Tools
Industrial and Organizational Psychology in Medical Simulation
Introduction
Industrial and organizational psychology (IOP) is the scientific study of human behavior in organizations and encompasses areas related to recruitment and selection, training and development, employee motivation, leadership, organizational change, and performance appraisal. Because of its emphasis on optimizing human performance and organizational outcomes, IOP can contribute several theoretical and practical strategies for enhancing the effectiveness of medical simulation training efforts. Increasingly, IOP currently applies to a broad range of areas within healthcare, including physician selection, skills verification, and team training.[1][2][3][4] With increased awareness of its potential, it is expected that the field of IOP will have an even more integral role in medical simulation in the future. The sections that follow highlight just a few areas in which IOP can inform medical simulation training endeavors.
Issues of Concern
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Issues of Concern
A cornerstone of IOP is its reliance on data to inform decisions and output. Likely because of the field’s historical roots in industrial applications, in which time-and-motion increases and the number of widgets produced as the criteria for success, IOPs are trained to optimize data collection and reporting processes. For example, IOPs know that no training intervention should occur without a thorough needs assessment. The needs assessment phase is designed to identify discrepancies between the current and desired state of knowledge, skills, abilities, or other attributes (KSAOs) among workers. Applied to medical simulation, this process might entail reviewing training or practice guidelines, surveying health current trainees or healthcare practitioners, observing clinical performance, or auditing healthcare outcomes data before designing a new simulation-based curriculum. Data from the needs assessment phase can help simulation leaders determine if a new curriculum is warranted, and if so, how to optimize the design and evaluation of that curriculum.
Another major contribution of the IOP field to medical simulation training is performance measurement. IOPs categorize training outcomes according to attitudes, behaviors, and cognitions and identify opportunities to measure each of these independently. For example, a common strategy among simulation educators is to measure course effectiveness along with participant self-report attitudes (e.g., “I found this course helpful,” “I feel more confident performing these procedures,” “I plan to apply principles from this course to my practice.”) Integration of IOP principles would ensure that the course is measured not only according to participant satisfaction and reactions, but also regarding increases in cognitive outcomes (procedural steps, when to use certain techniques, etc.) and actual behaviors (improvements in hands-on skills, retention, and transfer to the actual clinical environment). Finally, given that the primary placement of IOPs is in business settings, IOPs are well-suited to partner with simulation educators to document the return on investment of simulation activities. Aside from course effectiveness, measuring outcomes such as onboarding rates, task efficiency, opportunity costs, 360-degree ratings, differences across learner groups, and skill or knowledge transfer to new settings may be areas where IOPs have additional input and expertise.
Consideration of individual differences in the training and development process is another area in which IOP can offer value to medical simulation training. For optimal effectiveness, training curricula should acknowledge that learners are not a blank slate; instead, they bring prior experiences, mindsets, and motivations to the table as well. These individual differences impact the efficacy of various training interventions and should merit consideration during the design and implementation of simulation-based training. For example, work has shown that medical students with a learning goal orientation (the desire to develop the self by acquiring new skills, master new situations, and improve competence) lead to more successful task acquisition compared to trainees with a performance goal orientation (the desire to perform well to prove one’s competence to others.[5][6] Other research has shown that a trainee’s internal motivation influences procedural skills learning.[7] Finally, a learner’s locus of control – the degree to which an individual believes he/she has control over the outcome of events in their own lives – has been shown to impact training performance and transfer.[8]
IOPs also have a substantial literature base demonstrating that there are many contextual influences on the effectiveness of training interventions. For simulation educators, this means that not only does the learning environment in the simulation setting need to be considered during training delivery and assessment, but the context in which trainees will apply these skills must also get factored into retention and transfer evaluation. For example, learners report better task attention and engagement when in a psychologically safe environment in which they feel free to express genuine concerns and questions without fear of consequences.[9]
Clinical Significance
Simulation training interventions are known to enhance clinical performance.[10][11] By combining clinical practice guidelines with best practices in training, development, and assessment from the IOP literature, the effectiveness of those simulation training episodes can be optimally realized. For healthcare education to move forward in the most efficient and effective manner possible, it is critical that educators investigate related fields outside their domain, critically analyze their applicability to healthcare education, and implement approaches and methods with the strongest evidence base. Industrial and organizational psychology is likely just one field in which there is substantial overlap in overarching aims and can be applied to optimize effectiveness. Ultimately, these training measures can result in skills that will improve patient outcomes.
