers. Several clinical skills posed challenges, notably recognizing shoulder impaction, applying suprapubic pressure, and discouraging women from pushing. Two non‐technical skills were associated with high technical performance: effective patient communication, with teams calming the mother and guiding her collaboration during internal rotational maneuvers, and situation awareness, where teams promptly mobilized all essential personnel (senior midwife, consultant, pediatric team). Team communication, stress management, and task management skills were not associated with high technical performance. Conclusions Videos capturing teams managing real‐life shoulder dystocia are an effective tool to reveal challenges with certain technical and non‐technical skills. Teams with high technical performance are associated with effective patient communication and situational awareness. Future training should include technical skills and non‐technical skills, patient communication, and situation awareness.01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams – an observational study with a randomized cross-over design(BioMed Central, 15.07.2024) Dubois, Hanna; Manser, Tanja; Häbel, Henrike; Härgestam, Maria; Creutzfeldt, JohanAbstract Background In northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the physicians to the rest of the team – creating ‘distributed teams’. Patient participation is a core competency for healthcare professionals. Knowledge about how distributed teamwork affects patient participation is missing. The aim was to investigate if and how teamwork affecting patient participation, as well as clinicians’ perceptions regarding shared decision-making differ between co-located and distributed emergency teams. Methods In an observational study with a randomized cross-over design, healthcare professionals (n = 51) participated in authentic teams (n = 17) in two scripted simulated emergency scenarios with a standardized patient: one as a co-located team and the other as a distributed team. Team performances were filmed and observed by independent raters using the PIC-ET tool to rate patient participation behavior. The participants individually filled out the Dyadic OPTION questionnaire after the respective scenarios to measure perceptions of shared decision-making. Scores in both instruments were translated to percentage of a maximum score. The observational data between the two settings were compared using linear mixed-effects regression models and the self-reported questionnaire data were compared using one-way ANOVA. Neither the participants nor the observers were blinded to the allocations. Results A significant difference in observer rated overall patient participation behavior was found, mean 51.1 (± 11.5) % for the co-located teams vs 44.7 (± 8.6) % for the distributed teams (p = 0.02). In the PIC-ET tool category ‘Sharing power’, the scores decreased from 14.4 (± 12.4) % in the co-located teams to 2 (± 4.4) % in the distributed teams (p = 0.001). Co-located teams scored in mean 60.5% (± 14.4) when self-assessing shared decision-making, vs 55.8% (± 15.1) in the distributed teams (p = 0.03). Conclusions Team behavior enabling patient participation was found decreased in distributed teams, especially regarding sharing power with the patient. This finding was also mirrored in the self-assessments of the healthcare professionals. This study highlights the risk of an increased power asymmetry between patients and distributed emergency teams and can serve as a basis for further research, education, and quality improvement.01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Is intuition allied with jumping to conclusions in decision-making? An intensive longitudinal study in patients with delusions and in non-clinical individuals(Public Library of Science, 20.12.2021) Zander-Schellenberg, Thea; Kuhn, Sarah; Möller, Julian; Meyer, Andrea H.; Huber, Christian; Lieb, Roselind; Andreou, Christina01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Team performance during vacuum-assisted vaginal delivery: video review of obstetric multidisciplinary teams(Frontiers Research Foundation, 2024) Brogaard, Lise; Rosvig, Lena Have; Hjorth-Hansen, Kristiane Roed; Hvidman, Lone; Hinshaw, Kim; Kierkegaard, Ole; Uldbjerg, Niels; Manser, TanjaIntroduction Vacuum extraction is generally considered an operator-dependent task, with most attention directed toward the obstetrician’s technical abilities. Little is known about the effect of the team and non-technical skills on clinical outcomes in vacuum-assisted delivery. This study aimed to investigate whether the non-technical skills of obstetricians were correlated with their level of clinical performance via the analysis of video recordings of teams conducting actual vacuum extractions. Methods We installed between two or three video cameras in each delivery room at Aarhus University Hospital and Horsens Regional Hospital and obtained 60 videos of teams managing vacuum extraction. Appropriate consent was obtained. Two raters carefully reviewed the videos and assessed the teams’ non-technical skills using the Assessment of Obstetric Team Performance (AOTP) checklist, rating all items on a Likert scale score from 1 to 5 (1 = poor; 3 = average; and 5 = excellent). This resulted in a total score ranging from 18 to 90. Two different raters independently assessed the teams’ clinical performance (adherence to clinical guidelines) using the TeamOBS-Vacuum-Assisted Delivery (VAD) checklist, rating each item (0 = not done, 1 = done incorrectly; and 2 = done correctly). This resulted in a total score with the following ranges (low clinical performance: 0–59; average: 60–84; and high: 85–100). Interrater agreement was analyzed using intraclass correlation (ICC), and the risk of high or low clinical performance was analyzed on a logit scale to meet the assumption of normality. Results Teams that received excellent non-technical scores had an 81% probability of achieving high clinical performance, whereas this probability was only 12% among teams with average non-technical scores (p < 0.001). Teams with a high clinical performance often had excellent behavior in the non-technical items