Change in attitudes and performance of critical care teams after a multi-disciplinary simulation-based intervention

Objectives: To conduct an in-depth exploration of the self-reported long-term change in attitudes and performance after a full-day multidisciplinary simulation-based course focussed on team management of emergency events in the Critical Care Unit. To address the current lack of knowledge of factors which can lead to improved teamwork performance and their measurement through identification of measurable markers of behaviour and attitude change. Methods: A purposive sample of course participants underwent semi-structured interviews one to five months after course completion. Responses were coded using grounded theory to identify instances of learning, changes in attitudes or clinical performance, and measurable behavioural and attitudinal markers for such change. Interviews continued until data saturation was achieved. Results: Twenty nine participants (15 doctors and 14 nurses) were interviewed. Doctors became more confident in delegating and including nurses in decision making, and nurses became more confident and aware of the need for effective communication. Doctors reported that their ability to assign team roles improved over the day and that they made more frequent use of closed-loop communication. Both professional groups reported improvement in communication in the clinical setting after participation, including better vocalising of thoughts and use of colleagues' names. Attitudes to communication also improved and persisted in the clinical setting. Conclusions: Addressing gaps in current medical education knowledge, self-reported improvements in behaviour and attitudes translated to clinical performance after a simulation course. Measurable behavioural and attitudinal markers were identified that may assist with the development of evidence-based measurement tools in future team training work.