Student veterans develops team-building initiative for medical practices

<p>Lang believed the military aviation practices could relate to ace teamwork between medical professionals.</p>

Lang believed the military aviation practices could relate to ace teamwork between medical professionals.


Student veterans at Rutgers Robert Wood Johnson Medical School (RWJMS) are implementing a pilot team-building initiative after four years of research. Their goal is to build teamwork skills among medical professionals to improve patient care, according to an article on Rutgers Today. 

Richard Lang and Kevin Fitzpatrick, now alumni, were first-year student veterans when they began the program’s research in 2015.

Lang began volunteering at The Promise Clinic – a student-run project that provides primary care for local, medically underserved and uninsured residents – two weeks after his last military assignment, according to the article.

Four-member clinical teams for the project were developed and Lang wanted to find key differences in the functioning of each team.

Lang described the teamwork of military aviation missions in a clinical reflection for his course, “Patient-Centered Medicine (PCM),” according to the article. 

“The designated mission leader must hold a preflight briefing with all participating aircrew. They cover mission goals, roles and responsibilities, risk management and contingency plans,” Lang said. “After each mission, they hold a ‘debrief’ to review whether they accomplished mission objectives and identify areas for improvement.”

Lang compared the practices in military aviation missions to practices in medicine.

“These practices are likely as important in improving outcomes in medicine as they are in military aviation,” Lang said. “Consequences of errors are similar, but instead of risk to your own life as a pilot, it is a patient’s life that may be at risk.”

Lang and Fitzpatrick both compared their early clinical experiences to find that the behaviors they have observed were not unique, according to the article. 

Because they both observed areas where better teamwork and communication could improve the outcomes of patients, they thought incorporating lessons learned from the military could benefit medical school teams.

Carol A. Terregino, senior associate dean for education and academic affairs, associate professor of medicine and associate dean for admissions, told Lang and Fitzpatrick to build a student-faculty network to research models of team training, according to the article.

“Things need to change,” Terregino said. “Perhaps your help and faculty support can be the answer to comprehensive curricular and cultural change.”

She referred Lang and Fitzpatrick to Gregory Peck, acute care surgeon, assistant professor of surgery and director of trauma performance improvement. Peck joined Terregino as a faculty co-advisor for the project. 

This initiative also gained its first student project leaders: Kristin Raphel, a former Emergency Medical Technician (EMT) field supervisor, and Thomas Kuriakose, a former high school teacher and coach. 

The student project leaders researched the medical literature and found Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). This is a program designed to increase team performance through the health care delivery system, according to the article.

The project leaders chose TeamSTEPPS as their model based on their goals for the program and the degree to which it reflected the student veterans’ experience.

The four leaders completed the TeamSTEPPS training course, which qualified them to train their peers, and designed a student-led intervention for the curriculum. 

“We hoped to provide fellow students with usable teamwork tools and strategies to improve patient care at every stage of their career,” Lang said.

They designed a teamwork survey for medical school students that was approved by the Rutgers Institutional Review Board (IRB), according to the article. 

The survey found that a majority of medical students working in team environments do not conduct routine briefs or debriefs, and that students wanted teamwork training to be integrated into the curriculum.

The student leaders then held the TeamSTEPPS training intervention in 90-minute interactive sessions for 650 students. The training was then integrated into the health sciences thread following the endorsement of the Curriculum Committee, according to the article.

A postintervention survey was taken six months after the first survey and showed an increase in various teamwork characteristics. 

“We went from the pre-intervention survey, where 60% of students reported that briefing ‘sometimes or never’ happens, to the postintervention response, in which 60% reported briefing ‘always or most of the time,’” Lang said. 

After the completion of the survey, Andy Anderson, appointed chief executive officer of the Combined Medical Group of RWJBarnabas Health and Rutgers Health, used TeamSTEPPS to lead a redesign of Aurora Health Care's primary care practices.

The team won the Association of American Medical Colleges’ Northeast Group of Educational Affairs 2019, according to the article.

Because of TeamSTEPPS, the two pilot program leaders earned their medical degrees with distinction, with Lang’s in medical education and Raphel’s in leadership in academic health care.

“The prior experience of our TeamSTEPPS leaders made them aspirational peers of all medical students, continually striving to advance medical education to the end goal: ensuring quality care and safety for patients,” Terregino said.


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