Developing a High Performance Team Training Framework for Internal Medicine: The ABC's of Teamwork

Background:

Effective teamwork and communication can prevent error and mitigate harm. High‐performance team training was developed in the aviation industry for flight crews, and is being incorporated in healthcare settings such as emergency departments, operating rooms, and labor and delivery suites.

Purpose:

We translated and adapted high‐performance teamwork and communication principles from other industries and other disciplines to an inpatient internal medicine environment.

Description:

Key principles drawn from aviation and anesthesia crew training programs were selected, and were organized into the ABC's of teamwork. These included appropriate Assertiveness, effective Briefings, Callback and verification, Situational awareness, and Shared mental models. Assertiveness training emphasized the use of the ‘two‐challenge rule’, particularly in the setting of a hierarchy gradient. Effective briefings rely on standardized written and oral sign‐outs and handoffs. The callback technique is used to improve the reliability of verbal communication. The concepts of situational awareness and shared mental models ensure alignment of goals and behaviors of members of a high‐performance team. Once the content was selected, we developed a teaching session for internal medicine residents and faculty, and evaluated learners' patient safety attitudes and knowledge pre‐ and post‐training with a written survey.

Summary of Results:

Over fifty residents participated in the module. Surprisingly, greater than 90% were able to correctly identify the concept of situational awareness before intervention. We were interested in whether introducing key teamwork concepts would change resident attitudes, despite this baseline level of knowledge. We found that 65% of residents reported that they “would feel comfortable telling a senior clinician his/her plan was unsafe” before training; this increased to 90% after training (p=0.01). In survey research, this marker of assertiveness has been directly linked to the presence of a safety culture in an organization. We found that during the discussion portion of the module, residents were able to provide examples from their clinical practice that emphasized all of the ABC's of teamwork.

Statement of Conclusions:

Teamwork principles can be adapted from other disciplines and applied to internal medicine. After a single session, residents planned to change their teamwork behavior.

Author Disclosure Block:

A. Carbo, None; A. Tess, None; M. Saadeh, None; S.N. Weingart, None.