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Building Effective Teams. Kristen Nelson, MD Asst Professor, Pediatric Critical Care Medical Director, Pediatric Transport Director, Pediatric Cardiac Critical Care Johns Hopkins University School Of Medicine. Disclosures. I have no financial disclosures. Plan for Session.
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Building Effective Teams Kristen Nelson, MD Asst Professor, Pediatric Critical Care Medical Director, Pediatric Transport Director, Pediatric Cardiac Critical Care Johns Hopkins University School Of Medicine
Disclosures • I have no financial disclosures.
Plan for Session • Discuss basic concepts and tools regarding team building and techniques for both buidling and evaluating teams • Transition into smaller groups to cover team building in various settings
Objectives: At the conclusion of this session the learner will be able to: • Begin to develop a team-based training session specific for a certain skill or purpose • Discuss several different teaching techniques for such a session • Demonstrate effective teaching skills by debriefing such a session
Definitions • Team: Two or more people working interdependently towards a common goal • Synergism • Team Building: The process of gathering the right people and getting them to work together for the benefit of a project
More Definitions • Team Management: The direction to a group of individuals who work as a unit. Effective teams are result-oriented and are committed to project objectives, goals and strategies • Role: A unit of defined responsibilities that may be assumed by one or more individuals
What is necessary for team structure? • Goals and tasks/objectives • Members • Size • Leadership • Interaction • Time cycle • Decision-making techniques
Phases of Team Development(Tuckman) • Forming • Storming • Norming • Performing • high-quality teams • Adjourning, dissolving or reorienting • if the project has a completion phase
Team Coordination and Collaboration • Inform everyone of the goals, timetable, possible obstacles and scientific issues • Define each team members role • Design communication mechanisms • Plan for success • Plan for contingencies
Why Collaborate for Team-Building? • Inherent complexity of medicine • Single discipline cannot do it alone • Desire to explore problems and questions that are not confined to one discipline • Need to solve complex problems • Stimulus of enhanced technologies O’Sullivan P, Stoddard H, Kalishman S. Collaborative research in medical education: a discussion of theory and practice. Med Ed 2010; 44:1175-1184.
How do you teach team-building? • Different techniques, depending on the team purpose • May use different techniques at different phases of team development • ‘Teacher’ often role of facilitator, not team leader
What makes teaching effective? • Clear and Organized • Enthusiastic and Stimulating • Establishes Rapport • Actively Involves Learners • Knowledgeable and Analytical • Demonstrates Clinical Skill/Procedures • Provides Direction & Feedback • Accessible
Role Modeling/Demonstration • Learners are often listening to and looking at everything a facilitators says and does • Both in simulated and actual environments
‘Think Aloud’ • Verbalize thoughts when you are performing a task or observing something on the monitor, for example • Teaches clinical reasoning steps
Asking Open-Ended Questions • Avoid closed end or pimping (i.e, intimidating) questions • Instead ask "why do think that therapy was chosen," "what more do you think could we have done, "how do you think the patient is doing now” • Hypothetical • “What if we did this instead….”
Active Observation • ‘Amygdala highjacking’ • Explain rationale for observation • Ask the learner what they observed
Independent Learning with Feedback • Identify the need • Make an assignment (research the question or issue and bring back to the group) • Identify potential resources • Close the loop (learner reports back via discussion, oral report for example)
Debrief Each Session:5 steps for microskills teaching • Get a Commitment • Probe for Supporting Evidence • Reinforce What Was Done Well • Give Guidance About Errors or Omissions • Teach a General Principle
Other Techniques • Small group sessions • PBL, case review • Simulation • Role playing • Task trainers/mannequins • Team drills/skills • Large group sessions
3 break-outs • 1) Small group-Molly (error identification and resolution within a team) • 2) Simulation-Kristen (multidisciplinary-role assignment and conflict resolution) • 3) Large team-Deb (multidisciplinary-development of novel team for high-risk event)
Conscious Competence Model of Learning Unconscious Incompetence Conscious Incompetence Unconscious Competence Conscious Competence Unconscious Incompetence: requires demonstration of the skill and how it will benefit the person’s effectiveness Bristow, 2007
Conscious Competence Model of Learning Unconscious Incompetence Conscious Incompetence Unconscious Competence Conscious Competence Conscious Incompetence: requires a commitment to learn and practice the new skill Bristow, 2007
Conscious Competence Model of Learning Unconscious Incompetence Conscious Incompetence Unconscious Competence Conscious Competence Conscious Competence: requires continued practice (most important factor to move to the next level) Bristow, 2007
Conscious Competence Model of Learning Unconscious Incompetence Conscious Incompetence Unconscious Competence Conscious Competence Unconscious Competence: able to teach others but may have difficulty explaining exactly ‘how they do it’ Bristow, 2007
Small Group Discussions • State goals and objectives • Introduce the topic • Show your energy / excitement • Why is this important? • Reestablish a climate of mutual respect for everyone’s ideas • Remind the learners that participation is expected
Problem-Based Learning:Case Reviews • "Let me tell you about the case that is the stimulus for this team development.’ • Near misses are very powerful…as are hits
Arrange seating to promote discussion • Ideally in a circle • Do not sit at the head of the table • People tend to talk to the person sitting opposite them • People sitting next to each other tend not to talk to one another Beard, R. M., and Hartley, J. Teaching and Learning in Higher Education. (4th ed.) New York: Harper & Row, 1984 Barbara Gross DavisTools for Teaching; Jossey-BassPublishers: San Francisco, 1993.
Bring the Activity to Closure • Allow time at the end of the discussion to summarize key points • Ensure that learners leave with a clear understanding of the most important ideas
Basic Steps for Teaching Team-Based Procedural Skills • Introduce the skill • Reading materials, video or PowerPoint presentation, and/or class discussion • Demonstrate all steps (by the instructor) • Communicate the components of the skill - remember that learner may use your language • Ask learner to verbalize steps of procedure
Basic Steps for Teaching Procedural Skills(cont’d) • Directly supervise performance and give feedback • Provide opportunities for learner to practice procedure/skill • Train learner to self-reflect on skills and level of performance
Get a Commitment Encourages learner to process further and problem solve Examples... • “What do you think was wrong with the patient?”
Probe for Supporting Evidence • Helps you to assess the learner’s knowledge and thinking process Examples... • “What factors supported your diagnosis?” • “What was it that made you choose that treatment?”
Reinforce What Was Done Well • Describe specific behaviors • Behaviors that are reinforced will be more firmly established. • Example… “I liked that your differential took into account the patient’s age, recent exposures & symptoms.”
Guide Errors / Omissions • Describe what was wrong (be specific), what the consequence might be, and how to correct it for the future • Corrects mistakes and forms foundation for improvement. • Hands-on skill review • Example… “I noticed that you had trouble as a group trying to make the defibrillator work. What are the consequences of us not being able to use it? Let’s review the defibrillator”
Teach General Principles • Share practice ‘pearls’ • Allows learning to be more easily transferred to other situations
What if we don’t debrief our teaching sessions? • Mistakes can go uncorrected • Good performance is not reinforced • Clinical competence is not achieved • Learners generate their own feedback
Why might a team have difficulty improving? • External barriers • Failure to follow behavioral norms, inadequate resources, frequent change in team members • Internal barriers • Lack of clear leadership, lack of goals/plans, failure to plan, failure to resolve interpersonal conflict • Groupthink • Conforming; ‘blinders’
Summary • Improve learning through active participation • Many different techniques can be used to help build an effective team • Debriefing each session or step of team building and identifying areas for improvement is key to success