Journal of Nursing Education

Major Article 

Outcomes of TeamSTEPPS Training in Prelicensure Health Care Practitioner Programs: An Integrative Review

Jennifer Gunberg Ross, PhD, RN, CNE; Colleen Meakim, MSN, RN, CHSE, ANEF; Stacy Grant Hohenleitner, PhD, RN, NE-BC, NHA

Abstract

Background:

Patient safety, morbidity, and mortality are directly correlated with interprofessional collaboration among health care practitioners. TeamSTEPPS offers a standardized curriculum for interprofessional teamwork training that can be incorporated into prelicensure education. This article describes the current state of the science related to the quantitative literature exploring the outcomes of TeamSTEPPS training in prelicensure health care practitioner students' education.

Method:

The Whittemore's and Knafl's method guided this integrative review. The CINAHL and PubMed databases were queried and ancestral searches of the reference lists of all retrieved articles were conducted.

Results:

Nine quantitative research studies were identified for inclusion in this integrative review.

Conclusion:

The available literature suggests that using TeamSTEPPS within prelicensure education supports the development of teamwork knowledge and attitudes in interdisciplinary health care practitioner students. Most of the reviewed studies focused on nursing and medical students; thus, further research is needed on allied health care practitioner students. [J Nurs Educ. 2020;59(11):610–616.]

Abstract

Background:

Patient safety, morbidity, and mortality are directly correlated with interprofessional collaboration among health care practitioners. TeamSTEPPS offers a standardized curriculum for interprofessional teamwork training that can be incorporated into prelicensure education. This article describes the current state of the science related to the quantitative literature exploring the outcomes of TeamSTEPPS training in prelicensure health care practitioner students' education.

Method:

The Whittemore's and Knafl's method guided this integrative review. The CINAHL and PubMed databases were queried and ancestral searches of the reference lists of all retrieved articles were conducted.

Results:

Nine quantitative research studies were identified for inclusion in this integrative review.

Conclusion:

The available literature suggests that using TeamSTEPPS within prelicensure education supports the development of teamwork knowledge and attitudes in interdisciplinary health care practitioner students. Most of the reviewed studies focused on nursing and medical students; thus, further research is needed on allied health care practitioner students. [J Nurs Educ. 2020;59(11):610–616.]

It is well documented that medical errors are a major cause of death in the United States (Kohn et al., 2000; Makary & Daniel, 2016). Patient safety, morbidity, and mortality are directly correlated with interprofessional (IP) collaboration and effective communication among health care practitioners (HCPs) (Fewster-Thuente, 2014; Greiner & Knebel, 2003; Manser, 2009; O'Leary et al., 2012). Thus, strategies to promote teamwork and clear communication among HCPs are essential to promote positive patient outcomes (Brock et al., 2013; Haynes & Strickler, 2014; Leonard et al., 2004). Research has shown that it is important to introduce prelicensure HCP students to IP teamwork training early in their education, before students are completely enmeshed in their own professions (Fewster-Thuente, 2014), and to weave these concepts throughout the prelicensure curriculum, building from theory to application (Baker & Durham, 2013; Baker et al., 2015). Despite the importance of prelicensure interprofessional education (IPE), there is no agreement regarding the framework, timing, or teaching strategies for IPE with HCP students (Baker et al., 2015).

Background

Many agencies and organizations have embraced the need for teamwork and collaboration among HCPs. In 2003, the Institute of Medicine highlighted the need for reform in prelicensure HCP education (Greiner & Knebel, 2003). In response, the Quality and Safety Education for Nurses (QSEN) competencies were developed to support nursing education programs in preparing graduate nurses who can provide safe, quality patient care (Cronenwett et al., 2007). One of the six core QSEN competencies is Teamwork and Collaboration, which includes the concepts of IP communication, collaboration, and teamwork (Cronenwett et al., 2007).

In The Essentials for Baccalaureate Education for Professional Nursing Practice, the American Association of Colleges of Nursing (AACN) (2008) identified the need for IPE at the prelicensure level for nursing education. Moreover, national and international organizations, including The Joint Commission (TJC) and World Health Organization, have identified the need for IPE in prelicensure HCP education, as well as in the professional clinical setting (Gilbert et al., 2010; TJC, 2018). In recognition of the need for prelicensure IPE, in 2009, the Interprofessional Education Collaborative (IPEC), a partnership of national health professions educational associations, was formed to develop competencies for IPE curricular development across disciplines (IPEC, 2016).

