Primary care emergency team training in situ means learning in real context

Figures & data

Table 1. A display of the breadth and diversity of the participants’ topics in the debriefing sessions and focus groups (of the study) organised according to the eight theoretic elements constituting Wenger’s Social Theory of Learning.[22]

1. Theoretic element: social structure

• Team building through allocating roles and tasks

2. Theoretic element: situated experience

• Sense of safety emerging among the participants

• Collective interest in improvement

• Familiarity with the locality

3. Theoretic element: practice

• Practical skills

• Team building through inclusion and cooperation

• Closed-loop communication, names, voice, and report

• Learning to learn, teach oneself and teach others

• Debriefing skills applied in other settings.

4. Theoretic element: identity

• Appraising one’s own situatedness as it relates to that of others

5. Theoretic element: subjectivity

• Self-confidence and mutual trust

• Awareness of one’s own strengths and limitations

6. Theoretic element: collectivity

• Relational skills – group knowledge

• Team building, inclusion, “commitment”

• Building relationships based on trust and respect

• Collegial support through instrumental debriefing, defusing, relieving stress through conversation

• Insight into others’ competence to improve mutual respect and safety

• Identifying who needs to have an overview

7. Theoretic element: power

• Non-defensive feedback

• Training making it easier to admit mistakes

• Finding the expected leadership position, model, and management skills

• Reflections on hierarchies

8. Theoretic element: meaning

• Management of the patients’ and one’s own crises

Table 2. Correspondence between the model explored and statements made by Stocker et al. [10] concerning optimal simulation team training.

Statement 1 from Stocker et al.	“Scenario for concrete experience, followed by a debriefing with a critical, reflective observation and abstract conceptualization phase, and ending with a second scenario for active experimentation.”
Our model	Good correspondence: the model commences with a review session, continues with a “scenario for concrete experience, followed by a debriefing” and “a second scenario for active experimentation”. But our model adds a second debriefing session which is not explicitly divided into two phases, with more weight being given to “critical, reflexive observation” than to “abstract conceptualization”.
Statement 2	“The scenario needs to challenge participants to generate failures and feelings of inadequacy to drive and motivate team members to critical reflect and learn.”
Model explored	Very good correspondence: the scenarios seem to be challenging. Failures and feelings of inadequacy are revealed during the debriefing sessions and linked to critical reflection.
Statement 3	“There is a need for participants to challenge their existing frameworks and principles. Facilitators and peers must guide and motivate participants through the debriefing session, inciting and empowering critical reflexion. To do this, learners need to feel psychologically safe.”
Model explored	Good correlation: the participants reflected critically, but all participants, not only facilitators, strived toward creating a safe atmosphere.
Statement 4	“Real multidisciplinary team members acting within their specialty and roles support motivation and preparedness of participants for effective learning.”
Model explored	Very good correlation: none of the participants stepped out of their actual roles during any of the simulation sessions.
Statement 5	“It is mandatory to introduce cultural context and social conditions to the learning experience for effective team training.”
Model explored	Very good correlation: the training days took place in the participants’ own localities.