Setting and Problem
Inpatient medicine requires strong teamwork, yet there is a paucity of educational interventions to develop these skills. Additionally, residents often encounter high-stakes clinical scenarios involving decompensating patients with pathology they may not have managed previously. These scenarios often involve an interdisciplinary rapid response team and leave little room for error. We took an iterative approach in the development of a novel hospital medicine conference that fosters the application of medical knowledge and improves teamwork skills during acute clinical scenarios utilizing quality improvement methodology.
Intervention
A 60-minute hospital medicine conference was developed combining pedagogic approaches from team-based learning (TBL) and simulation for managing clinical scenarios in the acute care setting (Figure). The pilot occurred over 3 sessions and included medical students and postgraduate year 1–3 internal medicine residents; the topics included transfusion reactions and status epilepticus. Each session utilized the simulation center, a conference room, and 2 faculty members—one moderating the simulation room and one moderating the TBL room.
Structure of 1-Hour Conference
Abbreviations: IRAT, Individual Readiness Assessment Test; GRAT, Group Readiness Assessment Test; TBL, team-based learning.
Structure of 1-Hour Conference
Abbreviations: IRAT, Individual Readiness Assessment Test; GRAT, Group Readiness Assessment Test; TBL, team-based learning.
A week before each session, learners were assigned prereading. At the beginning of each session, learners were split into 2 groups, with half starting in the simulation center and the remainder starting in the TBL room.1 The TBL room first completed a multiple-choice question test known as the Individual Readiness Assessment Test (IRAT). They were then divided into small groups to discuss the same multiple-choice question known as the Group Readiness Assessment Test (GRAT). While in these groups, the TBL learners completed clinical case exercises requiring them to develop differential diagnoses and discuss medical management as a team. Simultaneously, simulation learners managed an unstable patient and then the learners switched rooms.
Combining TBL and simulation in a conference provided a novel experience that enhanced adult learning. Through the TBL component, learners applied their knowledge by solving clinically relevant problems in teams. The simulation component allowed learners to receive feedback on their medical decision-making.
Outcomes to Date
Through quality improvement methodology of plan-do-study-act cycles, this conference structure was optimized. After each session, learners submitted anonymous feedback through a post-survey that included open-ended questions asking them to identify the most and least effective portions of the session. Faculty debriefed after every session and made formative adjustments to the session structure based on learner feedback. Our first improvement cycle focused on changing the timing of team formation, our second cycle decreased the number of questions in the IRAT/GRAT, and the third cycle decreased the number of TBL exercises.
A total of 40 learner surveys were completed over the 3 sessions (session 1: n =13, session 2: n =13, session 3: n = 14); approximately 4 to 6 medical students participated in each session, but were not asked to identify themselves separately on the survey. Three questions were assessed in addition to the open-ended feedback. Question topics included (1) learner preference for TBL/simulation versus traditional lecture; (2) learner engagement; and (3) learner comfort level in caring for the clinical condition in the future. Post-survey results suggest that 92.5% (37 of 40) of learners agreed or strongly agreed that they preferred this style of conference over a traditional didactic lecture, 82.5% (33 of 40) agreed or strongly agreed that they were engaged, and 97.5% (39 of 40) responded that they felt at least moderately comfortable managing these acute clinical care scenarios.
Results suggest this conference may increase learner engagement and may be preferred over a traditional didactic lecture. It also may increase learner comfort managing acute clinical scenarios in hospital medicine.
Future goals include adding interprofessional learners to teams (eg, pharmacy, nursing) and expanding curriculum topics. This innovation will have additional evaluations to assess its effect on interprofessional learning in hospital scenarios and whether it has applicability to other specialties.
The authors would like to thank Donna Windish, MD, MPH, Department of Internal Medicine, Yale University School of Medicine, and Brook Watts, MD, MS, Professor of Medicine, Case Western Reserve University School of Medicine, and The MetroHealth System, for their valuable comments in the revision of this manuscript.