In an effort to create a national standard for health care team training to improve the quality, safety, and efficiency in the U.S. health care environment through improved team performance, communication, and collaboration, the Agency for Healthcare Research and Quality (AHRQ), along with the Department of Defense, created the evidence-based Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) program (AHRQ, 2019a; Haynes & Strickler, 2014; King et al., 2007). TeamSTEPPS focuses on specific teamwork communication strategies to support the knowledge, skills, and attitudes associated with team collaboration and communication (King et al., 2007). Specifically, the TeamSTEPPS approach emphases five key principles (team structure, communication, leadership, situation monitoring, and mutual support), as well as team competency outcomes in three areas (knowledge, attitudes, and performance) (AHRQ, 2020; King et al., 2007). Within each key principle are specific strategies that HCPs can use when working within IP teams to promote collaboration, effective communication, and adaptability (AHRQ, 2020; King et al., 2007). The TeamSTEPPS curriculum provides the learner with an introduction to these strategies through didactic training, case studies, video vignettes, and a pocket reference guide (AHRQ, 2019b). This curriculum offers a systematic approach to integrate teamwork concepts into health care practice that can be easily adapted to prelicensure HCP curricula (Baker et al., 2015). The purpose of this article is to describe the current state of the science related to the quantitative literature exploring the outcomes of TeamSTEPPS training in prelicensure HCP students' education.

Method

Whittemore's and Knafl's (2005) integrative review method guided this review. A comprehensive search of the Cumulative Index of Nursing and Allied Health Literature (CINAHL®) and PubMed® databases was conducted using various combinations of key terms—TeamSTEPPS; interprofessional; undergraduate; prelicensure; education; students; and nursing—to obtain quantitative studies related to the outcomes of TeamSTEPPS training in prelicensure HCP programs. Only articles written in English were included. To ensure the full scope of literature was reviewed, no limits on dates were applied. CINAHL was searched because it provides the most current and contemporary nursing and allied health literature, whereas PubMed offers a large database of biomedical and life sciences literature. The combination of these two databases provided a comprehensive review of nursing, medical, and allied health literature. Database searching identified 77 articles for initial review. Ancestral searches of the reference lists of all retrieved articles were also performed which identified 23 additional articles for review; thus, a total of 100 articles were generated for initial review. Textbooks and gray literature were not included in this review. First, each article's abstract was reviewed by the lead author to determine if the reported topic matched the purpose of the integrative review. Full-text articles were obtained if quantitative research methods, TeamSTEPPS, and prelicensure HCP education were included in the abstract. Then, the full-text articles were read by the same author to verify their relevance for the integrative review. A total of nine quantitative research studies exploring the outcomes of TeamSTEPPS training in prelicensure HCP education were ultimately isolated for this integrative review (Table A; available in the online version of this article) (Baker et al., 2015; Baker & Durham, 2013; Brock et al., 2013; Clark et al., 2015; Djukic et al., 2015; Hobgood et al., 2010; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010).

Summary of StudiesSummary of StudiesSummary of StudiesSummary of StudiesSummary of StudiesSummary of Studies

Table A :

Summary of Studies

Results

Design

All nine studies used a pretest–posttest quantitative research design. The majority of studies (n = 7) were a one-group design with no control group for comparison (Baker et al., 2015; Baker & Durham, 2013; Brock et al., 2013; Clark et al., 2015; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010). Moreover, most of the reviewed studies (n = 8) collected data from a single site (Baker et al., 2015; Baker & Durham, 2013; Brock et al., 2013; Clark et al., 2015; Djukic et al., 2015; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010); only one multi-site study was reviewed (Hobgood et al., 2010).

Sample

Sample sizes in the reviewed quantitative research studies ranged from 17 to 760. Overall, a total of seven types of HCPs were represented in the samples of the reviewed studies. The samples of all nine studies included prelicensure nursing students. The majority (n = 7) also included medical students in the study samples (Baker & Durham, 2013; Brock et al., 2013; Djukic et al., 2015; Hobgood et al., 2010; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010). Allied health students, including pharmacy (Baker & Durham, 2013; Brock et al., 2013; Clark et al., 2015), physician's assistant (Baker et al., 2015; Brock et al., 2013), respiratory therapy (Baker et al., 2015; Clark et al., 2015), radiology (Baker et al., 2015), and social work (Clark et al., 2015) were only included in a minority of the reviewed studies (n = 4).

