Impact of Interprofessional Education for Enhanced Teamwork in OBGYN Emergency: Results from a mixed methods study

Impact of Interprofessional Education for Enhanced Teamwork in OBGYN Emergency: Results from a mixed methods study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Interprofessional Education for Enhanced Teamwork in OBGYN Emergency: Results from a mixed methods study Haleema Yasmin, Shoaib Malik, Syed Moyn Ali, Sobia Ali, Anum S. Hussaini, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3290625/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Interprofessional education is a collaborative approach to developing healthcare students as future interprofessional team members and a recommendation suggested by the Institute of Medicine. Complicated medical issues can be best tackled by interprofessional teams, especially when dealing with emergency cases. The study aims to compare the scores on pre and post tests using TeamSTEPPS Teamwork Perception Questionnaire (TTPQ) before and after the implementation of interprofessional education sessions and to explore the perception and attitude transformation of health care providers regarding their teamwork in clinical settings after those sessions. Method This mixed method (concurrent embedded) study was conducted at OBGYN department of Jinnah Postgraduate Medical Centre, Karachi, Pakistan from January to April 2022. We conducted a quasi-experimental study to evaluate the six interprofessional teaching sessions of six groups of healthcare professionals, including obstetricians/gynecologists, anesthetists, midwives, operating room nurses, anesthesia technicians, and emergency physicians working in OBGYN emergency in simulated setting based on common OBGYN case scenarios. Participants were scored on TTPQ, a valid assessment tool, both before and after the intervention took place. FGDs and IDIs were conducted in the fifth and sixth weeks of the intervention to understand the feelings, values and perceptions of participants about teamwork during and after attending the sessions. Results Total 24 (40%) were males, 36 (60%) were females. The analysis revealed improvement in TTPQ subscales including team function, leadership, situation monitoring, mutual support, and communication (p-value < 0.05). Narratives from interviews identified effective communication and good leadership as core components and indicated that multiple factors can underpin IPE implementation. Results suggest that educational intervention can be challenging in real life unless all stakeholders are dedicated and committed to this approach. If rightly and inclusively implemented this approach, medical education can be very cost effective, pleasant, and critical for better patient outcomes. Conclusion Interprofessional education and training sessions were well accepted, suggesting indications of positive engagement towards teamwork. Participants expressed better grasp of teamwork skills, regarding all domains including leadership, management, and communication in obstetric crises. Interprofessional education teamwork skills obstetrics/gynecology emergency Figures Figure 1 Background Interprofessional education (IPE) is a collaborative approach to developing healthcare students as future interprofessional team members and a recommendation suggested by the Institute of Medicine (IOM). 1 IPE has been defined as members or students of two or more professions associated with health or social care, engaged in learning with, from, and about each other. 1 IPE provides an ability to share skills and knowledge between professions and allows for a better understanding, shared values, and respect for the roles of other healthcare professionals. 1 These skills can bring out effective and targeted clinical efforts for improving quality and safety of the care provided by these teams. Training the upcoming healthcare professionals to thrive in such a collaborative environment will help in improved healthcare outcomes for patients. 1 In order to get a broad spectrum of interprofessional stakeholders, including health profession educators, academic and health system leaders, clinical specialists, funders, planners, and policymakers, to take an interest in a collaborative model, certain measures are needed to gauge the impact of IPE beyond the classroom and simulation in real clinical practice. 2 Obstetric emergency (OB-ED) is a sub-specialized ED unit in most tertiary care hospitals including those in Pakistan. Although OB-EDs are exclusively devoted to the urgent care needs of pregnant and postpartum women. The wide variety of medical and surgical complications associated with pregnancy and postpartum 3 , entail that these services cannot be singlehandedly provided by obstetric and gynecologist (OBGYN) specialist healthcare cadre. It must encompass within itself a wider range of healthcare professionals including not only doctors from various disciplines like internal medicine, general surgery, anesthetists, infectious diseases 4 , psychiatric services 5 but other cadres of health professionals from various fields like those from, transfusion units 6 , nursing & midwifery OR & lab technicians and biochemical and forensic laboratories. Obstetric care is not only limited to the pregnant woman but expands to include the baby and the entire family. When a pregnant woman lands in an OB-ED, it is critical to establish interprofessional and interdepartmental collaboration and coordination to prioritize the well-being of both the baby and the mother. 7 The versatility and complexity of the healthcare needs of the patients drives the need to refine IPE and Interprofessional collaborative Practices (IPCP) for effective service delivery. Effective interprofessional teams understand the concepts of other professions, have knowledge about them, and can appreciate and enhance each other’s skills in healthcare delivery. 