Clinical trial NCT05213117: Optimizing Medical "Teaming" on Resident Based Teams
Official title: Optimizing Medical "Teaming" on Resident Based Teams
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Inter-professional Relations
Lead sponsor: Massachusetts General Hospital
Sponsor class: OTHER
First posted: 2022-01-28
Enrollment: 33
Sex: ALL
Minimum age (years): 24
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: SINGLE_GROUP
Intervention model description: The investigators plan to randomize 16-18 Post Graduate Year (PGY)-1 residents in internal medicine at Massachusetts General Hospital from the possible 74 PGY-1 incoming residents who agree to partake in the study to one general medicine clinical floor for the academic year. These co-localized residents will complete 16-20 weeks of scheduled rotation time on White 9. Similarly, the investigators plan to randomize 6-8 PGY-2 residents from a possible group of 64 PGY-2 residents who agree to participate in the study to one general medical clinical floor for the academic year. These participants will complete 4-6 weeks of scheduled rotation time on White 9. Rotations will be completed in the normal 2 or 4 week block rotations, randomly assigned throughout the academic year.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The main objective of this study is to evaluate the colocalization of internal medicine residents on one clinical inpatient hospital floor for all general medicine block rotations during the 2019-2020 academic year. Specifically, the aims of the study are to determine if co-localization improves familiarity with nursing staff, which in turn, improves team work, psychological safety, patient care and reduces burnout. The investigators' hypothesis is that co-localization will increase familiarity between residents and nurses and result in improved psychological safety, team work and patient outcomes.

Detailed description: Teamwork is critical in delivering high quality medical care. Failures in team communication and coordination have been cited as significant contributors to medical errors. In large teaching hospitals, patients receive care from transiently formed teams of nurses and residents who may only work together for as little as two weeks, as residents rotate through many clinical floors due to the complexity of resident scheduling. Unlike more established teams that work together over long periods of time, these transient groups are called "teaming;" a process where a group of diverse providers, with different roles, outlooks and levels of professional training transiently come together to carry out complex tasks. (Reference: Dr. Amy Edmondson, Harvard Business School) A key risk in "teaming" is the lack of familiarity of team members as studies suggest familiarity promotes an environment of psychological safety, where team members feel safe speaking up, asking for help and admitting errors. These skills are important for both team work and patient safety. The investigators hypothesize that in large residency programs where resident rotate on multiple floors, it is possible to improve the quality of "teaming" by increasing the frequency with which smaller groups of residents and nurses work together. As a result, the investigators propose a randomized controlled trial on an inpatient general medical floor to study the effect of co-localizing residents with nursing staff. One cohort of residents will be assigned to complete all general medical rotations on a single floor for the academic year. The investigators will assess the impact on psychological safety, team work and patient care. The investigators hypothesize by co-localizing residents with nursing, while these "teaming" are still transient, the slight increase in familiarity will promote a culture of psychological safety and improve team work. If benefits are found, resident scheduling can be adjusted in subsequent years.

Eligibility criteria: Inclusion Criteria:

* All incoming PGY-1 residents who volunteer to be randomized

Exclusion Criteria:

* Any incoming PGY-1 resident who declines to be randomized

Primary outcomes:
measure: Teamwork assessed by Simulation about Shortness of Breath
timeFrame: This simulation will be conducted at 6 months in this 12month study
measure: Teamwork assessed by Simulation about Negotiation with Angry Patient
timeFrame: This simulation will be conducted at 12 months in this 12month study
Secondary outcomes:
measure: Psychological Safety
timeFrame: Residents and Nurses will be surveyed at 6 months in this 12 month study
measure: Psychological Safety
timeFrame: Residents and Nurses will be surveyed at 12 months in this 12 month study
measure: Communication between Nurses and Interns
timeFrame: Observation will start at 6 months in this 12 month study and continue through study completion, an average of 6 months
Other outcomes:
Locations:
city: Boston
country: United States
facility: Massachusetts General Hospital
state: Massachusetts
Study officials:
affiliation: Massachusetts General Hospital
name: Kathleen F Finn, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Iyasere CA, Wing J, Martel JN, Healy MG, Park YS, Finn KM. Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial. JAMA Intern Med. 2022 Nov 1;182(11):1190-1198. doi: 10.1001/jamainternmed.2022.4373.