Most of the reviewed literature (n = 6) focused on students in the upper levels of an HCP curriculum (Baker et al., 2015; Brock et al., 2013; Hobgood et al., 2010; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010). Only one study included a range of student levels from various disciplines (Baker & Durham, 2013), whereas the final two articles did not specify the level of students (Clark et al., 2015; Djukic et al., 2015).

Conceptual Frameworks

Of the nine studies included in this review, only four identified conceptual or theoretical frameworks that were used in the development of the research study and associated intervention (Brock et al., 2013; Clark et al., 2015; Liaw et al., 2014; Reed et al., 2017). Three conceptual/theoretical frameworks were identified in the literature to support quantitative research related to the integration of TeamSTEPPS into prelicensure HCP education. First, TeamSTEPPS itself was specifically identified as a framework for two studies (Brock et al., 2013; Clark et al., 2015). Although TeamSTEPPS was identified as a conceptual framework in only two of the nine studies, given that Team-STEPPS was used in all of the reviewed studies this may have been used as a conceptual framework in more studies without explicit reporting of such. Similarly, the Core Competencies for Interprofessional Collaborative Practice (IPEC Framework) was used as the theoretical framework for one study (Reed et al., 2017). The IPEC Framework provides four domains for interprofessional education, including values and ethics, roles and responsibilities, IP communication, and teams and teamwork (IPEC Expert Panel, 2011). Finally, the 3-P Model of teaching and learning was used as a conceptual framework for the IPE simulation program that served as the intervention in one study (Liaw et al., 2014). The 3-P Model consists of three factors relevant to the teaching and learning process: presage (the learning context and characteristics of the involved participants), process (how the education is planned and delivered), and product (learning outcomes) (Biggs, 1993).

Instrumentation

A total of 25 instruments were used among the nine articles in this review to measure outcomes. Of these, 11 were researcher-developed (Brock et al., 2013; Clark et la., 2015; Djukic et al., 2015; Hobgood et al., 2010; Reed et al., 2017). Two of the researcher-developed tools were subsequently used in another study. The 12-question Teamwork Knowledge Assessment and the 36-question Collaborative Healthcare Interdisciplinary Relationship Planning (CHIRP)-Teamwork Attitudes Instrument were developed by Hobgood et al. (2010) and were subsequently used by Robertson et al. (2010); however, reliability and validity information was not provided for either of these instruments.

Only two instruments used in the reviewed studies were specifically designed for the TeamSTEPPS program: the Team-STEPPS Teamwork Attitudes Questionnaire (T-TAQ) (Brock et al., 2013; Clark et al., 2015) and the TeamSTEPPS Teamwork Perceptions Questions (T-TPQ) (Clark et al., 2015). The T-TAQ instrument has thirty 5-point Likert-style questions that assess attitudes toward team structure, leadership, situational awareness, mutual support, and communication (α = .93) (Baker et al., 2010). The T-TPQ contains thirty-five 5-point Likert-style questions to assess perceptions about teamwork (α = .88 to .95) (American Institutes for Research, 2010).

In addition to the two TeamSTEPPS tools, seven of the 25 instruments were designed to specifically explore IP teamwork. The Team Skills Scale, used by Djukic et al. (2015), allows students to self-report their ability to perform 15 team tasks on a 5-point Likert-style scale (α = .73 to .94) (Siegler et al., 1998). The Mayo High Performance Teamwork Scale (MHPTS) is a 16-item scale designed to measure teamwork skills (α = .85) (Malec et al., 2007). The MHPTS was modified by Hobgood et al. (2010) to become a 20-item scale, but no reliability or validity information on the modified version was reported. The Medical Team Training Program Evaluation Tool is a 15-item instrument designed to measure satisfaction with teamwork training (α = .86) (Robertson et al., 2009). The Self-Efficacy Measure for Interprofessional Practice Competencies for Students, a 16-item 10-point Likert scale instrument (α = .96) (Mann et al., 2012), was used by Reed et al. (2017) to measure students' self-perceived self-efficacy in IP competencies. Baker and Durham (2013) used the 20-item Interprofessional Collaborative Competencies Attainment Survey (ICCAS) (r = .9 to .93), which measures perceptions of collaborative behaviors and competencies on a 7-point Likert-scale in six areas: communication, collaboration, roles and responsibilities, collaborative patient and family-centered approach, conflict management and resolution, and team functioning (MacDonald et al., 2010).