2 Teamwork is an essential prerequisite of clinical care which is effective when the members can sincerely and frankly voice their opinions about each other’s professional performance and are willing to engage in healthy and direct discussions about each other’s professions and roles to enhance the quality of patient care. 8 During provision of healthcare by interprofessional groups (especially in emergency situations), lack of teamwork, communication and partnership can result in suboptimal patient care incidents, leading to inefficient institutional systems. There is limited data available for Pakistan’s basic and comprehensive emergency obstetrics and newborn care. 9 Interactive education, targeted simulated skill-based training, and advocacy have provided scientific evidence in enhancing interprofessional and interdisciplinary communication and collaboration for optimum patient care in OB-EDs. 10 The most readily studied and scientifically supported model to examine obstetric emergency care is the “three delays'' model 11 . Previously it was presumed that the first two delays – outside of the hospital – will have a greater impact on overall maternal mortality. It has been established that the third delay also significantly contributes to maternal mortality. 11 Among other factors adding up to the third delay, miscommunication and inadequate interprofessional collaboration was identified as a significant contributor to suboptimal care. Healthcare providers experienced that the communication between care providers at different levels – such as communication of on-floor midwifery staff, obstetricians with senior decision-making obstetricians and with the anesthetist needs to be better streamlined. 12 In view of the existing evidence and global practices, this study explores whether interprofessional education can improve the knowledge, skills, and behavior/perception for better teamwork among healthcare providers working in obstetrics and gynecology emergencies and and identifies experiences of healthcare providers learning through interprofessional education for management of various emergency cases in OBGYN about their teamwork approach and attitude in Pakistan. Methods Study Design We employed a mixed-method approach (concurrent embedded) to compare the scores of healthcare professionals (related to OBGYN emergency) on pre and posttest using TeamSTEPPS Teamwork Perception Questionnaire (TTPQ) before and after interprofessional education sessions and to explore the perceptions & experiences of participants regarding their attitude transformation in clinical teamwork after interprofessional education sessions. Quantitative We conducted a quasi-experimental study to evaluate the educational intervention by scoring the participants on a valid assessment tool (TTPQ) both before and after the teaching sessions. Qualitative We used a qualitative exploratory design to understand the values and perceptions of participants regarding their experience and perceptions about developing better teamwork skills and attitude after interprofessional education. All interviews were audio recorded with permission of the respondents. The transcripts were sent to the interviewees for member checking to confirm all ideas and responses. Study Setting and Population The study was conducted from January 2022 to April 2022 and included six groups of healthcare professionals, including Obstetricians/ Gynecologists (OBGYN), anesthetists, midwives, Operating Room (OR) nurses, anesthesia technicians, and emergency physicians, working in Jinnah Postgraduate Medical Centre (JPMC) in Karachi, Pakistan. These groups of professionals were selected to create interprofessional teams of relevant service providers in a simulated setting of OBGYN emergency. The objective of enhancing knowledge, skills and attitudes for teamwork by interprofessional teaching sessions was best achieved by focusing on the population that worked there (OB-ED) actually. JPMC is the largest public sector hospital of the metropolis. The obstetric emergency department (OB-ED) is one of the busiest departments of the institution that receives complex referred cases, needing urgent multidisciplinary coordinated care, henceforth considered a suitable study site. Sample size and Randomization For the quantitative component, a total of 60 participants, 10 from each professional group, were included in the study through purposive sampling technique. All participants were selected from different backgrounds, experience level, gender, age groups and profession to aid in generalizing the results of the study. For qualitative interviews, participants were purposely selected for the In-Depth Interviews (IDIs) and through simple random sampling (lottery method) for the Focus Group Discussions (FGDs). Data Collection Quantitative Pre and post tests were conducted before and after the teaching intervention in a simulated situation by role plays on three different case scenarios on obstetric emergency, reporting of adverse events and medical disorders in OBGYN. Each group was assessed on all three cases. All participants were divided into five groups with twelve people from various professional backgrounds in each group (n = 60). The pre and post tests were conducted for each group without mixing of participants. All groups were assessed by three assessors through TTPQ and an average of the three scores were awarded to each participant and group. For the intervention, teaching sessions on TeamSTEPPS modules were conducted in a blended format (online and face-to-face) to build teamwork knowledge, skills and improve attitudes. The educational intervention included six teaching sessions, one per week, developed by one obstetric faculty, one midwifery faculty and one ER physician, and reviewed by a medical educationist. The topics covered in teaching sessions were introduction and overview to healthcare teams with emphasis in collaborative care in OB-ED, including team function, communication in interprofessional teams, leadership in healthcare, situation monitoring, and mutual support. Participants were taught through case scenarios, interactive discussions and role plays in simulated settings on various patient interactions. Each session was followed by formative assessment/feedback at the end. Qualitative During week 5 and 6 of the study, we conducted four FGDs with various professionals groups and six IDIs with one person from each professional background. All interviews were either conducted online or face to face in the faculty office of OBGYN department, using a semi structured interview guide with open ended questions. The time taken for each interview and focus group discussion was around 25–30 minutes. The interview guide was piloted by using it on faculty members of various professions at