2020 Report on Education
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Team-based learning

Agnes Ryzynski, Manager, Sunnybrook Canadian Simulation Centre & Curriculum Development; Tracey DasGupta, Director, Interprofessional Practice, and Elizabeth McLaney, Director, Interprofessional & Academic Education
Agnes Ryzynski, Manager, Sunnybrook Canadian Simulation Centre & Curriculum Development; Tracey DasGupta, Director, Interprofessional Practice, and Elizabeth McLaney, Director, Interprofessional & Academic Education

The goal of the team-based learning priority is to improve the performance of interprofessional teams through team assessment, self-directed team development, practice-based simulation, and the promotion of team innovators.

Team assessment & development

Our largest focus this year was on team assessment. At Sunnybrook, we had 17 teams complete our in-house “Interprofessional Collaboration Team Assessment” and an additional 22 teams partner with our Organizational Development & Leadership department to go through a structured self-assessment and team development process. Teams have surfaced many different kinds of opportunities for growth – from using facilitation techniques to gain input from quieter team members, to shadowing activities that enhance role clarity, to creating debriefing tools that highlight successes and learning opportunities. Each year as we work with more teams, our pool of aggregate data grows. It is interesting to understand that our teams believe, for example, that they develop person-centered care plans, and consult each other appropriately across professions, but that they don’t spend as much time as they wish on reflecting as a group and learning from their successes and challenges. By understanding our teams as an organization, we can help support them to do their best work!

Competency based aggregate data for team assessment chart.

Competency based aggregate data for team assessment – % of respondents indicating that their team often or very often engages in the behaviours associated with each competency.

Click to view plain-text of infographic

IP Communications
IP Conflict Resolution
IP Values & Ethics
Reflection
Role Clarification
Shared Decision Making

Team example: “Conflict – Working Better Across Teams” Thompson Anxiety Centre
“We believe that our conflict resolution within the team is strong, however our ability to resolve conflicts in a timely and productive way with our teammates (at another site) requires some strengthening. We are changing a number of practices and cultural things, such as when we speak face to face vs email, in order to begin to change the dynamic.”

Team example: “Communication – Being a leader is not just a formal position” St. John’s Rehab, Burn Program
“We are leaders and role models in everything we do, from advocating for our patients and their families to changing practices on the floor to better reflect best practices in the field. Crucial conversations [workshop] showed us a totally different perspective of how and when to have a challenging conversation, and most importantly, it taught us how to step back and re-evaluate the situation and put ourselves in the other person’s shoes and try to understand each other to accomplish a common goal.”

A system role in team assessment

Sunnybrook has also taken a leadership role in partnering with the University of Toronto’s Centre for Interprofessional Education (CIPE) to advance a Team Assessment process and toolkit that is currently being implemented across the Toronto Academic Health Sciences Network (TAHSN).

Faculty and staff development to support team-based learning

As we continue to grow our investment in team-based learning, we are thrilled to support our staff and teams to grow their understanding – as well as their abilities – to teach, lead and work across professions. Last year we held an on-site, customized version of the CIPE’s BOOST! (Building Optimal Outcomes from Successful Teamwork) workshop for 37 members representing 14 different teams. We also held a recognition event where teams who had completed our Sunnybrook Interprofessional Collaboration Team Assessment process came together to share their work and celebrate each others’ progress. We sponsored a Health Professions Innovation fellowship that focused on using a team approach to optimize code white responses and support. And we sent two leaders to participate in the CIPE’s Collaborative Change Leadership (CCL) program with a project focused on enhancing the capacity of leaders to create psychologically safe teams.

Testimonial 1

Health Professions Innovation Fellowship Program attendee focuses on education and teamwork!

"The opportunity of the PBRI/TAHSN fellowship supported through the Education portfolio allowed the C5 staff to really work on team-based problem solving and reflection after code white violence events. Each time an event happened, unique members of C5 ward staff as well as responders (i.e., security from off unit) had the chance to engage in short and psychologically safe debriefing using a written format. Communication from these debriefing opportunities went on to leadership and the team could then act on further strategies to optimize patient and family care, staff and unit safety as well as changes to system wide processes for a better workplace. As I learned and worked and collaborated creatively with our whole team during this quality initiative, I could see the development of greater trust relationships, mutual respect for each other’s roles, and shared decision making through practice of better communication skills. Individual staff as well as the overall C5 team have benefited from team-based learning as we help each other move towards a safer work environment for everyone!” – Estella Tse, Occupational Therapist, C5 Trauma Service.
– In partnership with Education Research & Scholarship.