Two content-specific tools were used in one study to explore team performance specifically during resuscitation (Baker et al., 2015). The Team Emergency Assessment Measure (TEAM) is a 12-item Likert-style instrument (eleven 4-point Likert items and one 10-point Likert item) used to assess team performance in resuscitation (α = .89 to .98) (Cooper et al., 2010), whereas the 21-item 5-point Likert-style Trauma Team Performance Observation Tool (TPOT) is used to assess team performance specifically in trauma resuscitations (α = .83) (Capella et al., 2010). Both the TEAM and TPOT data collection instruments have been used previously in emergency clinical settings, but their applicability in undergraduate education is unknown (Baker et al., 2015).

One instrument, not specifically designed to explore teamwork, was used by Liaw et al. (2014) to measure one component of teamwork (communication). The Confidence Scale (C-scale) is an existing instrument with five items scored on a 10-point Likert scale to evaluate self-confidence in communication (α = .84 to .93) (Grundy, 1993).

Finally, satisfaction with research interventions was measured by Liaw et al. (2014) using two instruments: the Satisfaction with Simulation Experience Scale (SSES) and the Perceptions of IPE questionnaire. The SSES, which contains seventeen 5-point Likert-style questions, is designed to evaluate student satisfaction with simulation experiences (α = .94) (Levett-Jones et al., 2011). The Perceptions of IPE questionnaire contains eight items rated on a 5-point Likert scale to evaluate perceptions of IPE (Dagnone et al., 2008) (α = .91 to .92) (Liaw et al., 2014).

TeamSTEPPS Training

The majority (n = 7) of reviewed studies used some form of IP simulation as a component of the TeamSTEPPS training for prelicensure HCP students (Baker et al., 2015; Brock et al., 2013; Clark et al., 2015; Liaw et al., 2014; Hobgood et al., 2010; Reed et al., 2017; Robertson et al., 2010). In addition to simulation, most of the TeamSTEPPS trainings (n = 6) also included didactic lessons to teach the TeamSTEPPS curriculum either in person (Baker et al., 2015; Brock et al., 2013; Hobgood et al., 2010; Reed et al., 2017; Robertson et al., 2010), online (Djukic et al., 2015), or through a hybrid of in person and online (Dujkic et al., 2015; Reed et al., 2017). All of the prelicensure TeamSTEPPS trainings were limited to either a one-time encounter lasting several hours (Baker et al., 2015; Brock et al., 2013; Hobgood et al., 2010; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010) or one curricular course (Baker & Durham, 2013; Clark et al., 2015; Djukic et al., 2015); none of the reviewed studies reported a full curricular integration of the TeamSTEPPS training program.

Findings

The majority of studies (n = 5) in this literature review found that use of at least some portion of the structured TeamSTEPPS curriculum with prelicensure IP health care students significantly improved knowledge (Brock et al., 2013; Djukic et al., 2015; Hobgood et al., 2010; Reed et al., 2017; Robertson et al., 2010) and attitudes related to teamwork (Brock et al., 2013; Clark et al., 2015; Djukic et la., 2015; Hobgood et al., 2010; Robertson et al., 2010). In addition, although five studies found that TeamSTEPPS training improved prelicensure HCP students' teamwork skills competence (Baker & Durham, 2013; Baker et al., 2015; Djukic et al., 2015; Hobgood et al., 2010; Reed et al., 2017), only four of these studies reached statistical significance (Baker & Durham, 2013; Baker et al., 2015; Djukic et al., 2015; Reed et al., 2017). Two studies explored the concepts of self-confidence (Liaw et al., 2014) and self-efficacy (Reed et al., 2017), which were both found to significantly increase in prelicensure HCP students after TeamSTEPPS training.

Discussion

Despite the documented need for IP teamwork in the health care setting, empirical evidence that explores prelicensure HCP student outcomes following TeamSTEPPS training remains limited. This integrative review focused on the quantitative literature exploring the outcomes of TeamSTEPPS training on prelicensure HCPs and yielded only nine studies for inclusion.