the same hospital to evaluate the usefulness and clarity of various questions. Data Processing and Analysis Quantitative All the data was recorded on Statistical Software for Social Sciences (SPSS), version 22. The frequencies and percentages were calculated for categorical variables like gender, profession, years in clinical practice etc. Mean and standard deviation were calculated to show the overall test scores. The Cronbach alpha was computed to check inter-consistency between the questions on the applied model of TTPQ. Pretest and post test scores of the participants were evaluated by paired samples t test and all p-values were two sided and considered significant if p ≤ 0.05. Qualitative Manual analysis of the interviews was done for complete understanding and sense. Line by line readings were done from transcribed narratives and relevant statements were grouped into codes by two researchers for ensuring rigor in the study. The text data was further coded under these open codes to make sub codes and therefore compared with each other to make axial codes. These axial codes were then discussed and merged by both researchers with consensus to build themes. Results Quantitative Forty-two participants opted for the course while the rest were nominated by relevant departments. Table 1 shows demographic characteristics of all participants enrolled for the teaching intervention of the study. Table 1 Demographic characteristics of the participants Demographic variables n (%) Gender Male 24 (40%) Female 36 (60%) Age 35 Years 17 (28.3%) Years in Clinical Practice 10 Years 16 (26.7%) Session attended 5 sessions 30 (50%) < 5 sessions 30 (50%) Institute Public 23 (38.3%) Private 25 (41.7%) Semi-Private 12 (20%) The overall pre-assessment of Cronbach’s alpha was 78.1% and posttest was 89.1%, indicating reliability of the questionnaire, as shown in Table 2 . Table 2 Inter-reliability among the questions (TTPQ) TTPQ Model Cronbach 's Alpha Pre-Assessment Post-Assessment Overall 0.781 0.891 Team Function 0.686 0.796 Leadership 0.708 0.721 Situation Monitoring 0.511 0.514 Mutual Support 0.709 0.765 Communication 0.716 0.742 The overall TTPQ mean pre and post test scores for all included professionals are presented in Table 3 , showing that the highest score was achieved by the emergency physicians. Table 3 Mean pre and post test scores among different professions Model Professions Pretest Score Post test Score TTPQ Obstetrician / Gynecologist 73.10 ± 9.80 168.70 ± 22.54 Anesthetist 68.10 ± 9.86 178.00 ± 16.26 Midwife 31.60 ± 10.61 167.60 ± 10.49 OR Nurse 41.50 ± 10.37 173.90 ± 12.91 Anesthesia technician 51.80 ± 17.29 129.50 ± 13.83 Emergency Physician 84.00 ± 15.78 158.00 ± 13.17 The professionals from all included fields were assessed by the TTPQ subscales showing a significant difference found in most of the subscales between pre and post-test scores (p-value < 0.05), as presented in Tables 4 to 9. Table 4 Pre and posttest assessment of Obstetrician / Gynecologist by TTPQ sub scale Profession TTPQ Pretest Score Post test Score p-value Obstetrician Team Function 1.84 ± 0.54 4.76 ± 0.17 0.032 Leadership 1.76 ± 0.41 3.75 ± 0.16 < 0.001 Situation Monitoring 1.81 ± 0.47 1.84 ± 0.47 2.251 Mutual Support 1.80 ± 0.48 4.63 ± 0.20 0.012 Communication 1.70 ± 0.41 4.61 ± 0.15 0.041 Table 5 Pre and posttest assessment of Anesthetist by TTPQ sub scale Profession TTPQ Pretest Score Post test Score p-value Anesthetist Team Function 2.13 ± 0.36 4.71 ± 0.15 0.034 Leadership 1.93 ± 0.23 3.97 ± 0.12 0.012 Situation Monitoring 2.07 ± 0.53 2.17 ± 0.53 0.021 Mutual Support 1.99 ± 0.47 4.56 ± 0.17 0.224 Communication 1.74 ± 0.09 4.56 ± 0.16 0.124 Table 6 Pre and posttest assessment of Midwife by TTPQ sub scale Profession TTPQ Pretest Score Post test Score p-value Midwife Team Function 1.63 ± 0.36 4.74 ± 0.11 < 0.001 Leadership 1.74 ± 0.29 2.87 ± 0.01 0.062 Situation Monitoring 1.63 ± 0.43 1.68 ± 0.41 0.041 Mutual Support 1.71 ± 0.45 4.69 ± 0.11 0.061 Communication 1.61 ± 0.32 4.80 ± 0.10 0.011 Table 7 Pre and posttest assessment of OR Nurse by TTPQ sub scale Profession TTPQ Pretest Score Post test Score p-value OR Nurse Team Function 2.20 ± 0.69 4.79 ± 0.15 0.033 Leadership 2.23 ± 0.63 3.27 ± 0.21 0.001 Situation Monitoring 2.14 ± 0.43 2.44 ± 0.47 < 0.001 Mutual Support 2.14 ± 0.59 4.70 ± 0.22 0.0632 Communication 2.04 ± 0.38 4.69 ± 0.09 0.0621 Table 8 Pre and posttest assessment of Anesthesia technician by TTPQ sub scale Profession TTPQ Pretest Score Post test Score p-value Anesthesia technician Team Function 1.76 ± 0.47 4.77 ± 0.07 0.061 Leadership 1.71 ± 0.25 3.51 ± 0.02 0.015 Situation Monitoring 1.64 ± 0.31 1.74 ± 0.41 0.012 Mutual Support 1.81 ± 0.24 4.69 ± 0.09 0.041 Communication 1.80 ± 0.50 4.79 ± 0.14 0.032 Table 9: Pre and posttest assessment of Emergency Physician by TTPQ sub scale Profession TTPQ Pretest Score Post test Score p-value Emergency Physician Team Function 1.99 ± 0.69 4.60 ± 0.24 0.021 Leadership 2.04 ± 0.57 2.80 ± 0.12 0.046 Situation Monitoring 1.94 ± 0.41 1.96 ± 0.49 0.021 Mutual Support 1.89 ± 0.53 4.67 ± 0.14 0.049 Communication 1.94 ± 0.59 4.64 ± 0.10 0.033 Qualitative: The thematic analysis identified five overarching themes and 20 codes in total, as illustrated in Fig. 1 . (I) Motivated and Empowered Participants gave positive remarks as team members for the IPE sessions to learn teamwork in an acute care setting. This theme is further divided into four codes. (a) Compelling direction The respondents mentioned that the exact nature of the scenarios like the ones in real life made them feel compelled to work in the right direction. Simulated scenarios with the team members from various professional backgrounds made them work together for improved patient outcomes. “ We were grouped in a way that all needs were being met in time. This resulted in working for better patient care through decisions in a timely manner.” (OR Nurse) (b) Sense of Meaning The respondents shared that they were meaningfully contributing to the given situations as per the need of the cases. One participant mentioned, “The feeling that every group member can contribute according to the needs of the patient under appropriate leadership of the team gives a real sense that we are also essential to the group’s success.” (Midwife) (c) Diversity Team members conveyed positive perceptions for diversity in