Interprofessional teamwork for managing medical deterioration in pregnancy: What contributes to good clinical performance in simulated practice?

Mary Lavelle, Gabriel B. Reedy, Thomas Simpson, Anita Banerjee, Janet E. Anderson

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives To identify the patterns of teamwork displayed by interprofessional teams during simulated management of medical deterioration in pregnancy and examine whether and how they are related to clinical performance in simulated practice. Design Exploratory observational cohort study. Setting Interprofessional clinical simulation training with scenarios involving the management of medical deterioration in pregnant women. Participants Seventeen simulated scenarios involving 62 qualified healthcare staff working within the National Health Service attending clinical simulation training (midwives (n=18), obstetricians (n=24) and medical physicians (n=20)). Main outcome measure(s) Teamwork behaviours over time, obtained through detailed observational analysis of recorded scenarios, using the Temporal Observational Analysis of Teamwork (TOAsT) framework. Clinician rated measures of simulated clinical performance. Results Scenarios with better simulated clinical performance were characterised by shared leadership between obstetricians and midwives at the start of the scenario, with obstetricians delegating less and midwives disseminating rationale, while both engaged in more information gathering behaviour. Towards the end of the scenario, better simulated clinical performance was associated with dissemination of rationale to the team. More delegation at the start of a scenario was associated with less spontaneous sharing of information and rationale later in the scenario. Teams that shared their thinking at the start of a scenario continued to do so over time. Conclusions Teamwork during the opening moments of a clinical situation is critical for simulated clinical performance in the interprofessional management of medical deterioration in pregnancy. Shared leadership and the early development of the shared mental model are associated with better outcomes.

Original languageEnglish
Pages (from-to)463-470
Number of pages8
JournalBMJ Simulation & Technology Enhanced Learning
Volume7
Issue number6
DOIs
Publication statusPublished - Jul 2021
Externally publishedYes

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