title: Primary care emergency team training in situ means learning in real context.
abstract: OBJECTIVE
  The purpose of our study was to explore the local learning processes and to improve in situ team training in the primary care emergency teams with a focus on interaction.
  
  
  METHODS
  As participating observers, we investigated locally organised trainings of teams constituted ad hoc, involving nurses, paramedics and general practitioners, in rural Norway. Subsequently, we facilitated focus discussions with local participants. We investigated what kinds of issues the participants chose to elaborate in these learning situations, why they did so, and whether and how local conditions improved during the course of three and a half years. In addition, we applied learning theories to explore and challenge our own and the local participants' understanding of team training.
  
  
  RESULTS
  In situ team training was experienced as challenging, engaging, and enabling. In the training sessions and later focus groups, the participants discussed a wide range of topics constitutive for learning in a sociocultural perspective, and topics constitutive for patient safety culture. The participants expanded the types of training sites, themes and the structures for participation, improved their understanding of communication and developed local procedures. The flexible structure of the model mirrors the complexity of medicine and provides space for the participants' own sense of responsibility.
  
  
  CONCLUSIONS
  Challenging, monthly in situ team trainings organised by local health personnel facilitate many types of learning. The flexible training model provides space for the participants' own sense of responsibility and priorities. Outcomes involve social and structural improvements, including a sustainable culture of patient safety. KEY POINTS Challenging, monthly in situ team trainings, organised by local health personnel, facilitate many types of learning. The flexible structure of the training model mirrors the complexity of medicine and the realism of the simulation sessions. Providing room for the participants' own priorities and sense of responsibility allows for improvement on several levels. The participants demonstrated a consistent, long-term motivation to strengthen safety, both for their patients and for themselves.
authors.affiliation: a National Centre of Rural Medicine, Department of Community Medicine, Faculty of Health Sciences , University of Tromsø , Norway ;
authors.forename: Helen
authors.initials: H
authors.lastname: Brandstorp
authors.affiliation: b Department of Community Medicine , Faculty of Health Sciences , University of Tromsø , Norway ;
authors.forename: Peder A
authors.initials: PA
authors.lastname: Halvorsen
authors.affiliation: c Anaesthesia Department , Østfold Hospital Trust , Grålum , Norway ;
authors.forename: Birgitte
authors.initials: B
authors.lastname: Sterud
authors.affiliation: d Division of Emergency Medical Services , University Hospital of North Norway , Tromsø , Norway ;
authors.forename: Bjørgun
authors.initials: B
authors.lastname: Haugland
authors.affiliation: b Department of Community Medicine , Faculty of Health Sciences , University of Tromsø , Norway ;|e General Practice Research Unit, Department of Public Health and General Practice , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.
authors.forename: Anna Luise
authors.initials: AL
authors.lastname: Kirkengen
mesh_terms: D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004501:Education, Medical / Q000379:methods*; D004632:Emergency Medical Services; D004635:Emergency Medicine / Q000193:education*; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D007858:Learning; D009664:Norway; D009726:Nurses; D010820:Physicians; D011320:Primary Health Care; D012424:Rural Population
keywords: General practice; Norway; in situ team training; medical emergency team; patient safety culture; primary care team; rural medicine; team based learning; team communication