Most of the available literature focuses on nursing and medical students (Djukic et al., 2015; Hobgood et al., 2010; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010) with limited attention to the allied health professions (Baker & Durham, 2013; Baker et al., 2015; Brock et al., 2013; Clark et al., 2015). This makes it difficult to generalize any findings beyond nursing and medical students. In addition, most of the existing literature focuses on students in the upper levels of an HCP curriculum (Baker et al., 2015; Brock et al., 2013; Djukic et al., 2015; Hobgood et al., 2010; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010). The limited literature including entry-level HCP students (Baker & Durham, 2013) is concerning because of the documented need to integrate IPE early in prelicensure education (Fewster-Thuente, 2014). Furthermore, the integration of TeamSTEPPS into prelicensure HCP curriculum at this time is generally limited to one curricular course, or a one-time educational experience (Baker & Durham, 2013; Baker et al., 2015; Brock et al., 2013; Clark et al., 2015; Hobgood et al., 2010; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010), rather than being integrated throughout the curriculum. This finding, along with the lack of longitudinal studies on this topic, is troublesome because of the documented need for HCP students to be exposed to IPE throughout their prelicensure education (Baker & Durham, 2013; Baker et al., 2015).

The existing literature does not provide evidence for best practice in teaching strategies for TeamSTEPPS training in prelicensure HCP education since various educational modalities have been implemented successfully. To teach the Team-STEPPS curriculum to prelicensure HCP students, didactic lecture or discussion generally occurs either in person (Baker et al., 2015; Brock et al., 2013; Hobgood et al., 2010; Reed et al., 2017; Robertson et al., 2010), through a hybrid of in person and online (Dujkic et al., 2015; Reed et al., 2017), or completely online (Dujkic et al., 2015). Simulation is the most common teaching strategy identified to allow prelicensure HCP students to apply TeamSTEPPS strategies (Baker et al., 2015; Brock et al., 2013; Clark et al., 2015; Hobgood et al., 2010; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010). Video vignettes (Robertson et al., 2010) and case studies (Clark et al., 2015) offer alternatives to simulation to support the application of TeamSTEPPS strategies but have not been as widely studied as simulation. Based on this literature review, the delivery method of the didactic content does not seem to affect outcomes, with all educational delivery methods yielding increased knowledge (Brock et al., 2013; Dujkic et al., 2015; Hobgood et al., 2010; Reed et al., 2017; Robertson et al., 2010), attitudes (Brock et al., 2013; Hobgood et al., 2010; Robertson et al., 2010), and skills (Baker et al., 2015; Dujkic et al., 2015; Reed et al., 2017). However, because multiple didactic delivery methods were directly compared in only one study (Hobgood et al., 2010), it is impossible to conclude whether the positive student outcomes were due to the didactic format, other educational interventions (such as simulation), or a combination. Thus, further research is needed before best practices can be developed for prelicensure HCP students' TeamSTEPPS training.

Most of the available research related to TeamSTEPPS in prelicensure HCP education has significant limitations including the use of one-group designs (Baker & Durham, 2013; Baker et al., 2015; Brock et al., 2013; Clark et al., 2015; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010), convenience samples from single sites (Baker et al., 2015; Baker & Durham, 2013; Brock et al., 2013; Clark et al., 2015; Djukic et al., 2015; Liaw et al., 2014; Reed et al., 2017; Robertson et al., 2010), and researcher-developed or researcher-modified instruments (Brock et al., 2013; Clark et al., 2015; Djukic et al., 2015; Hobgood et al., 2010; Liaw et al., 2014; Reed et al., 2017). Because of the one-group designs, internal validity is threatened and results from these studies must be interpreted with caution. The single-site convenience samples limit generalizability of the findings. The use of researcher-developed or modified instruments without established reliability and validity affects the rigor of the studies.