the professional teams dealing the emergency cases. Comments by respondents having greater clinical experience in the field were even more positive for having groups made in an inclusive manner. “The sense that all the help required can be sought was so satisfying. The combination of the group was felt as just right and rich due to representation from all areas. This gave satisfaction that the team is there to handle challenges of different types.” (Obstetrician) (d) Overcoming challenges and breaking Silos All providers expressed that efforts for the training and education of health care professionals were conducted very rarely; however, it was still perceived positively by everyone. They stated that such training has supported them in facing difficult situations in clinical simulated settings with better understanding and feeling that help can be sought. One participant commented, “We usually seek help from our obstetrics colleagues in duties but being able to ask help and guidance from other professionals like emergency physicians and anesthesia team members was a good experience. I felt as if the trend of a rigid connection is being broken and replaced by a flexible way of structuring communication effectively.” (Midwife) (II) Role identification During performance of given tasks in the simulated situations, participants gave great value to structured instructions and tools, description of responsibilities without ambiguity. Four codes were identified under this theme. (a) Clear responsibility The participants perceived uniformly that the clear identification of roles and responsibilities was obvious in these educational sessions in simulation. This was felt to be worth practicing in their practical lives. A respondent mentioned, “We were very sure on how to communicate, whom to call and what to be expected from us. Everything was just clear before the actual performance. This made us be clear about the exact input expected from me or us as individuals and a team to do what is meant to be done.” (OT technician) (b) Accountability The perception of being accountable for the roles and actions was also being uniformly felt and perceived as a positive experience for improving quality of patient care during these sessions. “The group members and leaders were vigilant during the tasks. We had briefings and debriefings throughout to make us accountable for the job we had to do. If that part was not done well the group and the patient will suffer. This feeling made us very particular to perform well.” (Anesthetist) (c) Structured and effective communication This was a strong feeling by the majority of the respondents rather a very common statement by most of them. They conveyed structured as well as clear communication in a professional manner was the key to success in emergency situations. “The communication was very instrumental. Using various tools and practicing them appropriately were great experiences during the acute situations. I think we should all be teaching this way right from basic clinical years. This part was most significant in my opinion.” (Obstetrician) (d) Human resource management The interviewees stated very strongly about this aspect that having a diverse, willing to work and appropriately trained team from various healthcare professional cadres is sufficient to deal with tasks at hand even in relatively scarce human resources in a clinical setting. A participant stated, “The teams were gathered to perform a clear task. They were willing to accept limitations and ask for help and support when necessary.” (Emergency Physician) Another participant mentioned, “Many professionals were present and everyone was willing and motivated to work. We felt we could ask for support from each other and could multitask. Human resources should be trained and managed well. This can change the working environment and related stress.” (Obstetrician) (III) Shared Mindset The groups felt that during simulations sharing of ideas and feelings was being accepted in a non-threatening manner. Most of them felt that a plan was properly shared, and they were able to implement the policies and protocols well. This theme is further classified into four codes: (a) Mutual respect and trust The respondents felt that everyone brings a different set of skills and personality traits. The participants perceived that teamwork, if done appropriately, can develop an environment of mutual respect and trust. They said that the feeling that you are valued, and your expertise are needed for patient care satisfies oneself. “The team showing respect and trust can do far better than criticizing negatively. This sense needs to be inculcated from the very initial years of training. We did not perform well in cases where the members were not trusting each other.” (Anesthetist) (b) Common goal The research participants felt a common goal of better patient outcome especially in an emergency situation was significant during the sessions. They thought it was a driving force to keep the team focused. “Patient centered approach is the must. All professionals are taught patient care and autonomy in their curriculum. If we all keep the patient in the center considering ourselves as care providers the problems can be solved. The idea of a common Goal is necessary to be built into the minds of all team members. The refresher training means a lot for it.” (Midwife) (c) Solidarity The interviewees in individual as well as group discussions were narrating the perception of feeling united for a cause clearly. They felt if healthcare providers are trained well in interprofessional sessions the group dynamics work perfectly. “The combined briefings and huddles of the teams made understanding of tasks at hand easier. It united us clearly at the time of real working practice.” (Obstetrician) (d) Supportive behaviors The narratives stated that supporting the team members’ specially offering support to those with lesser experience can improve the team culture greatly. “It appeared as learning together made all the providers work towards the cause and be supportive when required by other colleagues. The focus and commitment were all shared .The plans made ahead of the task cleared us when we need to jump in if someone is unable to perform optimally.” (OR Technician) (IV) Effective leadership Leadership skills development