A novel use of team-based learning to improve teamwork during ACLS

Abstract

Background: Faculty members are limited in their ability to observe and evaluate leadership, professionalism, and team-oriented behaviors of their residents in high-risk, high-stress situations such as code events.  This challenge comes from the need to balance patient safety and resident autonomy.  Additionally, residents often find themselves in the position of “code” leader without sufficient training in how to lead “ad hoc” teams, including how to manage team communication and difficult inter-personal issues that often develop during these high-stress events.

Methods: We developed a novel instructional design that combined Team-Based Learning with high-fidelity simulation in order to focus on the development of team-based behaviors. American Heart Association/Advanced Cardiac Life Support (ACLS) certified post graduate year-2 internal medicine residents in a large urban academic medical center underwent a six-week integrated team-based learning/ACLS simulation curriculum during a series of academic half-days.  Team-based learning can not only increase the ability of learners to solve practical problems but can also improve attitudes about the value of working in teams.  Simulation experiences are known to improve ACLS skills.  Given the strengths of each instructional method, we integrated high fidelity simulations as the application exercises of a team-based learning framework.  Application exercises emphasized dealing with disruptive team members or situations.

Results: 27 residents completed the course.  Pre-post medical knowledge increased based on quiz results (p < .05); and, pre-post self-efficacy ratings in ACLS skills and in attitudes towards team-based behaviors all increased (p < .01).

Conclusions: Integrating team-based learning and high-fidelity simulation was a unique solution to the challenges of holding learners accountable for pre-simulation preparation and providing practice and feedback on dealing with disruptions to good team based behaviors.  Our experience with this integrated instructional strategy was encouraging and future evaluation is needed to determine replicability and clinical translational impact.