The entry level position for a Cardio-thoracic Surgeon would most likely be a General Surgeon Resident.
Team-oriented Medical Simulation (TOMS)
"The first hour of TOMS training consists of a pre-briefing that highlights relevant teamwork concepts such as situational awareness, communication, and decisionmaking. The second hour is devoted to simulated laparoscopic and anesthetic procedures, using a life-like mannequin with live abattoir organs to simulate surgery. The third hour consists of a team-led debriefing that uses videotaped examples of the team’s own performance to diagnose problems and identify strategies for improvement."
(found on http://www.ahrq.gov/downloads/pub/advances/vol4/Baker.pdf)
"MedTeams is a system of teamwork training and organizational change that focuses on behavioral solutions to the problem of patient safety and to the delivery of improved patient care. Based on a set of teamwork principles that are widely used in crew resource management (CRM) programs in military and commercial aviation, MedTeams is now being implemented as a performance and safety solution in emergency care.
The results, details of which may be found in Morey et al., demonstrated the effectiveness of the MedTeams system. Improvements were obtained in the experimental group for six out of the seven key measures assessed. The quality of team behaviors improved, workload was not increased by practicing teamwork, staff attitudes towards teamwork were enhanced, preparation of patients for admission from the ED improved, and the proportion of highly satisfied patients increased.
The most important finding from the validation was that clinical errors were substantially and significantly reduced. A clinical error was defined as any clinical task that actually or potentially put a patient at risk. These errors were witnessed by a specially trained emergency center nurse or physician observing cases for the purpose of rating teamwork behaviors."
(http://www.rhodeislandhospital.org/services/simulation-center/research-interests/medteams.html)
"The primary purpose of DOM is to increase patient safety, reduce medical errors, and improve the quality of health care by improving trainees’ skills in team-building, recognizing adverse situations, counteracting the effects of stress and fatigue, communicating, and decisionmaking. DOM provides interdisciplinary team training to surgeons, nurses, and anesthesiologists. The program draws heavily on CRM training from aviation25 and was developed by Crew Training International (CTI). CTI (http://www.cti-crm.com) recently renamed DOM LifewingsTM (http://www.saferpatients.com). DOM, which is quite similar to MedTeams and to MTM, includes 8 hours of classroom-based, interactive training that incorporates facilitated discussion, role playing, case studies, behavior modeling, and knowledge testing.25 During the 8- hour session, two highly trained CTI instructors (typically former pilots) lead participants through strategies for building an effective team. These techniques include recognition of adverse situations, recommendations for managing conflict constructively, guidance for mitigating the effects of stress, training in decisionmaking skills, recommendations for providing effective performance feedback, and principles for mitigating the effects of fatigue.25 To reinforce the principles of DOM training, CTI developed a “challenge and response checklist,” which trainees are required to use in the OR." (http://www.ahrq.gov/downloads/pub/advances/vol4/Baker.pdf)
"The Air Force developed MTM training specifically in response to an incident at an Air Force facility in which poor teamwork led to a neurologically impaired newborn. Similar to MedTeams, the primary purpose of MTM is to reduce medical errors, in this case by teaching human-factors concepts to interdisciplinary teams of medical professionals. A secondary purpose is to change the military's traditional medical culture, which focuses on individual performance, an emphasis that creates communication barriers. In contrast, MTM specifically fosters a culture that values team performance and encourages effective communication. Its theoretical position is that this new culture will facilitate teamwork, thereby reducing errors."
"The MTM training program has two major components: a three-day train-the-trainer course and a medical treatment facility course. Upon completing the train-the-trainer course, graduates return to their respective medical facilities to train the remaining staff in teamwork principles. 21 The MTM curriculum includes an introduction to the program, overviews of key patient safety and CRM issues, and specific modules for seven team skills (Table 1). Case studies, vignettes, and tools are interspersed throughout the curriculum to reinforce the importance of effective teamwork."
(http://www.ncbi.nlm.nih.gov/books/NBK20580/)
Team-oriented Medical Simulation (TOMS)
"The first hour of TOMS training consists of a pre-briefing that highlights relevant teamwork concepts such as situational awareness, communication, and decisionmaking. The second hour is devoted to simulated laparoscopic and anesthetic procedures, using a life-like mannequin with live abattoir organs to simulate surgery. The third hour consists of a team-led debriefing that uses videotaped examples of the team’s own performance to diagnose problems and identify strategies for improvement."
(found on http://www.ahrq.gov/downloads/pub/advances/vol4/Baker.pdf)
- This simulation is vital to team success because it covers very important concepts and simulates what could happen out in the field because great doctors have to be prepared for anything.