Psychological safety

Our Collaborative Change Leadership (CCL) program attendees were so successful in their work, and such attention has been garnered for the topic of psychological safety that their work has been presented at the Sunnybrook/CIPE Interprofessional Collaboration Showcase and the CIPE’s Community of Practice. Most recently this work was accepted for presentation at the international Collaborating Across Borders conference in the fall of 2019, and is being embedded within Sunnybrook’s Management Excellence Program (MExP) so that all new leaders will be versed in how to lead for psychological safety.

Testimonial 2

Education Champions/Collaborative Change Leadership (CIPE)* workshop attendees foster psychological safety at Sunnybrook!

"Our psychological safety initiative has included stakeholder engagement across the organization that led to the development of key vital behaviours and actions that have informed our vision and our strategic priorities. The key behaviours include practices of reflection, honouring diverse opinions, accountability and practicing thanks and appreciation. These practices focus on consistent demonstration of behaviours that create comfort and the ability to speak up, in self and in others. Our collective learning leads to effective collaboration within our teams. To date, there have been three major outcomes of the initiative that reach our staff, including leaders, teams and individuals. First, in support of enhancing and accelerating leadership performance, a psychological safety workshop has been added into the MExP Program, since October 2019. Second, by invitation, in follow-up to team assessment results, psychological safety discussions are co-facilitated with associates from our Organizational Development and Leadership (OD&L) department. Third, an online module is now available to all staff, via OD&L SLI modules: sunnynet.ca/psychologicalsafety. The outcomes have been a collaboration with our OD&L colleagues, Quality and Patient Safety stakeholders and front-line staff passionate about this work. We continue to seek and be responsive to opportunities in our journey to change and impact a culture of psychological safety at Sunnybrook!" – Lina Gagliardi, Professional Leader, Social Work and Spiritual & Religious Care; Manager, Spiritual Care (acute care); Manager, Health Care Navigator Team, and Isabella Cheng, Professional & Education Leader, Occupational Therapy.
*Centre for Interprofessional Education, University of Toronto

Organizational definition for team-based learning

This year, after completing an extensive literature review and thematic analysis, we proudly debuted our new organizational definition for team-based learning. This language serves as a common foundation for understanding and working together to advance this key education priority. Team-based learning (TBL) brings together team members from diverse professions and roles to engage in interactive learning. It involves authentic practice in a psychologically-safe environment which drives critical thinking and collaborative problem solving. At Sunnybrook, we believe that TBL develops high-performing teams who leverage creativity and innovation to directly impact patient safety, highquality care and robust educational outcomes.

Capturing the spirit of the 2019 IPC Showcase

About 200 attendees came together on Wednesday, June 12, 2019 to celebrate excellence in team learning and collaborative care. The annual event was packed with speakers, workshops and poster presentations that all celebrated the value and joy of working together. Laughter filled the auditorium as keynote speaker Luis Serrano, Chief Fun Officer at FUNdamentals of Play, used stories and interactive games to help attendees discover key ways to catapult joy at work as individuals and teams.


"We spend one-third of our lives at work and yet up to 70 per cent of the Canadian workforce are unengaged and unenthused at work,” he said. “It’s up to us to own our happiness.” Serrano stressed the need to find and live our values, connect and engage with those around us, and add play to our daily lives at work."


For presenter Jennifer Shaffer, professional practice leader for physiotherapy at St. John’s Rehab, that means working with colleagues of all professions to help patients reach their goal, and passing that value on to students. As part of every structured student placement, Shaffer and her colleagues fabricate a complex case study and randomly assign students an alternative profession. The student then needs to speak to other team members to find out what role they’d play in treating the make-believe patient and how they would collaborate.

“We have students who otherwise would never have met each other, shadowing each other or other clinicians, and even meeting up for lunch to discuss their roles,” Shaffer said.

The enthusiasm continued throughout the day with workshops and presentations that echoed the theme of being present in order to find joy and make meaningful connections.


"The most valuable gift you can give yourself is time – taking time to be more fully present in your journey, to become more inspired, and to connect with those around us,” said Kristen Winter, Vice President, Human Resources and Organizational Development & Leadership at Sunnybrook in the event’s closing presentation. “We can’t be present for others without first taking time to be present for ourselves.”


Simulation in team-based learning

  1. Obstetrical In-Situ Simulation Outreach Program

    The Sunnybrook Canadian Simulation Centre received an unrestricted educational grant from Ferring Pharmaceuticals to provide in-situ simulation for interprofessional clinical teams caring for obstetric patients at hospitals in the GTA. A need for simulation education in this population was identified, specifically that the incidence of post partum hemorrhage is increasing in North America. Additionally, simulation-based practice drills have been recommended by many organizations since the publishing of the seminal document “To Err is Human” by the Institute of Medicine in 2000. More recently, recommendations endorsed by anaesthesia, obstetric and nursing administrative and academic bodies recommend facility-wide standards and drill practices to enhance patient safety.

