Analysis and Comparison of Nurse and Physician Team Trauma Assessment Skills

Bauchwitz, B., Niehaus, J., and Weyhrauch, P.

Presented poster at the Medical Health Systems Research Symposium (MHSRS), Kissimmee, FL (August 2016)

Background: Trauma assessment is key to patient outcomes. One approach to training trauma assessment is simulation-based training using patient scenarios to allow trainees to practice skills. Training can be individual or team-based, depending on the training application. To accurately assess performance, models of skills, metrics, and ways to assess those metrics in simulation are needed. Previous research in the area include looking at objective measures of performance using simulation [1]. Because teams can include multiple roles (such as nurses and physicians) skills and metrics may differ between roles even when performing a common task. To support automatic assessment of skills in the context of team performance, an analysis and comparison of roles and required skills is needed.

Methods: The Methodology for Annotating Skill Trees (MAST) [2] was used to analyze primary and secondary trauma assessment for two roles: physicians and nurses. Several sources were used for the analysis, including published curricula such as Advanced Trauma Life Support (ATLS), Trauma Nurse Core Course (TNCC), Prehospital Trauma Life Support, and Tactical Combat Casualty Care. MAST was used to develop a hierarchical descriptions of tasks, subtasks, techniques, skills, and metrics and measures of performance, called a “skill tree”. In addition to the description of the task itself, the skill tree analysis included (1) descriptions of required information, such as the goals of each step; (2) the required information about the patient such as relevant signs and symptoms; and (3) rules and other decision making models required for correctly performing the task.

Results: Two skill trees were manually created to define the tasks and required skills for primary and secondary trauma assessment for physicians and nurses. In each analysis, over 100 sub-tasks were identified and annotated. A preliminary comparison indicated there were differences in how skills are taught and described. The ATLS and TNCC curriculum showed key differences in the organization and scope of training.

Conclusion: These differences have significant impact on future team training simulations and training curriculum, specifically the prerequisite knowledge and skills needed to use the simulations and the scope and features of the simulations. Identification of subtasks, information elements, skills, and metrics can be validated and serve as blueprint for developing simulation-based training for teaching trauma assessment skills in simulation.

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