"MedTeams is a system of teamwork training and organizational change that focuses on behavioral solutions to the problem of patient safety and to the delivery of improved patient care. Based on a set of teamwork principles that are widely used in crew resource management (CRM) programs in military and commercial aviation, MedTeams is now being implemented as a performance and safety solution in emergency care.
The results, details of which may be found in Morey et al., demonstrated the effectiveness of the MedTeams system. Improvements were obtained in the experimental group for six out of the seven key measures assessed. The quality of team behaviors improved, workload was not increased by practicing teamwork, staff attitudes towards teamwork were enhanced, preparation of patients for admission from the ED improved, and the proportion of highly satisfied patients increased.
The most important finding from the validation was that clinical errors were substantially and significantly reduced. A clinical error was defined as any clinical task that actually or potentially put a patient at risk. These errors were witnessed by a specially trained emergency center nurse or physician observing cases for the purpose of rating teamwork behaviors."
(http://www.rhodeislandhospital.org/services/simulation-center/research-interests/medteams.html)
- MedTeam is newly implemented into Emergency Care training and development in many hospitals around the United States after its initial success in the military. This type of training focuses on under-pressure teamwork and clarity of mind in an immediate situation which results in less clinical errors and optimal patient care.
"The primary purpose of DOM is to increase patient safety, reduce medical errors, and improve the quality of health care by improving trainees’ skills in team-building, recognizing adverse situations, counteracting the effects of stress and fatigue, communicating, and decisionmaking. DOM provides interdisciplinary team training to surgeons, nurses, and anesthesiologists. The program draws heavily on CRM training from aviation25 and was developed by Crew Training International (CTI). CTI (http://www.cti-crm.com) recently renamed DOM LifewingsTM (http://www.saferpatients.com). DOM, which is quite similar to MedTeams and to MTM, includes 8 hours of classroom-based, interactive training that incorporates facilitated discussion, role playing, case studies, behavior modeling, and knowledge testing.25 During the 8- hour session, two highly trained CTI instructors (typically former pilots) lead participants through strategies for building an effective team. These techniques include recognition of adverse situations, recommendations for managing conflict constructively, guidance for mitigating the effects of stress, training in decisionmaking skills, recommendations for providing effective performance feedback, and principles for mitigating the effects of fatigue.25 To reinforce the principles of DOM training, CTI developed a “challenge and response checklist,” which trainees are required to use in the OR." (http://www.ahrq.gov/downloads/pub/advances/vol4/Baker.pdf)
- This type of training is classroom-based rather than simulated and doesn't require any strenuous capabilities, but does challenge medical doctors to work as a team to provide the most successful patient care. The current leading program for this type of training is LifewingsTM, and a doctor who completed the training said,“ The commitment of time and resources to attend LifeWings training is minimal compared to the gain in knowledge, insight and confidence to lead a culture of safety initiative. Culture change is a hard, slow process that requires a solid foundation and understanding of the art and science of safety training.” (http://www.healthitoutcomes.com/doc/lifewings-develops-strategies-hospital-ceos-survive-healthcare-reimbursement-model-0001) So ultimately, this form of training is effective.
"The Air Force developed MTM training specifically in response to an incident at an Air Force facility in which poor teamwork led to a neurologically impaired newborn. Similar to MedTeams, the primary purpose of MTM is to reduce medical errors, in this case by teaching human-factors concepts to interdisciplinary teams of medical professionals. A secondary purpose is to change the military's traditional medical culture, which focuses on individual performance, an emphasis that creates communication barriers. In contrast, MTM specifically fosters a culture that values team performance and encourages effective communication. Its theoretical position is that this new culture will facilitate teamwork, thereby reducing errors."
"The MTM training program has two major components: a three-day train-the-trainer course and a medical treatment facility course. Upon completing the train-the-trainer course, graduates return to their respective medical facilities to train the remaining staff in teamwork principles. 21 The MTM curriculum includes an introduction to the program, overviews of key patient safety and CRM issues, and specific modules for seven team skills (Table 1). Case studies, vignettes, and tools are interspersed throughout the curriculum to reinforce the importance of effective teamwork."
(http://www.ncbi.nlm.nih.gov/books/NBK20580/)
- Obviously, this is another approach that helps new and experienced doctors work together and rely on their own capabilities in an immediate situation. This type of team training is used in most, of not all teaching hospitals and military education areas due to its success. Some programs are more effective than others, but all of them show improvement at the end of the course and obviously strengthen doctors' comfort in dealing with emergency situations and greatly improving patient care.