    The learning objectives of this program include:
    • To apply principals of crisis resource management to the management of obstetrical emergencies
    • To improve interprofessional communication and collaboration
    • To analyze patient safety threats, both existing and latent, in their own clinical environment and formulate a plan to solve or mitigate these threats

    To date, the Sunnybrook Canadian Simulation Centre has been fortunate to provide expertise to educate several care teams in multiple GTA hospitals.

  2. OBGYN Chinese delegates visit the Sunnybrook Canadian Simulation Centre

    In the spring of 2019, the Sunnybrook Canadian Simulation Centre partnered with Sunnybrook’s Women and Babies team to showcase our highperforming obstetrical team to our visiting colleagues from China. We immersed our Chinese colleagues into a Code Omega Obstetrics simulation to demonstrate Sunnybrook’s best-practice interdisciplinary team approach to managing this critically ill population. Our visiting Chinese delegates also received expert instruction, practice and feedback on management of shoulder dystocia. Thank you to our DAN Women and Babies colleagues for showcasing our high performing obstetrical team to our international colleagues.

  3. Trauma In-Situ Simulations in the news

    The Sunnybrook Canadian Simulation Centre insitu trauma simulations were highlighted by CityTV to educate the public on how a trauma hospital team prepares for real-life management of trauma patients with a special focus on the escalating gunshot emergencies in Toronto.

  4. IV Pump Procurement: Human Factors Simulation Testing

    The current IV pumps at Sunnybrook needed to be replaced due to technical issues and discontinuation. The Sunnybrook Canadian Simulation Centre partnered with the Sunnybrook IV Pump Evaluation team on two mission critical stages of the replacement pump assessment. The first stage of assessment with the Simulation Team was to design clear objectives and quantitative metrics as well as multiple IV pump scenarios that would adequately test clinical and human factors elements with front-line staff. Over the course of a 3-week period, more than 100 frontline staff tested the possible replacement pump in the simulation centre.

    Given the possible replacement IV pump was significantly heavier than the present IV pump, the Simulation Centre staff executed a real-life simulation scenario in Stage 2 to test the feasibility of transporting a critical care patient with eight pumps on an IV pole. The objectives were to assess mobility, human factors and gather qualitative feedback from front-line porters and RN’s who are responsible for transporting patients with the pumps. As a result of the partnership with the Sunnybrook Canadian Simulation Centre, the IV Pump Evaluation Team was able to move forward with recommending the replacement pump to the Senior Leadership Team.

  5. Emergency Department Pediatric Simulation Curriculum

    Our Sunnybrook Emergency Department (ED) sees a low volume of high-acuity pediatric patients. A needs assessment amongst our ED health-care providers revealed a need for a formal pediatric Continuing Medical Education (CME) curriculum. The ED collaborated with the Sunnybrook Canadian Simulation Centre to design and deliver pediatric CME to the interprofessional ED staff throughout the year. The goal of this curriculum is to practice critical skills in neonatal emergencies, improve team communication and function and to identify system gaps in the management of the pediatric population.

  6. Faculty development workshops

    This year, the Sunnybrook Canadian Simulation Centre once again hosted multiple faculty development workshops to support our simulation faculty. These workshops are crucial to ensure that the simulation centre is adhering to simulation best practices and offering the highest level of quality education to our learners.
    • Advance Care Planning (ACP) Simulation Facilitator Training Workshop
      This workshop is designed to provide future ACP Simulation Workshop Facilitators with the skills and knowledge to facilitate simulation workshops and take on various roles as a simulated patient.
    • Corporate Nursing Orientation (CNO) Simulation Day Facilitator Workshop
      This workshop is designed to provide future CNO simulation day facilitators with the competencies required to facilitate the corporate nursing simulation day that is held monthly at Sunnybrook for all new nurses employed at Sunnybrook.

Thank you to our entire dedicated simulation faculty for maintaining the highest quality of education for our Sunnybrook Canadian Simulation Centre learners!

“Best workshops we’ve had in clerkship. Very helpful.”

“One of the most helpful workshops in med school!”

“Such a valuable learning experience. I think it helped bring some otherwise nebulous concepts to life.”

– Third year medical students: Anesthesia Clerk Simulation Program


“I had to do CPR on a real patient a few weeks ago. I recall actively remembering what I had learned in the workshop to resuscitate the patient. All in all, we did about 10 rounds of CPR, so good technique was really important to us. The patient made it, and I remember feeling very grateful for having a better idea of what to do in that situation – the workshop taught by Roman and Susan was integral to that.”

