Team regulation in a simulated medical emergency: An in-depth analysis of cognitive, metacognitive, and affective processes.
This study examined the nature of cognitive, metacognitive, and affective processes among a medical team experiencing difficulty managing a challenging simulated medical emergency case by conducting in-depth analysis of process data. Medical residents participated in a simulation exercise designed to help trainees to develop medical expertise, effective leadership, and team management skills. Purposive sampling was used to select one team for case study based on overall performance. Video and audio data were collected from the simulation and debriefing session and a follow-up interview was conducted with the team leader. Performance measures were also collected from expert raters (i.e., experienced staff physicians). Video data were reviewed and coded for cognitive, metacognitive, and emotional events exhibited by team members during the simulation. Interview and debriefing transcripts were coded for themes related to these regulatory processes. Results from quantitative and qualitative analyses revealed that the team exhibited lower-order cognitive and metacognitive process (e.g., summarizing, providing information) more often than higher-order processes (e.g., evaluation, reasoning). Furthermore, team members expressed negative emotions (e.g., anxiety) more often than positive emotions (e.g., enjoyment). Chi square analyses of the team leader revealed that negative emotions were significantly more frequently preceded by lower-order processes compared to higher-order processes. Qualitative thematic analyses provided further corroboration of these findings. The findings suggest that medical trainees (particularly teams experiencing difficulty managing a challenging case) may require further scaffolding in their use of regulatory processes within medical emergencies. The results from this study are discussed in terms of implications for theories of self-regulation, methodological advances, and instructional design for medical education. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Medical Expert Checklist and Ottawa Management Skills Global Rating Scale. Separate analysis of team leader and team members.
Video and audio recording review
Communication, leadership, problem-solving, situational awareness, resource utilization, and CRM ( resource management) performance.Pekrun and Ekman’s emotion taxonomies.
Purpose of this study was to examine the nature of cognitive, affective, and metacognitive (CAM) processes within the context of a high-fidelity simulation session designed to equip medical residents with medical content expertise and resource management skills
One per year over 3 years. One team of six medical (including two observer). Out of 3 teams and 3 case simulations.
What is the nature of cognitive, affective, and metacognitive processes within a medical team experiencing difficulty with a challenging medical emergency simulation?
Not generalizable because only one medical and team was analyzed.
“It may be necessary in such cases to explicitly verbalize the evaluation process so that other team members can provide input. By consulting with the team, the leader would be engaging in resource utilization.”Clearer role identification was needed.
Observers filled rating scales and checklists independently about leader’s performance, interviews with participants
Simulation , case study, medical emergency
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