as well as practice was clearly stated in the discussion as a vital and facilitating factor. They all believed that being a true healthcare leader is mandatory to interprofessional teamwork. The responsibility of a team leader for empowering members and motivational mechanisms made the goals to be achieved easier. This theme is further classified into four codes: (a) Strategic thinking Leadership strategies were felt as key factors to successful performance during the analysis of data. One participant shared, “The perception and desire for work to get more effective outcomes is enhanced when we think strategically as leaders.” (Emergency nurse) Another stated, “Every healthcare professional has to be a strategic leader and be open to interchange the role when deemed necessary. Planning and putting thoughts to action can get things done easily.” (Anesthetist) (b) Developing each other The respondents from non-physician groups specifically laid stress on mutual development by healthcare leaders for improved team performance and considered it can be instrumental for clinical care. “To improve care delivery, all team members need to be vigilant and see where the coworkers need to be strengthened. This should happen in a respectful, non-threatening manner. Coordination neglect can be devastating. We can contribute immensely by developing the team members towards excellence. A healthcare leader needs to practice it repeatedly.” (OR nurse) (c) Self-awareness The data revealed the feelings of interviewees for self-awareness as a significant ability for teamwork and as leader of the team. “Ability for better decision making depends on the actual trait of knowing your emotions and weaknesses and how they will affect my actions especially in challenging scenarios of high stakes. It requires developing insights into our own emotions and their impact on others to be able to control other people’s actions when working in teams.” (Emergency Physician) (d) Team Building Skills The respondents from all the professional backgrounds emphasized the dedicated need by leaders for team building and empowering all team members. “Leaders need to guide by example. The steep needs of service delivery can be met when the more qualified team members of healthcare try to fill in the critical gaps by other professionals by building morals, trust and competencies of their co members.” (Obstetrician) (V) Collaborative learning All professionals mentioned that having a desire to learn while working together results in better and combined learning. One can memorize the events along with professional relationship experience further resulting in deeper understanding of thus gained knowledge. This theme is further classified into four codes: (a) Reflecting on practice The feelings during interviews and discussions were expressed by respondents for a strong perception about reflecting on practice. They conveyed that mindful reflection on your learning was enhanced by the experience of working in interprofessional teams. It lets them feel what they need to work on further, especially when they do a comparative analysis of their own work performance. A respondent said, “Professional development results in better performance. Reflecting on the learning experience in interprofessional teams was perceived as developing myself in a positive direction.” (Anesthetist) (b) Mentoring Mutually All the interviewees felt when they learnt together it was a better learning experience for everyone, Each and every participant felt they were able to learn from each other. It gave them a feeling of strong peer support. “ The group members were ready to not only conceptualize the taught material but at the same time were very willing to teach the co members. This mutual mentoring resulted in critical thinking and better decision making in less time effectively .” (OR nurse) (c) Common goals The interprofessional education sessions made the participants realize that the goal is common to achieve better patient care in a timely fashion. This can be satisfying for patients and families, care providers and the institutions. “The patient was the center of care. Their quality of care was the common aim. This was the bond which through the combined sessions got stronger.” (Obstetrician) (d) Task shifting It was a common statement by the majority of the participants that the sharing of tasks as per competency of the colleagues can improve teamwork as well as manage work efficiently. “The tougher tasks were equally shared and even the task allocation to other colleagues made the complicated cases be solved in a less stressful manner. While in Simulations needing critical care the anesthetists were relying on his anesthesia technician teams for monitoring and delivery of medication which gave them time to be more focused on patients' response to the clinical management provided.” (Anesthetist) Discussion The results of this study substantially contribute to the literature in providing quantitative and qualitative evidence that interprofessional teaching and learning activities not only improved providers’ perspectives on subscales of team function, leadership, situation monitoring, mutual support, and communication but also indirectly contributes to enhanced patient outcomes in terms of quality of care, patient safety, and conflict-resolution in OBGYN emergency settings. The theme of overcoming challenges focused on enhanced conflict management and accountability through interprofessional collaboration. Maintaining secure, high-quality treatment in obstetric operating rooms demands interprofessional cooperation, especially between midwives and doctors. 13 In addition to that, this study highlighted how simulated scenarios with the team members from various professional backgrounds made a combined thinking process to work for improved patient outcomes. Global studies have collected evidence that explicitly supports the use of interprofessional simulation-based training in the management of obstetric crisis. Despite the triage for critical cases in obstetric emergencies, they can nonetheless be fatal, necessitating prompt response, shared decision-making, and clinical expertise. 