– Arshia Pedram Javidan, MD/MSc (SLI) Candidate, Class of 2021 University of Toronto, Faculty of Medicine


“A huge thank you and congratulations to all the organizers of this incredible day of learning…I found the combination of practice in the am and sim + debrief in the pm to be VERY effective… This event was the most well-done learning activity I’ve participated in. Sunnybrook and learners here are lucky to have such enthusiastic and knowledgeable educators/clinicians!”

– ED Interprofessional Obstetrics Simulation Day participant


“Great practice time to work on skills, get tips for improvement.”

– OBGYN resident


“Excellent! Should be mandatory training.”

“Such great teamwork. Reinforces how working together works well.”

– OB Outreach Simulation Program participant


Learner stats for Sept. 2018 - Sept. 2019
Undergraduate 827
Postgraduate 968
Nursing 895
Physicians 280
Health disciplines staff & students 52
Other 77
Total learners 3,099
Learner quotes: RN, Corporate Nursing Orientation Simulation Day
“Non-judgmental environment. Really, really helpful. I feel way more prepared.”

“The sim lab was very informative and I loved learning from practicing and observing.”
 
 

Making a difference through team-based learning

What our students are saying:
We have seen an increase in the number of favourable reports by students when we ask them about how often they see Sunnybrook teams learning together!
What our patients are saying:
We have seen a slow and steady increase in how well our patients say that team members on our units are working together!
 

 

Favourable ratings: 

I experienced team members learning together collaboratively across professions.

Infographic 2

How would you rate how well the team members on your unit worked together?

 

 

Nursing Education Report 2020

Developing Nurse Leader Program (DNLP)

Nursing Education, in partnership with Organizational Development and Leadership, welcomed over 70 nurses from all campuses to participate in the newly revised program for team leaders and charge nurses. The additional content provided to these future team leaders was designed to provide them with the tools to better understand how their role influences patient care beyond their own unit. The evaluations of this additional content averaged 5.5/6. The additional content included the following topics: A systems-level look at Sunnybrook’s reporting structure, emergency preparedness, quality and patient safety, patient flow, manager of shift operations, occupancy and transition planning, and working with students. A letter of commitment exercise was also introduced where learners write a letter to their patient care manager sharing what they have learned, and what they are committing to when they return to their unit. The feedback from the PCMs was very positive, and closed the loop on learning and expectations. One participant wrote “It is good to know that emergencies are looked at and prepared for within a structured framework.” A learner wrote that “the managers appreciate the letters a lot” and “makes us realize you don’t need an official title to be a good leader.” 

Collaborative practice

To support the integration of registered practical nurses across our acute care units, a partnership was forged with Humber College to develop a Sunnybrook-specific advanced health-assessment course. The purpose of this professional development opportunity was to support high-quality patient care by preparing staff with the clinical knowledge and reasoning required to care for acute care patients. The program drew on the learner’s previous entry-to-practice nursing knowledge and skills to achieve competency with advanced patient assessments. Nursing Education and Human Resources provided a number of information sessions, and learners applied via a screening process. Sunnybrook supported over 20 nurses to attend the course, and many successfully transitioned into acute care positions.

Launch of agency nurse website for orientation

Sunnybrook works in collaboration with select nurse staffing agencies to support patient care needs across the organization. To support the provision of high-quality care expected at Sunnybrook, Nursing Education launched a secure website ensuring that new policies, procedures and required learnings are readily available to meet the new and ongoing needs of agency staff. Agency nurses must complete required orientation modules, including in-person education sessions to demonstrate competence prior to working in patient care areas. This training aligns with accreditation standards outlined by Accreditation Canada as well as the Institute for Quality Management in Health Care (IQMH).

New nursing partnership with Michener Critical Care Program

As a regional trauma and stroke centre, Sunnybrook cares for an increasingly large number of critical care patients, and is increasingly in need of more critically care-trained nursing staff. In response to growing external and internal staffing demands, Nursing Education led the review process of Critical Care certificate programs across the city. Sunnybrook has since embarked on a new and exciting partnership with the Michener Institute to recruit 35 nurses for their new program. Units are looking forward to welcoming the acute care nurses attending the program into critical care areas as staff in the near future.

Preceptor workshop

Nursing Education in partnership with Organizational Development and Leadership facilitates an in-person preceptor workshop several times a year. In December 2018, the preceptor workshop, which traditionally operated as a nurse-only opportunity, began integrating other health professionals into the courses. The interprofessional program now supports opportunities for all health professionals to develop the foundational knowledge and skills required to support, teach, role model and supervise learners across Sunnybrook.