Medical Simulation and Information Sciences Department – Advancing Inter-professional Team-Based Learning in Military Medical Settings (Team_INTEL)

• Patient risk factors versus the medical staff’s individual skills (i.e., surgical, central line insertion, administration of anesthesia, diagnosis of disease/injury) and
• Patient risk factors versus the medical team assigned to the patient condition (i.e., communication, team process, safety, morale, leadership).

Within the medical community, the perception of communication is sadly misleading. A 2005 survey2 showed that before team training, teamwork was initially perceived by the surgeon and attending surgeons as good, but anesthesiologist and operating room (OR) personnel perceived teamwork as poor. After the team training was implemented, only the surgeon’s communication with the anesthesiologist improved significantly, not with the OR supporting personnel. This survey was conducted in a civilian medical environment, and, due to differences in military culture, it is unknown whether this survey or results of the survey would carry over into military medical settings.

Research has shown a connection in the cohesion of the team process when the patient is the center focus of any medical procedure (non-emergency and emergency settings)3. The pre-briefing before the procedure and the debriefing following the procedure are focused completely on patient safety and the patient outcomes. This approach results in a way forward for continuing improvement, discovering lessons learned, and process modification or correction to keep the pathway clear for lifelong learning, course correction, and ultimately an improvement in medical team processes to eliminate medical errors. Quality teams are encircled by a culture of trust and respect for all professional skillsets that builds excellence within the team during all phases of the team effort.

For the purposes of this announcement, there are two main schools of thought on team training.
• Medical Team Training (MTT)
• Medical Team-Based Learning (TBL)

The military and civilian sectors have utilized MTT in more advanced learning states in medical teams; TBL has not been integrated as well in the medical community4. TBL encourages the pursuance of adaptation, flexibility, and lifelong learning, all of which are essential for the medical professional to acclimate quickly in varying military medical environments. TBL has some similarities to MTT: TBL stresses understanding of roles and situation awareness beforehand; in other words, never assume everyone is automatically on the same page. It is very important the leadership role be identified, structure explained, goals understood, expectations of the upcoming encounter discussed, and, finally, Question & Answer discussions be incorporated in a “no fear” environment. After the medical procedure is conducted, it is followed by a debriefing. This step is not omitted and is extremely important as it promotes lessons learned and process improvements. The results are reflected in a decrease in errors and close calls, and a decrease in patient morbidity and mortality rates.

The FY17 JPC-1/MSIS Team_INTEL is seeking research to determine, define, and validate learning strategies that foster inter-professional team-based learning during the early stages i.e. when teams are forming and groups are becoming familiar with each other and are starting to implement their roles and responsibilities of medical skills training in order to eliminate the current culture of focusing on the individual’s medical skills and leaving team training practice at a later date during “on the job training.”

• It is expected that award recipients will use statistical approaches to determine the best metrics and evaluation criteria that will objectively assess a foundation on team-based learning training practice guideline(s);
• It is expected that award recipients will provide definitions to the metrics and evaluation criteria that will be objectively or subjectively collected, and provide the respective measurement tools (either currently commercially available or to be developed via this anticipated award mechanism);
• It is expected that award recipients will utilize inter-professional teams from different clinical practice skillsets (i.e., novice through experts; different areas of military services);

It is encouraged that the validation of member team skills are not based solely on student learners, as team leaders are typically more advanced learners of a higher rank and need to be included to measure true effectiveness of the team effectiveness training program;
• It is expected that award recipients will include a model of training that should be able to be used across the services, throughout the continuum of care, and in various military team-based environments from Roles 1-45;
• It is expected that the Team_INTEL should be adaptive to teaching not only student learners new to a TBL environment but include those who have been in team environments and can influence and alter unproductive team behavior practices;
• It is anticipated that the outcomes of the research will result in a model that is implemented into data/knowledge systems and tested in a lab-type environment. Actual interfaces will need to be described and defined in the outcome;
• It is anticipated that many of these variables, metrics, and evaluation criteria will be employed across the military, Veterans Health Administration, academic, inpatient, outpatient clinics, rural healthcare settings, private and public hospitals, and international healthcare situations;
• It is anticipated that research outcomes, analysis, methodologies, and conclusions will be disseminated and propagated to the military and the Government, but also to the public at large. Public benefits from this research are encouraged.