14 Moreover, simulation-based strategic education with the cadre of providers in this study also reported significantly enhanced team function and situation monitoring skills which are critical in early identification of a clinical problem. Further in qualitative assessments, collaborative practice towards a common goal was a majorly highlighted theme. Since OBGYN emergencies are demanding and unpredictable, it can cause an ethical conundrum. They call for quick decisions that may be beyond the staff's training and experience 15 . When compared to developed nations where poor maternal/neonatal consequences are often attributed to poor administration, many facilities in developing countries fail to control the OB crisis due to insufficiently qualified staff. 16 As per the reports of the surveillance body about obstetric malpractice in one western institution, communication barriers were held accountable for 31% of adverse episodes. 17 These challenges were also highlighted in the qualitative analysis of this study. “Ineffective communication” was reported as a disruptor in patient care. Deficient basic knowledge of the subject and poor English language skills were few factors identified by participants other than doctors to hamper their ability to contribute efficiently to the crisis This necessitates a focus on distinct communication ensuring the team members have understood the task at hand clearly. Furthermore, interpersonal teamwork and communication skills should be fostered across various domains including nursing, midwifery, medical, and other maternity healthcare providers owing to the prompt need for information reciprocation to deal with distinct purposes. 14 , 18 Shaw-Battista et al. have cited the positive outcomes of virtual learning modules, case-based seminars, and hands-on training workshops employed on their trainees to perform better under perceptive clinical supervision and obstetric crisis. 19 Similarly, this study helped identify provider motivation with a sense of meaning towards patient care and enabled them to identify roles with clear responsibilities through effective communication, in an environment of shared trust and respect under effective leadership as critical parameters resulting in improved teamwork. The recent work of Avery and colleagues in IPE intervention for midwifery students and OBGYN residents reported enhanced overall ability to collaborate, valued teamwork and team experiences, learned to communicate better with one another, and showed mutual respect toward one another’s scope of practice. 15 The qualitative results of this study are also comparable to the work of Avery and colleagues, as our participants also experienced confidence in team work, mutual respect towards participants of other professions, and collaborative learning, with improved TTPQ scores on mutual support for all groups. Lastly, the findings from the FGDs highlighted how interprofessional education intervention motivated the participants and empowered them to work collaboratively with a shared mindset and clearly assigned roles. They were compelled to perform in one direction and a common goal – optimum patient care – through structured and effective communication via strategic planning and effective leadership. These professionals are required to be skilled top players in their own discipline, and they must also be effective team players. Over the past few years, healthcare teams have faced several challenges, including managing a pandemic globally while continuing to provide regular and preventive healthcare, attempting to eliminate inequalities and racism, educating the forthcoming generation of healthcare professionals, and combatting long-term public humanitarian crises, such as violence and mental disorders health concurrently. These subjects call for interprofessional cooperation and unanimous ingenuity. The COVID-19 pandemic stands as a classic example of needing collaboration of a variety of professionals, including doctors, public health specialists, respiratory technicians, nurses, and environmental services, among many others. 20 The pandemic has somehow compelled different professions of healthcare to come together to perform as a team in times of adversity. As highlighted in this study, this can effectively be achieved through shared mindsets, involving mutual respect for individuals of all professions and extended supportive behaviors. The results of this study will serve as a prototype for cultivating an environment of interprofessional training and collaboration in various similar hospital settings. It will help build strategies to implement interprofessional teaching and training sessions by utilizing the lessons learned through circumstantial and contextual evidence. It may help sensitize providers towards the needs and demands of patients with multidisciplinary complaints and broaden the horizon of their management approach to include all biological, psychological, and social aspects of patient care. The ultimate goal of this research is to enhance patient care and patient satisfaction with the better quality of care in our health system. Pertinent to the scenario of OB-ED, improved knowledge, skills, and behavior can translate into improved patient satisfaction which may ultimately translate into improved maternal mortality indicators. In relation to our study, context specificity emerges as an important limitation. Our current study is mostly compared with the findings of western research, primarily based in the UK, USA, and Canada, owing to inadequate work on this subject in Pakistan. The small sample size and shorter duration of this study is the other limiting factor. Strength of study is a mixed method approach for deeper understanding of the findings. The findings can be used to upscale the approach for teaching the providers in a national context. The knowledge generated can be used for implementation research for the future. Conclusion Inefficient communication and leadership challenges are among the leading sources of medical errors and ineffective patient care. 21 Currently, education and health system authorities generally fail to consider the importance of workplace learning as an effective means of promoting collaborative practice throughout the learning continuum and hence, the need for collective realization and rectification in this matter. While acknowledging the historical, cultural, and societal roots of the challenges impacting interprofessional collaboration in clinical practice, we firmly believe that the sociological concerns (such as power, hierarchy, professional boundaries, and gender disparity) must be addressed if team-oriented training programs are to become a reality. We discovered several potential untapped directions for future research when gathering the theoretical foundations of interprofessional education and training. Even though numerous studies have highlighted the benefits of team training programs, more research is required to comprehend how to effectively develop and implement these programs, particularly diverse clinical units in different regions. 