Curriculum Innovation: Design, Implementation, and Evaluation of an Interdisciplinary Teamwork-Focused Neurocritical...

Neurocritical care (NCC) is a niche clinical subspecialty dependent on interdisciplinary cohesion to operate in critical situations. Team cohesion in an intensive care unit (ICU) depends not only on technical skills or medical knowledge but also on nontechnical skills such as teamwork, communication, and leadership. Developing and practicing these skills as an interdisciplinary team is not standard in most professional training programs.

This project aimed to (1) design and implement a NCC in situ simulation program aimed at practicing teamwork, (2) demonstrate feasibility and acceptability of recurring in situ simulations, and (3) assess baseline teamwork scores and clinician preparedness to respond to a clinical emergency.

The NLN Jeffries Simulation Theory was used to guide the simulation program design. A 1-year pilot project consisted of monthly NCC in situ simulations. Debriefing with Good Judgment was used to guide postsimulation reflection. Feasibility was evaluated by participation metrics and simulation schedule adherence. Acceptability was assessed through postsimulation evaluations. Teamwork and preparedness were measured using the Mayo High Performance Teamwork Scale (MHPTS) and 10-point Likert scale, respectively. Statistical comparison of MHPTS scores between disciplines and preparedness before vs after simulation was conducted.

In 1 year, we conducted 12 in situ simulations, with 167 simulation learner encounters, representing 95 unique learners and 72% of our core NCC team (i.e., nurses, advanced practice providers [APPs], fellows, faculty). Analysis of program evaluations (84% survey completion rate) showed that 91% of all learners strongly agreed that the simulation provided an experiential, collaborative, trusting, and learner-centered environment. Overall, MHPTS scores were similar between disciplines, although in pairwise comparison, pharmacists rated teamwork significantly lower than both nurses (p = 0.01) and APPs (p = 0.004). Learners rated their preparedness to respond to a clinical emergency significantly higher after the simulation (p < 0.001).

In situ simulation training is a feasible and acceptable method to introduce teamwork training into ICU culture. Team-based simulation improves self-reported preparation to respond to clinical emergencies. Simulation training that takes place in the clinical setting provides a powerful tool for enhancing teaching and addressing patient care gaps.