We enrolled a total of 48 students in 12 teams, with all four disciplines represented in each team. The participants had a mean age of 23.9±7 years, and 45 (93.8%) were female.
DISCUSSION
We found that TeamSTEPPS education improved team dynamics among undergraduate health professionals. While previous work has evaluated the impact of training on participants such as physicians and nurses in various resuscitation situations, such as cardiac arrest and trauma, few studies have assessed the impact of TeamSTEPPS education on undergraduate health professional students in the disciplines included in our study [
8-
10]. Over 150,000 students graduate annually from the four studied disciplines [
11-
13]. Since these professionals perform critical roles as members of healthcare teams, it is essential for efforts to continue to integrate team-based training into the undergraduate curriculum.
This brief TeamSTEPPS intervention showed an overall improvement in team leadership as measured by TPOT question 5; however, several questions did not show improvement, including conducting a brief prior to patient arrival (question 1) and providing constructive feedback to the team members (question 4). Similar results were also seen with question 1 of TEAM. These findings might indicate that the team leaders were comfortable with their role in rendering a plan of care and ensuring prioritization of tasks, but that they were not comfortable directing and evaluating others. Although the roles and responsibilities of each team member were covered in the online trauma training program, the appreciation and awareness of all team members of their roles may need to be reinforced. Another reason for these findings may be the siloed nature of undergraduate health professional education. This was the first time that the PA students were provided with the opportunity to work and learn with other health professional students. These findings may support the need for interprofessional learning experiences early in the curricula of health professional students, in order to break down the barriers of a siloed education system and to facilitate interprofessional communication and teamwork. Our experience conducting hundreds of interprofessional scenarios has indicated that students first need to be competent with their own skill sets prior to directing and evaluating the work of others [
7].
Moreover, the TPOT findings indicated that TeamSTEPPS training improved the general categories of situation monitoring and communication among team members; however, no change was observed in the area of mutual support among team members. TeamSTEPPS training also did not improve teammates’ feedback (question 12), the use of ‘call-out’ (questions 15 and 18), the use of ‘call-back’ (questions 19), or how often they requested additional information from each other (questions 16, 17, and 21). The findings from TEAM regarding team communication were similar (questions 3, 7, and 9). The theme of lack of communication among team members as measured by TPOT and TEAM may also be due to the ‘silo-based’ educational structure of undergraduate health professional education. Similar results have been observed among other undergraduate health professional students during resuscitation scenarios [
13].
Although team-based learning has achieved broad support, commitment to this educational modality is not universal. Along with health profession curricula that ‘silo’ students during their undergraduate education, barriers to the adoption of team-based learning include communication, conflict resolution, time constraints, the attitudes of team members, and the presence or absence of resources such as electronic health resources. Previous research has suggested that team-based learning should be introduced early in the education of undergraduate health profession students through joint courses and should continue throughout their educational experience. These educational programs should begin with strategies that build trust between students of different professions, urge them to value each discipline’s unique contribution to health care, and finally, provide them with an opportunity to practice together to provide quality care [
7,
14]. It is therefore important to have reliable educational modalities such as TeamSTEPPS and validated tools such as TEAM and TPOT to accurately assess the impact of team-based on learning on undergraduate students, especially in trauma care. In order to facilitate this, the Interprofessional Education Collaborative has identified four core competencies: values and ethics for interprofessional practice, roles and responsibilities, interprofessional communication, and teams and teamwork [
15]. TeamSTEPPS touches on many of these aspects, making it an ideal education modality for providing such training.
We trained two research assistants to review videos of undergraduates performing trauma resuscitations. These assistants had greater inter-rater reliability with TEAM than with TPOT. While our investigative team has a history of training undergraduates in simulation and trauma resuscitation, the systematic usage and evaluation of these tools was new to us. It may be that TPOT requires more training than TEAM to ensure adequate inter-rater agreement when assessing undergraduate health professionals.
Our results support the use of TEAM and/or TPOT in assessing undergraduate trauma education; however, each tool has benefits and limitations. Previous research has shown that TEAM can be easily learned with minimal instructions, is calculated rapidly, and has good inter-rater reliability as assessed by interclass correlation coefficients [
9]. One of the limitations of TEAM is that the reviewer must be familiar with the non-technical skills of resuscitation in order to effectively score team performance [
8]. TPOT was designed based on the Agency for Health Quality and Research TeamSTEPPS curriculum. TPOT can be used by a variety of reviewers, has good inter-rater reliability, and has been successfully used in the clinical setting to assess teamwork globally [
10].
This study has several limitations. First, this study occurred in a simulated setting. Further work is required to validate these findings in a clinical context. In addition, several other tools are used to evaluate team performance during trauma scenarios, including the Observational Skill-Based Clinical Assessment Tool for Resuscitation (OSCAR) [
9,
16]. OSCAR provides greater detail at the individual level, while TEAM and TPOT focus primarily on the team as a whole [
8,
9]. Running the same scenario twice for each participant may have confounded the results. While this may have had an impact on the technical skills of the resuscitation, the non-technical skills measured by TEAM and TPOT were not reinforced by faculty after the first scenario and may be less susceptible to confounding. Moreover, no debriefing or feedback were provided after the first scenario. Of the participants, 93.8% were female. While this may have introduced gender-specific biases, this percentage is representative of practicing members in the healthcare sector [
17]. We sought to determine the impact of TeamSTEPPS on team trauma care; however, other ways of providing team trauma education may exist. We provided a shortened version of TeamSTEPPS. Although the original TeamSTEPPS curriculum can take over eight hours to complete, we designed this module to be short enough to be taught within a typical lecture time and still allow time for the implementation of the simulated trauma resuscitation. Although this was an abbreviated version of TeamSTEPPS, it was created by the consensus of the authors who have extensive experience with team-based training, with three of the authors being certified master TeamSTEPPS trainers (VOTB, MM, and JNC). Having trained hundreds of students in team-based learning, we felt that our module had face validity despite not including the complete TeamSTEPPS training course.
In conclusion, trauma team education incorporating TeamSTEPPS improves both TEAM and TPOT scores among undergraduate health professionals. Curriculum designers should consider incorporating TeamSTEPPS training into undergraduate health profession education.