of “team interaction,” “anticipation,” “avoidance fixation,” and “focused communication.” Teams with a low or average clinical performance often neglected to consider analgesia, had delayed abandonment of the attempted vaginal delivery and insufficient use of appropriate fetal monitoring. Interrater reliability was high for both rater-teams, with an ICC for the non-technical skills of 0.83 (95% confidence interval [CI]: 0.71–0.88) and 0.84 for the clinical performance (95% CI: 0.74–0.90). Conclusion Although assisted vaginal delivery by vacuum extraction is generally considered to be an operator-dependent task, our findings suggest that teamwork and effective team interaction play crucial roles in achieving high clinical performance. Teamwork helped the consultant anticipate the next step, avoid fixation, ensure adequate analgesia, and maintain thorough fetal monitoring during delivery.01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Developing the TeamOBS-vacuum-assisted delivery checklist to assess clinical performance in a vacuum-assisted delivery: a Delphi study with initial validation(Frontiers Research Foundation, 2024) Brogaard, Lise; Hinshaw, Kim; Kierkegaard, Ole; Manser, Tanja; Uldbjerg, Niels; Hvidman, LoneIn Northern Europe, vacuum-assisted delivery (VAD) accounts for 6–15% of all deliveries; VAD is considered safe when conducted by adequately trained personnel. However, failed vacuum extraction can be harmful to both the mother and child. Therefore, the clinical performance in VAD must be assessed to guide learning, determine a performance benchmark, and evaluate the quality to achieve an overall high performance. We were unable to identify a pre-existing tool for evaluating the clinical performance in real-life vacuum-assisted births. We aimed to develop and validate a checklist for assessing the clinical performance in VAD. We conducted a Delphi process, described as an interactive process where experts answer questions until answers converge toward a “joint opinion” (consensus). We invited international experts as Delphi panelists and reached a consensus after four Delphi rounds, described as follows: (1) the panelists were asked to add, remove, or suggest corrections to the preliminary list of items essential for evaluating clinical performance in VAD; (2) the panelists applied weights of clinical importance on a Likert scale of 1–5 for each item; (3) each panelist revised their original scores after reviewing a summary of the other panelists’ scores and arguments; and (4) the TeamOBS-VAD was tested using videos of real-life VADs, and the Delphi panel made final adjustments and approved the checklist. Twelve Delphi panelists from the UK (n = 3), Norway (n = 2), Sweden (n = 3), Denmark (n = 3), and Iceland (n = 1) were included. After four Delphi rounds, the Delphi panel reached a consensus on the checklist items and scores. The TeamOBS-VAD checklist was tested using 60 videos of real-life vacuum extractions. The inter-rater agreement had an intraclass correlation coefficient (ICC) of 0.73; 95% confidence interval (95% CI) of [0.58, 0.83], and that for the average of two raters was ICC 0.84 95% CI [0.73, 0.91]. The TeamOBS-VAD score was not associated with difficulties in delivery, such as the number of contractions during vacuum extraction delivery, cephalic level, rotation, and position. Failed vacuum extraction occurred in 6% of the video deliveries, but none were associated with the teams with low clinical performance scores. The TeamOBS-VAD checklist provides a valid and reliable evaluation of the clinical performance of vaginal-assisted vacuum extraction.01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Exploring objective measures for assessing team performance in healthcare: an interview study(Frontiers Research Foundation, 10/2023) Wespi, Rafael; Birrenbach, Tanja; Schauber, Stefan K.; Manser, Tanja; Sauter, Thomas C.; Kämmer, Juliane E.01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Coordination and communication in healthcare action teams(Hogrefe, 10/2020) Burtscher, Michael J.; Nussbeck, Fridtjof W.; Sevdalis, Nick; Gisin, Stefan; Manser, TanjaCommunication and coordination represent central processes in healthcare action teams. However, we have a limited understanding of how expertise affects these processes and to what extent these effects are shaped by interprofessional differences. The current study addresses these questions by jointly investigating the influence of different aspects of expertise – individual expertise, team familiarity, and expertise asymmetry – on coordination quality and communication openness. We tested our propositions in two hospitals: one in Switzerland (CH, Sample 1) and one in the United Kingdom (UK, Sample 2). Both samples included two-person anesthesia action teams consisting of a physician and a nurse ( NCH = 47 teams, NUK = 48 teams). We used a correlational design with two measurement points (i.e., pre- and postoperation). To consider potential interprofessional differences, we analyzed our data with actor-partner interdependence models. Moreover, we explored differences in the effects of expertise between both hospitals. Our findings suggest that nurses’ expertise is the most important predictor of coordination quality and communication openness. Overall, differences between the two hospitals were more prevalent than interprofessional differences between physicians and nurses. The current study provides a nuanced picture of the effects of expertise, and thereby extends our understanding of interprofessional teamwork.01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Assessing patients' perceptions of safety culture in the hospital setting: Development and initial evaluation of the patients' perceptions of safety culture scale(Lippincott Williams & Wilkins, 2020) Monaca, Clara; Bestmann, Beate; Kattein, Martina; Langner, Daria; Müller, Hardy; Manser, Tanja01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Behavioural observation tool for patient involvement and collaboration in emergency care teams (PIC‑ET‑tool)(BioMed Central, 01.07.2023) Dubois, Hanna; Creutzfeldt, Johan; Manser, Tanja01A - Beitrag in wissenschaftlicher Zeitschrift