Assessing changes in individual psychological and teamwork factors for reconfigured organ retrieval team during high and low demand simulation

Objectives: Explore viability of a reconfigured organ retrieval team assessing individual psychological and teamwork variables, compared across two conditions varying in complexity and pressure.Background: A recent review of the UK national organ retrieval service (NORS) indicated potential reconfiguration of teams. Non-technical skills (NTS) and individual psychological factors are relevant to effective team performance for each retrieval event and the ability of staff to manage associated demands on an ongoing basis. Exploring the associated psychological factors from individual and team perspectives makes an important contribution to inform viability considerations. Task conditions may vary with complexity and time pressure and the impact on individual and team capacity to work effectively will vary correspondingly.

Methods: Mental readiness was explored prior to each simulation and self-rated mental effort and teamwork were assessed immediately post. Attitudinal change (pre-post) was reported for each simulation condition. Expert ratings of non-technical skills were completed via live observation using established checklists, modified for use in organ retrieval context. Continuous cardiovascular responses were assessed to examine potential correlation with momentary changes in effort due to task demands. Team performance was filmed to enable data interpretation to reflect specific events within the simulation.

Results: Self-rated mental readiness and post-simulation mental effort revealed a non-uniform pattern of individual differences between the two conditions. Non-technical skills were generally self-assessed to be lower in the DCD scenario than DBD. Ratings of NTS were contrasted between self and expert observers; however data indicated a possible ‘ceiling’ effect, suggesting more sensitive measurement is required. Attitudinal change was compared between conditions and attitude towards reconfigured teams were mostly positive for DBD but negative for DCD.

Conclusion: Data collected on this exploratory simulation provided a range of information on relevant individual and team factors to contribute to viability considerations for proposed changes to reconfiguration of organ retrieval teams. The methods employed during this study also revealed a number of important considerations to inform planning of future simulation training, including the need to: increase the demands of simulation training, enhance the training of expert observer raters, utilise more sensitive rating scales, and consider the order effect of scenarios. It is important that measures utilised in this training environment offer both a practical and time efficient means of assessment.