Barriers to and Facilitators of Implementing Team-Based Extracorporeal Membrane Oxygenation Simulation Study: Exploratory Analysis

Introduction: Extracorporeal membrane oxygenation (ECMO) is a critical tool in the care of severe cardiorespiratory dysfunction. Simulation training for ECMO has become standard practice. Therefore, Keck Medicine of the University of California (USC) holds simulation-training sessions to reinforce and improve providers knowledge. Objective: This study aimed to understand the impact of simulation training approaches on interprofessional collaboration. We believed simulation-based ECMO training would improve interprofessional collaboration through increased communication and enhance teamwork. Methods: This was a single-center, mixed methods study of the Cardiac and Vascular Institute Intensive Care Unit at Keck Medicine of USC conducted from September 2021 to April 2023. Simulation training was offered for 1 hour monthly to the clinical team focused on the collaboration and decision-making needed to evaluate the initiation of ECMO therapy. Electronic surveys were distributed before, after, and 3 months post training. The survey evaluated teamwork and the effectiveness of training, and focus groups were held to understand social environment factors. Additionally, trainee and peer evaluation focus groups were held to understand socioenvironmental factors. Results: In total, 37 trainees attended the training simulation from August 2021 to August 2022. Using 27 records for exploratory factor analysis, the standardized Cronbach alpha was 0.717. The survey results descriptively demonstrated a positive shift in teamwork ability. Qualitative themes identified improved confidence and decision-making. Conclusions: The study design was flawed, indicating improvement opportunities for future research on simulation training in the clinical setting. The paper outlines what to avoid when designing and implementing studies that assess an educational intervention in a complex clinical setting. The hypothesis deserves further exploration and is supported by the results of this study.