title: Making an "Attitude Adjustment": Using a Simulation-Enhanced Interprofessional Education Strategy to Improve Attitudes Toward Teamwork and Communication.
abstract: BACKGROUND
  Health care providers must effectively function in highly skilled teams in a collaborative manner, but there are few interprofessional training strategies in place. Interprofessional education (IPE) using simulation technology has gained popularity to address this need because of its inherent ability to impact learners' cognitive frames and promote peer-to-peer dialog. Provider attitudes toward teamwork have been directly linked to the quality of patient care. Investigators implemented a simulation-enhanced IPE intervention to improve staff attitudes toward teamwork and interprofessional communication in the emergency department setting.
  
  
  METHODS
  The 3-hour course consisted of a didactic session highlighting teamwork and communication strategies, 2 simulation scenarios on septic shock and cardiac arrest, and structured debriefing directed at impacting participant attitudes to teamwork and communication. This was a survey-based observational study. We used the TeamSTEPPS Teamwork Attitudes Questionnaire immediately before and after the session as a measurement of attitude change as well as the Hospital Survey on Patient Safety Culture before the session and 1 year after the intervention for program impact at the behavior level.
  
  
  RESULTS
  Seventy-two emergency department nurses and resident physicians participated in the course from July to September 2012. Of the 5 constructs in TeamSTEPPS Teamwork Attitudes Questionnaire, 4 had a significant improvement in scores-6.4%, 2.8%, 4.0%, and 4.0% for team structure, leadership, situation monitoring, and mutual support, respectively (P < 0.0001, P = 0.029, P = 0.014, and P = 0.003, respectively). For Hospital Survey on Patient Safety Culture, 3 of 6 composites directly related to teamwork and communication showed a significant improvement-20.6%, 20.5%, and 23.9%, for frequency of event reporting, teamwork within hospital units, and hospital handoffs and transitions, respectively (P = 0.028, P = 0.035, and P = 0.024, respectively).
  
  
  CONCLUSIONS
  A simulation-enhanced IPE curriculum was successful in improving participant attitudes toward teamwork and components of patient safety culture related to teamwork and communication.
authors.affiliation: From the Yale Center for Medical Simulation (A.H.-W.W.), Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Department of Emergency Medicine (M.G., D.S.), New York University School of Medicine, New York, NY; and Department of Emergency Medicine (H.M.), University of California-San Francisco, San Francisco, CA.
authors.forename: Ambrose Hon-Wai
authors.initials: AH
authors.lastname: Wong
authors.forename: Maureen
authors.initials: M
authors.lastname: Gang
authors.forename: Demian
authors.initials: D
authors.lastname: Szyld
authors.forename: Heather
authors.initials: H
authors.lastname: Mahoney
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003299:Cooperative Behavior; D003479:Curriculum; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007400:Interprofessional Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety; D000066908:Simulation Training / Q000458:organization & administration*