Furthermore, the outcomes that are measured following TeamSTEPPS training are inconsistent. Knowledge (Brock et al., 2013; Djukic et al., 2015; Hobgood et al., 2010; Reed et al., 2017; Robertson et al., 2010) and attitudes (Brock et al., 2013; Clark et al., 2015; Djukic et al., 2015; Hobgood et al., 2010; Robertson et al., 2010) have been studied most extensively with consistently positive results. Although teamwork skills competence (Baker & Durham, 2013; Baker et al., 2015; Djukic et al., 2015; Hobgood et al., 2010; Reed et al., 2017) has also been studied, the results have been mixed. Given that TeamSTEPPS is designed to support outcomes in knowledge, attitudes, and skills, it is imperative that students' skills competence be assessed as an outcome measure for TeamSTEPPS training. Thus, further research is warranted to determine HCP students' skills competence outcomes more definitively following TeamSTEPPS training. Finally, self-efficacy (Reed et al., 2017) and self-confidence (Liaw et al., 2014) have also been explored, but there are not enough studies to support the effect of prelicensure TeamSTEPPS training on these measures. These varied outcome measures, combined with the numerous evaluation tools (n = 25) used in these nine studies, make it difficult to compare results among studies. Standard outcome measures, as well as reliable and valid instruments that specifically relate to the TeamSTEPPS curriculum, should be used in studies exploring prelicensure HCP student outcomes following TeamSTEPPS training. This practice would streamline the findings from these studies and allow rigorous conclusions to be drawn to support best educational practices in teamwork and collaboration.

Implications for Education

The findings from this review highlight the benefit of integrating TeamSTEPPS teamwork training into prelicensure HCP curricula. Regardless of educational modality, exposure to the TeamSTEPPS curriculum during prelicensure education results in positive outcomes for HCP students, including increased teamwork knowledge and attitudes. These positive findings support previous research that HCP students should be introduced to IP teamwork training during their prelicensure education, before they are completely immersed in their own professions (Fewster-Thuente, 2014). Unfortunately, the existing literature does not provide a consensus on best practices for teaching IP TeamSTEPPS collaboration and communication strategies to prelicensure HCP students; however, simulation is currently the most common teaching strategy used to practice the application of TeamSTEPPS strategies. Prelicensure HCP educators should complete formal training on the TeamSTEPPS program to obtain the foundational knowledge needed to teach the TeamSTEPPS curriculum to prelicensure HCP students. Furthermore, educators should engage in curriculum revision to support the integration of the TeamSTEPPS program throughout prelicensure HCP education. Didactic instruction is appropriate to integrate early in the curriculum to provide students with foundational knowledge acquisition, whereas IPE simulations later in the curriculum will allow upperclassmen students to apply and practice learned strategies (Baker & Durham, 2013; Baker et al., 2015). As HCP students work together in IP teams during their prelicensure education, they can gain an appreciation for, and understanding of, each member of the team and their role.

Implications for Practice

Effective communication and collaboration among IP teams improves patient safety, reduces medical errors, and decreases patient morbidity and mortality (Fewster-Thuente, 2014; Greiner & Knebel, 2003; Manser, 2009), all of which lead to decreased health care costs (O'Leary et al., 2012). Thus, HCP students who are trained in teamwork and collaboration are more likely to provide safe, cost-effective care that leads to improved patient outcomes. The findings from this review demonstrate that integration of the TeamSTEPPS curriculum into prelicensure HCP student education enhances knowledge and attitudes regarding teamwork (Brock et al., 2013; Dujkic et al., 2015; Hobgood et al., 2010; Reed et al., 2017; Robertson et al., 2010). Therefore, HCPs who receive teamwork training during their prelicensure education will be more prepared to work within IP teams immediately upon entry to practice. This will allow these newly licensed practitioners to seamlessly enmesh themselves into the collaborative IP culture of the health care institution without additional teamwork training, thus decreasing educational costs for the health care institution.

Implications for Research

As IPE continues to be incorporated into prelicensure curricula for HCPs, additional research is required to establish best educational practices to support student learning. Recommendations for future research related to TeamSTEPPS integration into prelicensure HCP education include evaluation of the effect of innovative teaching strategies for TeamSTEPPS training on HCP students' teamwork skills; direct comparison of the outcomes of various teaching strategies for the Team-STEPPS curriculum; use of two-group designs; comparison of student outcomes among different IPE curricula; implementation of longitudinal study designs exploring teamwork knowledge, skills, and attitudes throughout an entire prelicensure curriculum and postgraduation; and inclusion of more varied disciplines (beyond nursing and medicine) in prelicensure TeamSTEPPS training to explore the effects of this training on various HCP students.

