Team training in obstetrics: A multi-level evaluation.
BACKGROUND
Obstetric complications and adverse patient events are often preventable. Teamwork and situational awareness (SA) can improve detection and coordination of critical obstetric (OB) emergencies, subsequently improving decision making and patient outcomes. The purpose of this study was to assess the effectiveness of a team training intervention in improving learning and transfer of teamwork, SA, decision making, and cognitive bias as well as patient outcomes in OB.


METHODS
An adapted TeamSTEPPS training program was delivered to OB clinicians. Training targeted communication, mutual support, situation monitoring, leadership, SA, and cognitive bias. We conducted a repeated measures multilevel evaluation of the training using Kirkpatrick's (1994) framework of training evaluation to determine impact on trainee reactions, learning, transfer, and results. Data were collected using surveys, situational judgment tests (SJTs), observations, and patient chart reviews.


RESULTS
Participants perceived the training as useful. Additionally, participants acquired knowledge of communication strategies, though knowledge of other team competencies did not significantly improve nor did self-reported teamwork on the unit. Although SJT decision accuracy did not significantly improve for all scenarios, results of behavioral observation suggest that decision accuracy significantly improved on the job, and there was a marginally significant reduction in babies' hospital length of stay.


CONCLUSIONS
These findings indicate that the training intervention was partially effective, but more work needs to be done to determine the conditions under which training is most effective, and the ways in which to sustain improvements. Future research is needed to confirm its generalizability to additional OB units and departments.
Institute for Simulation & Training and Department of Psychology, University of Central Florida.
Shirley C
SC
Sonesh
Institute for Simulation & Training and Department of Psychology, University of Central Florida.
Megan E
ME
Gregory
Institute for Simulation & Training and Department of Psychology, University of Central Florida.
Ashley M
AM
Hughes
Institute for Simulation & Training and Department of Psychology, University of Central Florida.
Jennifer
J
Feitosa
Institute for Simulation & Training and Department of Psychology, University of Central Florida.
Lauren E
LE
Benishek
Department of Psychology, University of Central Florida.
Dana
D
Verhoeven
Department of Psychology, Wichita State University.
Brady
B
Patzer
Division of Behavioral and Organizational Sciences, Claremont Graduate University.
Maritza
M
Salazar
College of Nursing, University of Central Florida.
Laura
L
Gonzalez
Institute for Simulation & Training and Department of Psychology, University of Central Florida.
Eduardo
E
Salas
D000328:Adult; D001364:Awareness; D004493:Education / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009774:Obstetrics / Q000379:methods* / Q000592:standards*; D010348:Patient Care Team / Q000706:statistics & numerical data* / Q000639:trends; D061214:Patient Safety / Q000592:standards; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D011795:Surveys and Questionnaires