Our institution, Beth Israel Deaconess Medical Center (BIDMC) in Boston, is a teaching tertiary referral academic hospital of Harvard Medical School. There are 673 licensed beds, including 493 medical/surgical beds. There are 77 critical care beds and 62 OB/GYN beds. The perioperative nursing staff provides patient-focused care to the surgical patient population as well as surge ICUs during the pandemic. The patient population includes cardiothoracic, vascular, orthopedics, neurosurgery, transplant, general surgery, trauma, ENT, GYN, podiatry, GI, ophthalmology, cardiology, and urology patients on two campuses. A multidisciplinary team consisting of RNs and surgical and anesthesia teams provide perioperative patient care.
The COVID-19 pandemic has wrought havoc among health care staff and the general population. Communication and teamwork among anesthesia providers, surgeons, and nurses can be key in the smooth transition and delivery of perioperative patient care and satisfaction. Therefore, interprofessional interaction and teamwork are valuable skills for our anesthesiology residents rotating through the PACU, where they interact with nurses and surgeons to help patients recover from the effects of general or regional anesthesia. Despite the importance of interprofessional interaction and teamwork in the PACU, these aspects are not currently explicitly described or taught during this rotation. Due to this educational gap and the challenges of interprofessional communication and teamwork highlighted by the pandemic, we aimed to improve interprofessional education (IPE) for anesthesiology trainees, surgery trainees, and nurses by promoting emotional intelligence.
“The COVID-19 pandemic has wrought havoc among health care staff and the general population. Communication and teamwork among anesthesia providers, surgeons, and nurses can be key in the smooth transition and delivery of perioperative patient care and satisfaction.”
Implementing a solution
We conducted this interventional cohort study after receiving institutional review board (IRB) approval with a waiver of documentation of consent by the Committee on Clinical Investigations at BIDMC. Study participants included anesthesiology residents, surgery residents, and PACU nurses at BIDMC. Participants underwent a curriculum that consisted of case-based discussion sessions conducted once a month as part of regular education. Participants at each session included one to three anesthesiology residents, one to three surgery residents, and one to three nurses. The general timeline was set for each discussion session, which was about one hour long (Figure 1). We performed a qualitative analysis of responses to a reflective exercise to determine recurring themes in the participants’ reflections and feedback for the curriculum. The responses were analyzed via transcribing, coding, constant comparing, induction, theoretical sampling, theoretical saturation, and reaching a substantive theory. We followed grounded theory principles, which focus on induction and an open approach where the emphasis may evolve as researchers realize what is important to study participants.
Figures 2 and 3 show the qualitative themes developed from 102 reflections. The most frequent theme (33%) was to intentionally cultivate personal qualities required for teamwork after the session, as exemplified in the following reflection: “Yes, it made me recognize that we should consistently remind ourselves how important it is to be self-aware and respectful of colleagues. In the long run, taking the extra minute to be courteous can save time at every step as well as make for more enjoyable interactions and enable better patient care in the process.” Thirty percent of the reflections belonged to the theme of developing strategies that foster inclusion, as exemplified in the this reflection: “I thought it was great! I think so many people could benefit from sharing their own experiences in a safe space.” Nineteen percent belonged to the theme of developing relationships with each specialty, while 18% dealt with self-development of emotional intelligence awareness.
This module demonstrates that the participants value such interdisciplinary discussions where real-life case vignettes can be openly discussed, which can help them recognize their own emotions and what they can and cannot control. For example, we may not be able to change other people’s behaviors, but we can still take positive action. Participants also can now better understand the root causes of the stress in certain situations by reflecting on the perspectives of others and identify possible ways to alleviate such stress. The novel findings of this study were that stress and morale improve with interprofessional sessions using focused case vignettes that point out areas of strain within teams.