22 The feasibility of other techniques, such as e-learning and hybrid learning can be experimented with and evaluated to enable the instillation of interprofessional knowledge at the level of the medical undergraduates. 23 Bringing healthcare specialists and students of varied backgrounds together with obstetrics and gynecology residents in a mutual clinical setting has the potential to induce positive changes in the current paradigm of healthcare provision, particularly in prenatal, perinatal, and postnatal care. Operationalizing the objectives of interdisciplinary and interprofessional patient care necessitates an effective education and training program which concentrates concurrently on multiple prospects in line with each participant’s respective profession. From norm-setting, identifying incompatibilities, adapting to new information, and reciprocating with the established communication channels are important measures to be incorporated into the program format, making it possible to expose many aspects that are important in training and education programs. 24 Further investigations must be carried out to not only assess the interventions but also the inducible evolution in patient safety and mortality rates. 25 Declarations Availability of data and material: The datasets used and/or analyzed for study are available from the corresponding author on reasonable request. Acknowledgements Authors would like to thank the staff of OBGYN Emergency Department of JPMC who participated in the study, JSMU MHPE class of 2018 for their encouragement to take up this challenging project and Professor Syeda Kausar Ali for her mentorship. Funding: Authors did not receive any funding for this study. Author information: Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan Haleema Yasmin Department of Anesthesia, Jinnah Postgraduate Medical Centre, Karachi, Pakistan Shoaib Malik Department of Medical Education, Jinnah Sindh Medical University, Karachi, Pakistan Syed Moyn Ali Department of Health Professions Education, Liaquat National Hospital & Medical College, Karachi, Pakistan Sobia Ali Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, 02215 Anum S. Hussaini APPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan Lubna Ansari Baig Authors' contributions HY conceived the idea of the study, identified participants, developed and conducted the teaching sessions, pre and post tests, and qualitative interviews, and finalized the manuscript. SM assisted in the assessment process of the pre and post tests. MA assisted HY in developing content for the teaching sessions. SA and participated in field notes for the qualitative interviews and assessment process of the pre and post tests. ASH reviewed the material for the classroom sessions, prepared the manuscript and incorporated all the feedback. LAB reviewed the contents of role plays and instructions for the classroom sessions for the five core components taught to the IPE groups. Corresponding author Correspondence to Dr. Haleema Yasmin. Ethics declarations Competing interests The authors declare that they have no competing interests. Ethics approval and consent to participate The study was conducted after IRB approval from Jinnah Sindh Medical University (JSMU) and JPMC. Prior to participation in the study, all participants were explained about the protocol and procedures of the study and were asked to provide informed, written and verbal consent. Anonymity of data was ensured by either putting numbers or initials on the results and interview data. No remuneration was offered to any participant. The interview recordings and the quantitative data were saved on a personal computer not accessible to the general public. Consent for publication Not applicable. References Bridges D, Davidson RA, Soule Odegard P, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Medical Education Online. 2011;16(1):6035. Cox M, Cuff P, Brandt B, Reeves S, Zierler B. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Journal of Interprofessional Care. 2016;30(1) Yang L, Yamamoto-Hanada K, Ishitsuka K, Ayabe T, Mezawa H, Konishi M, Shoda T, Sago H, Saito H, Ohya Y, Japan Environment and Children’s Study Group. Medical and surgical complications in pregnancy and obstetric labour complications in the Japan Environment and Children’s Study (JECS) cohort: a birth cohort study. Journal of Obstetrics and Gynaecology. 2020 Oct 2;40(7):918-24. Kumari A, Suri J, Mittal P. Descriptive audit of maternal sepsis in a tertiary care centre of North India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018 Jan 1;7(1):124-8 Rochon-Terry G, Gruneir A, Seeman MV, Ray JG, Rochon P, Dennis CL, Grigoriadis S, Fung K, Kurdyak PA, Vigod SN. Hospitalizations and emergency department visits for psychiatric illness during and after pregnancy among women with schizophrenia. The Journal of clinical psychiatry. 2016 Apr 27;77(4):8345. Vaid P, Kapoor B, Kapoor M, Kapoor BB. Role of blood and blood components transfusion in obstetric emergencies. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2020 May 1;9(5):2029-35. Chagolla BA, Keats JP, Fulton JM. The importance of interdepartmental collaboration and safe triage for pregnant women in the emergency department. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2013 Sep 1;42(5):595-605. Orchard C, Bainbridge L, Bassendowski S, Stevenson K, Wagner SJ, Weinberg L, Curran V, Di Loreto L, Sawatsky-Girling B. A national interprofessional competency framework. Utz B, Zafar S, Arshad N, Kana T, Gopalakrishnan S, Van Den Broek N. Status of emergency obstetric care in four districts of Punjab, Pakistan–results of a baseline assessment. J Pak Med Assoc. 