Enhancing Healthcare Team Outcomes
Perhaps one of the most impactful contributions of Industrial and organizational psychology to medical simulation is incorporating team science principles into simulation-based team training. One of the foundational contributions to medical simulation training is construct clarity, in which conceptual and theoretical foundations of teamwork, team effectiveness, and team performance are offered and described.[12][13][14][4] Other work has provided empirical work highlighting how the incorporation of team science principles can help improve the efficacy of simulation-based team training. For example, work has shown that team-level cognitions, such as team mental models (a team’s shared, organized understanding and mental representation about key elements of the team’s environment), team familiarity (the extent to which team members have worked with one another in the past), team situation awareness (the extent to which a team similarly perceives, understands, and interprets their task environment), and team-level goals (group-level goals that require input from all) can result in more effective team-level interventions.[15][16][17][18]
References
Gardner AK, Cavanaugh KJ, Willis RE, Dunkin BJ. Can Better Selection Tools Help Us Achieve Our Diversity Goals in Postgraduate Medical Education? Comparing Use of USMLE Step 1 Scores and Situational Judgment Tests at 7 Surgical Residencies. Academic medicine : journal of the Association of American Medical Colleges. 2020 May:95(5):751-757. doi: 10.1097/ACM.0000000000003092. Epub [PubMed PMID: 31764083]
Gardner AK, Grantcharov T, Dunkin BJ. The Science of Selection: Using Best Practices From Industry to Improve Success in Surgery Training. Journal of surgical education. 2018 Mar-Apr:75(2):278-285. doi: 10.1016/j.jsurg.2017.07.010. Epub 2017 Jul 24 [PubMed PMID: 28751186]
Ritter EM, Gardner AK, Dunkin BJ, Schultz L, Pryor AD, Feldman L. Video-based assessment for laparoscopic fundoplication: initial development of a robust tool for operative performance assessment. Surgical endoscopy. 2020 Jul:34(7):3176-3183. doi: 10.1007/s00464-019-07089-y. Epub 2019 Sep 11 [PubMed PMID: 31512036]
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Level 2 (mid-level) evidenceGardner AK, Diesen DL, Hogg D, Huerta S. The impact of goal setting and goal orientation on performance during a clerkship surgical skills training program. American journal of surgery. 2016 Feb:211(2):321-5. doi: 10.1016/j.amjsurg.2015.07.028. Epub 2015 Nov 6 [PubMed PMID: 26687963]
Gardner AK, Jabbour IJ, Williams BH, Huerta S. Different Goals, Different Pathways: The Role of Metacognition and Task Engagement in Surgical Skill Acquisition. Journal of surgical education. 2016 Jan-Feb:73(1):61-5. doi: 10.1016/j.jsurg.2015.08.007. Epub 2015 Sep 26 [PubMed PMID: 26395402]
Cook DA, Gas BL, Farley DR, Lineberry M, Naik ND, Cardenas Lara FJ, Artino AR Jr. Influencing Mindsets and Motivation in Procedural Skills Learning: Two Randomized Studies. Journal of surgical education. 2019 May-Jun:76(3):652-663. doi: 10.1016/j.jsurg.2018.09.018. Epub 2018 Nov 22 [PubMed PMID: 30473262]
Level 1 (high-level) evidenceSmith-Jentsch KA, Salas E, Brannick MT. To transfer or not to transfer? Investigating the combined effects of trainee characteristics, team leader support, and team climate. The Journal of applied psychology. 2001 Apr:86(2):279-92 [PubMed PMID: 11393440]
Tsuei SH, Lee D, Ho C, Regehr G, Nimmon L. Exploring the Construct of Psychological Safety in Medical Education. Academic medicine : journal of the Association of American Medical Colleges. 2019 Nov:94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions):S28-S35. doi: 10.1097/ACM.0000000000002897. Epub [PubMed PMID: 31365407]
Brydges R, Hatala R, Zendejas B, Erwin PJ, Cook DA. Linking simulation-based educational assessments and patient-related outcomes: a systematic review and meta-analysis. Academic medicine : journal of the Association of American Medical Colleges. 2015 Feb:90(2):246-56. doi: 10.1097/ACM.0000000000000549. Epub [PubMed PMID: 25374041]
Level 1 (high-level) evidenceZendejas B, Brydges R, Wang AT, Cook DA. Patient outcomes in simulation-based medical education: a systematic review. Journal of general internal medicine. 2013 Aug:28(8):1078-89. doi: 10.1007/s11606-012-2264-5. Epub [PubMed PMID: 23595919]
Level 1 (high-level) evidenceDriskell JE, Salas E, Driskell T. Foundations of teamwork and collaboration. The American psychologist. 2018 May-Jun:73(4):334-348. doi: 10.1037/amp0000241. Epub [PubMed PMID: 29792452]
Gardner AK, Scott DJ. Concepts for Developing Expert Surgical Teams Using Simulation. The Surgical clinics of North America. 2015 Aug:95(4):717-28. doi: 10.1016/j.suc.2015.03.001. Epub 2015 May 23 [PubMed PMID: 26210965]
Bisbey TM,Reyes DL,Traylor AM,Salas E, Teams of psychologists helping teams: The evolution of the science of team training. The American psychologist. 2019 Apr; [PubMed PMID: 30945891]
Gardner AK, Scott DJ, AbdelFattah KR. Do great teams think alike? An examination of team mental models and their impact on team performance. Surgery. 2017 May:161(5):1203-1208. doi: 10.1016/j.surg.2016.11.010. Epub 2017 Jan 4 [PubMed PMID: 28063607]
Joshi K, Hernandez J, Martinez J, AbdelFattah K, Gardner AK. Should they stay or should they go now? Exploring the impact of team familiarity on interprofessional team training outcomes. American journal of surgery. 2018 Feb:215(2):243-249. doi: 10.1016/j.amjsurg.2017.08.048. Epub 2017 Nov 4 [PubMed PMID: 29132646]
Gardner AK, Kosemund M, Martinez J. Examining the Feasibility and Predictive Validity of the SAGAT Tool to Assess Situation Awareness Among Medical Trainees. Simulation in healthcare : journal of the Society for Simulation in Healthcare. 2017 Feb:12(1):17-21. doi: 10.1097/SIH.0000000000000181. Epub [PubMed PMID: 27504889]
Level 2 (mid-level) evidenceGardner AK,Kosemund M,Hogg D,Heymann A,Martinez J, Setting goals, not just roles: Improving teamwork through goal-focused debriefing. American journal of surgery. 2017 Feb; [PubMed PMID: 27765182]