Conclusion

Planning, implementing, and evaluating the provision of patient care is a multifaceted process that requires the use of effective teamwork skills among IP health care team providers to ensure that safe, high-quality patient care is provided. To ensure this happens, IP team training must be incorporated into the prelicensure curriculum for HCPs. However, robust quantitative research about evidence-based teaching strategies to support prelicensure IPE using the TeamSTEPPS curriculum is lacking in the current literature. Continued research is needed to empirically support best practices for IPE training, specifically using the TeamSTEPPS program, in prelicensure HCP education to support safe, quality patient care.

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Summary of Studies

StudyStudy DesignStudy PurposeSampleInstrumentationMajor FindingsLimitations
Hobgood et al. (2010)Quantitative Pre/posttestTo determine the effectiveness of four different types of teaching strategies for an adapted TeamSTEPPS curriculum for prelicensure nursing and medical studentsN = 438 Senior nursing students (n = 203) Fourth-year medical students (n = 235)Researcher-developed teamwork knowledge test Researcher-developed Collaborative Healthcare Interdisciplinary Relationship Planning (CHIRP)-Teamwork Attitudes Instrument Researcher-developed standardized patient evaluation (SPE) Modified version of the Mayo High Performance Teamwork Scale (MHPTS) (Malec et al., 2007)TeamSTEPPS curriculum significantly improves students' knowledge and attitudes related to teamwork regardless of the educational modality used to present the informationUse of researcher-developed instruments without proven reliability and validity
Robertson et al. (2010)Quantitative One-group Pre/posttestTo determine the effect of a modified TeamSTEPPS training program on students' knowledge and attitudes towards teamwork and ability to recognize team skillsN = 213Fourth-year nursing students (n = 88)Third-year medical students (n = 104)Teamwork Knowledge Test (Hobgood et al., 2010) Collaborative Healthcare Interdisciplinary Relationship Planning (CHIRP) Scale (Hobgood et al., 2010) Team Skills Checklist Video Rating (Hobgood et al., 2010) Medical Team Training Program Evaluation Tool (Robertson et al., 2009)A modified TeamSTEPPS training program supported increased knowledge and attitudes related to teamwork for nursing and medical studentsSingle site limits generalizability One-group design threatens internal validity
Baker & Durham (2013)Survey Pre/posttestTo examine students' perceived collaborative competencies after participation in an elective interprofessional education (IPE) courseN = 17 First- and second-year nursing students Second-year medical students Third-year pharmacy studentsInterprofessional Collaborative Competencies Attainment Survey (ICCAS) (MacDonald et al., 2010)Significant increase in ICCAS scores after IPE courseSmall convenience sample limits generalizability
Brock et al. (2013)Unclear Pre/posttestTo explore students' attitudes, beliefs, and reported opportunities to participate in team communication following a 4-hour TeamSTEPPS trainingN = 149 Fourth-year medical students (n = 73) Third-year nursing students (n = 46) Second-year pharmacy students (n = 23) Second-year physician assistant students (n = 7)TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) (Baker et al., 2010) Researcher-developed Attitudes, Motivation, Utility, and Self-Efficacy (AMUSE) Three additional researcher-developed toolsSignificant increase in positive attitudes towards teamwork Significant increase in understanding of keyTeamSTEPPS conceptsUse of researcher-developed tools, all of which do not have proven reliability and validity Single site of data collection limits generalizability One-group design threatens internal validity
Liaw et al. (2014)One-group Prospective Quasi-experimental Pre/posttest Exploratory, descriptiveTo evaluate the effect of a simulation IPE program on students' confidence in communicating and perceptions towards IPE To explore students' satisfaction with IPE simulationN = 125 Fourth-year medical students (n = 33) Third-year nursing students (n = 92)C-scale (Grundy, 1993) Modified Perceptions of IPE questionnaire (Dagnone et al., 2008) Satisfaction with Simulation Experience Scale (SSES) (Levitt-Jones et al., 2011)Significant increase in self-confidence and perception Satisfaction with the learning experienceOne-group design threatens internal validity Single site of data collection limits generalizability
Baker et al. (2015)Prospective One-group Pre/posttestTo determine the effect of TeamSTEPPS training on students' team dynamics during a trauma resuscitationN = 48 Second-year radiologic science students (n = 12) Fourth-year physician assistant students (n = 12) Second-year respiratory care students (n = 12) Fourth-year nursing students (n = 12)Team Emergency Assessment Measure (TEAM) (Cooper et al., 2009) Trauma Team Performance Observation Tool (TPOT) (Capella et al., 2010)TeamSTEPPS education improves prelicensure health care professionals' team dynamicsSingle site of data collection limits generalizability One-group design threatens internal validity Lack of reliability and validity data for instruments
Clark et al. (2015)Survey One-group Pre/posttestTo determine changes in students' knowledge of IP collaboration after participating in an elective IP course focused on the care of critically ill patientsN= 37 Nursing students Pharmacy students Respiratory therapy students Social work studentsModified T-TAQ questions (Baker et al., 2010) Modified TeamSTEPPS Teamwork Perceptions Questions (T-TPQ) questions (American Institutes for Research, 2010) Researcher-developed Likert-style questionsTeamSTEPPS can provide a framework to foster an appreciation for the value of IP practice in the prelicensure academic environmentSmall convenience sample limits generalizability One-group design threatens internal validity Lack of statistical reporting affects ability to interpret results
Djukic et al. (2015)Quantitative Two-group Pre/posttestTo examine the impact of two different types of e-learning on nursing and medical students' knowledge, attitudes, and skills related to IP teamwork and collaborationN = 760 Nursing students Medical studentsResearcher-developed multiple-choice knowledge tests Team Skills Scale (Siegler et al., 1998) Attitudes toward Health Care Teams Scale (Siegler et al., 1998)A virtual IP program based on Geriatric Interdisciplinary Team Training and TeamSTEPPS does not have any disadvantages for nursing or medical students when compared to a blended-learning program except in relation to medical students' attitudes towards team valuesSingle site of data collection limits generalizability Low reliability on some of the data collection instrument subscales
Reed et al. (2017)Quantitative, descriptive One-group Pre/posttestTo explore the effect of TeamSTEPPS training on nursing and medical students' knowledge, self-efficacy, and team performanceN = 201 Senior nursing students (n = 103) Fourth-year medical students (n = 98)Self-Efficacy Measure for Interprofessional Practice Competencies for Students (Mann et al., 2012) Researcher-developed TeamSTEPPS Fundamentals Examination Researcher-developed Team Performance EvaluationTeamSTEPPS based simulation improves TeamSTEPPS knowledge, self-efficacy, and IP performance in nursing and medical studentsOne-group design threatens internal validity Single-site convenience sample limits generalizability

