Simulation: It’s Not All About Teamwork


Competent Professionals. That’s the thing that ALL health care teams are made of!

Those of us involved in simulation know that it is a powerfully, wonderful tool for educating and assessing people with regard to teamwork skills, responsibilities and communications. However that does not mean that every implementation of simulation needs to involve teamwork and communication skills.  Since the famous Institute of Medicine report came out in 1999 citing critical deficiencies in teamwork in healthcare environment and how they can be attributed to medical errors and less than quality patient care, as well as a recommendation for simulation to fill some of these gaps, many people have taken it as a mandate that simulation MUST include team training and communications. I say, Not the case.

In fact, I would argue it’s detrimental to think that way. Teams are built upon the pillars and shoulders of competent healthcare professionals. There are still gaps in educational needs in the ability to more efficiently educate individual healthcare providers, as well as provide assessment into their overall competence based on where they are in the spectrum of entry-level student to practicing clinician. While I would certainly advocate for teamwork and communication skills to be incorporated into any healthcare curriculum from beginning to end, I think there are plenty of appropriate times to ensure there is a mastery of individual competence in those goals and objectives that are surrounding knowledge, skills critical thinking and attitudes that we expect a competent professional to bring to a team.

The design and execution of the innovative education programs involving simulation has many different variables when we consider the needs of that of ensuring individual or personal confidence, versus that of a team. In fact the learning objectives would look quite different if we compare evaluating that of the responsibility of an individual person providing care, to that of the skill set that person should develop to be an integral part of the healthcare team, as further compared to the skill set that we would expect a team of professionals to demonstrate when involved in the care of the patient(s).

The detrimental part that I speak of I see far too commonly in my travels and observations of simulation efforts. There are many times when simulations are conducted that are largely designed to educate, and/or assess aspects those objectives that are largely individual in nature, such as decision-making, analysis, or perhaps psychomotor motor skills. Then at the last minute there is a design decision to include more students and literally “throw in” some elements of teamwork and her communications into the design of the scenario that ends up not being well thought out.

The end result is not hard to predict. Such simulations usually produce less than desired outcomes with regard to ensuring individual competence improvement, and are often confusing and/or inefficient with regard to being able to impart the skills associated with teamwork and communications.

So I do think that teamwork and communications, as well as team leadership skills are an important set of competencies that we need to continuously teach and evaluate across the spectrum of healthcare education and believe that simulation is one of many excellent tools to accomplish this.

However, I advocate that you proceed carefully with a well vetted list of objectives that lead to adequate scenario and curriculum design. I think you should carefully determine whether your overall educational effort is best suited for the competency of an individual, or is it largely directed towards focusing on teamwork and interpersonal communication efficiencies and effectiveness.

I do believe we can design encounters that effectively involve elements of both, but not without careful planning and forethought. In such attempts there is always a natural tension between those elements of design detail and assessment that can be applied to individual competence and those that can be applied to the team components.

Attention to these details will assist you in creating more robust educational encounters for your learners. It will also afford you better outcomes for your overall investment of time and money into your education program.

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