and faculty provided feedback to the students. All of their discussions were about communication.

Through repeated simulation opportunities, students improved their skills as they practiced working as a team. The intermediate outcome of these experiential exercises was to improve the knowledge and skills around the attitude of working together in a team. Knowing that communication is the most single important patient safety issue, the long-term outcome was to improve communication among and across teams.

Their work was not set up to assess whether the skills acquired in the academic simulation lab transferred into practice, although it is a critical area for assessing the effect of this training.

Assessment Plan

From the onset, Zierler and her colleagues anticipated that their assessment plan would need to be flexible and responsive to their changing curricular needs. For example, the instructors stopped students in the middle of their simulation exercise if something was not working as they had envisioned. They would change the exercise on the spot and get students’ feedback about the alteration before continuing with the simulation. As the curriculum changed, the assessment of learners and faculty also changed in order to keep the assessment relevant to the training.

Both students and faculty benefitted from the assessments that took place halfway through the training. Students were assessed on teamwork and communication, and faculty were observed for how they facilitated the clinical case and communicated with students. Faculty could coach students on the clinical aspects but not on their ability to communicate. This was done so students learned from faculty about providing good care, but could use the “safe environment” to make mistakes in communication in order to learn.

The assessments consisted of self-evaluations and peer evaluations. The selected peer evaluators were given objective questions to impartially determine whether there was an appropriate handoff. This entails accurately and effectively transferring information from one care team to another, which, if done well, can decrease medical errors. Peer evaluators also looked at whether the teams huddled when they encountered a difficult situation, whether there was a briefing to different groups who entered into their exercise, and whether each member felt mutually supported within their team.

Zierler found it interesting that the evaluators who observed their peers in the initial case simulation actually performed better than the other students when they engaged in the third case. Although still analyzing the data, Zierler believed the students’ improved performance was the result



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