Call For Manuscript Peer Reviewers

The Journal of Nursing Education (JNE) is expanding its review panel and invites qualified individuals affiliated at all levels of nursing education programs to serve as peer reviewers. JNE is a peer-reviewed journal that publishes research and other scholarly works involving and influencing nursing education and has published original articles focused on undergraduate and graduate nursing education for over 50 years. Regular monthly features include Major Articles, Research Briefs, Educational Innovations, Quality Improvement Briefs, and Syllabus Selections. General qualifications for serving as a peer reviewer include:

  • Experience as a nurse educator or educator in a related field (e.g., statistics, information literacy, basic or social sciences) in or affiliated with one or more types of nursing programs.
  • A record of publishing in the peer-reviewed and other nursing and related literature, preferably with at least two peer-reviewed published articles.
  • Expertise and experience in one or more of the following areas: undergraduate and/or graduate nursing programs, teaching–learning methods, scholarly inquiry methods, academic issues, and clinical population focus.
  • Knowledge of trends and issues in nursing education, higher education, and health care.
  • Willingness to use the online peer review system (Editorial Manager) and complete assigned reviews within the specified time frame.

Reviewers are expected to complete substantive reviews of approximately 6 to 10 manuscripts of varying lengths each year, assigned according to the reviewer's designated areas of expertise in the journal's online peer review system. New reviewers will be provided with detailed guidelines for writing substantive reviews and using the online review system.

If interested in being considered as a peer reviewer for JNE, please send a cover letter and CV to: Jaime Clayton, ELS, Executive Editor, at jclayton@slackinc.com.

Authors

Dr. Ross is Associate Professor, Ms. Meakim is Clinical Assistant Professor, and Dr. Hohenleitner is Adjunct Clinical Instructor, Villanova University, M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Jennifer Gunberg Ross, PhD, RN, CNE, Associate Professor, Villanova University, M. Louise Fitzpatrick College of Nursing, 800 Lancaster Avenue, Villanova, PA 19085; email: jennifer.ross@villanova.edu.

Received: October 18, 2019
Accepted: August 12, 2020

10.3928/01484834-20201020-03

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