Leveraging just-in-time simulation to train ad hoc teams.

Abstract

Background: Simulation prepares clinicians for managing healthcare emergencies in ad hoc teams. However, simulation curricula are often resource, personnel, and time intensive. Applying "just-in-time" (JIT) methodology to simulation training for ad hoc teams may provide similar benefits with fewer resources, although its effectiveness and perceived benefit remain unknown.

Methods: To determine if JIT teamwork simulation for ad hoc teams is perceived to increase confidence in managing emergencies and improve teamwork during a call shift, anesthesiology residents participated in JIT teamwork simulation training immediately prior to their overnight call shift from 2020 to 2022. After the call shift, residents completed a survey gathering feedback about the simulation, its impact on their confidence managing the simulated emergencies, and their perception of the call team's dynamic and management of real emergencies overnight.

Results: Of 109 participants, 66 (60.5%) completed the survey. Confidence in managing emergencies rose from 39.8 (SD = 20.7) to 66.4 (SD = 17.9) out of 100 after simulation (P < 0.001, Cohen's d = 1.38). Content analysis of the open-ended responses focusing on the residents' perception of the call team's dynamic and management of real emergencies overnight resulted in two categories: (1) improved ad hoc teaming and (2) improved use of crisis resource management skills by the overnight team.

Conclusions: After a single session before an overnight shift, JIT teamwork simulation increased anesthesia residents' self-reported confidence in managing emergencies, and residents perceived an improvement in ad hoc teamwork and use of crisis resource management skills overnight.