2015 May 1;65(5):480-5. McCoy EE, Weidner AK, Benson LS, Darney BG, Prager SW. Practice change following an interdepartmental training on early pregnancy loss management in the emergency department. Cogent Public Health. 2022 Dec 31;9(1):2052402. Mgawadere F, Unkels R, Kazembe A, van den Broek N. Factors associated with maternal mortality in Malawi: application of the three delays model. BMC pregnancy and childbirth. 2017 Dec;17(1):1-9. Kiruja J, Essén B, Erlandsson K, Klingberg-Allvin M, Osman F. Healthcare providers experiences of comprehensive emergency obstetric care in Somaliland: An explorative study with focus on cesarean deliveries. Bowyer L. The confidential enquiry into maternal and Child health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer 2003–2005. The seventh report of the confidential enquiries into maternal deaths in the UK. Lentz GM, Mandel LS, Lee D, Gardella C, Melville J, Goff BA. Testing surgical skills of obstetric and gynecologic residents in a bench laboratory setting: validity and reliability. American journal of obstetrics and gynecology. 2001 Jun 1;184(7):1462-70. Fransen AF, van de Ven J, Banga FR, Mol BW, Oei SG. Multi‐professional simulation‐based team training in obstetric emergencies for improving patient outcomes and trainees' performance. Cochrane Database of Systematic Reviews. 2020(12). Crofts JF, Mukuli T, Murove BT, Ngwenya S, Mhlanga S, Dube M, et al. Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe. Bulletin of the World Health Organization. 2015;93:347-51 Shanafelt TD, Dyrbye LN, West CP, Sinsky CA. Potential impact of burnout on the US physician workforce. InMayo Clinic Proceedings 2016 Nov 1 (Vol. 91, No. 11, pp. 1667-1668). Elsevier. Merién AE, Van de Ven J, Mol BW, Houterman S, Oei SG. Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstetrics & Gynecology. 2010 May 1;115(5):1021-31. Baker MJ, Durham CF. Interprofessional education: a survey of students’ collaborative competency outcomes. Journal of Nursing Education. 2013 Dec 1;52(12):713-8. Wagner B, Meirowitz N, Shah J, Nanda D, Reggio L, Cohen P, et al. Comprehensive perinatal safety initiative to reduce adverse obstetric events. Journal for Healthcare Quality. 2012 Jan;34(1):6-15. Plaat F, Wray S. Role of the anaesthetist in obstetric critical care. Best Practice & Research Clinical Obstetrics & Gynaecology. 2008 Oct 1;22(5):917-35. Forster AJ, Fung I, Caughey S, Oppenheimer L, Beach C, Shojania KG, van Walraven C. Adverse events detected by clinical surveillance on an obstetric service. Obstetrics & Gynecology. 2006 Nov 1;108(5):1073-83. Young MP, Gooder VJ, Oltermann MH, Bohman CB, French TK, James BC. The impact of a multidisciplinary approach on caring for ventilator-dependent patients. International Journal for Quality in Health Care. 1998 Feb 1;10(1):15-26. Feitosa J, Fonseca A. Teamwork: education and training in healthcare. InComprehensive Healthcare Simulation: InterProfessional Team Training and Simulation 2020 (pp. 49-63). Springer, Cham. Stringer M, Suplee PD. Limited ultrasound technology: Uses, collaboration, and knowledge acquisition. Biomedical Instrumentation & Technology. 2007:39. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3290625","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":235097361,"identity":"a00cc943-ae74-419e-8ec1-79f7bd87564c","order_by":0,"name":"Haleema Yasmin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIiWNgGAWjYDCCAwxsDAwFcK4EAz8DSISgFgMkLZINJGoBsg8Q0MJ3+wDbgx8GNnK67WcMP/7MscgzvpH87MGHCgZ5frEDWLVInktgN+wxSDM2O5NjLM27TaLY7EaaueGMMwyGM2cnYNVicIaBTYLH4HDitgM5BtKM2yQSt91IMJPmbWNIMLiNW4vkH4P/9dvOvzH++ROoZfOM9G8EtUjzGBxIMLuRYyYBdFjiBokc/LZInmFsk5YxSDbcduNZmTVIy4wzb8okZ5yRwOkXvjPMxyTfVNjJm51P3nzz57a6xP729G0SHyps5PmlsWthYGBsgDI4oLEjAFYpgUM5CmB/AKH5DxCjehSMglEwCkYQAADqR14zdZ5gqwAAAABJRU5ErkJggg==","orcid":"","institution":"Jinnah Postgraduate Medical Centre","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Haleema","middleName":"","lastName":"Yasmin","suffix":""},{"id":235097363,"identity":"06e6fc27-028a-4669-b61a-f3e9ed4c1def","order_by":1,"name":"Shoaib Malik","email":"","orcid":"","institution":"Jinnah Postgraduate Medical Centre","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shoaib","middleName":"","lastName":"Malik","suffix":""},{"id":235097366,"identity":"32bb5d92-ecf1-4af6-b50e-b1efc8f99d5a","order_by":2,"name":"Syed Moyn Ali","email":"","orcid":"","institution":"Jinnah Sindh Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Syed","middleName":"Moyn","lastName":"Ali","suffix":""},{"id":235097368,"identity":"893c0cbf-d31f-4cf1-8254-e414e459e3c5","order_by":3,"name":"Sobia Ali","email":"","orcid":"","institution":"Liaquat National Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sobia","middleName":"","lastName":"Ali","suffix":""},{"id":235097370,"identity":"d5b9b9da-0f55-4681-9a12-143b99cc9db3","order_by":4,"name":"Anum S. Hussaini","email":"","orcid":"","institution":"Harvard University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anum","middleName":"S.","lastName":"Hussaini","suffix":""},{"id":235097372,"identity":"13e39ad3-4626-481f-93d6-b0aea5994382","order_by":5,"name":"Lubna Ansari Baig","email":"","orcid":"","institution":"Jinnah Sindh Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lubna","middleName":"Ansari","lastName":"Baig","suffix":""}],"badges":[],"createdAt":"2023-08-23 22:29:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3290625/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3290625/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":43773617,"identity":"f4b82da3-6b38-43e8-8e76-5430a9da81b1","added_by":"auto","created_at":"2023-09-27 14:42:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":61948,"visible":true,"origin":"","legend":"\u003cp\u003eMajor themes and codes extracted from data\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3290625/v1/a7303591dd10ea5c960078cf.jpg"},{"id":45506061,"identity":"29631099-7d78-46c8-9ddc-7f92b65597eb","added_by":"auto","created_at":"2023-10-31 04:30:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":664919,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3290625/v1/0dfbc3a5-4066-48ab-9766-79902b572678.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Interprofessional Education for Enhanced Teamwork in OBGYN Emergency: Results from a mixed methods study","fulltext":[{"header":"Background","content":"\u003cp\u003eInterprofessional education (IPE) is a collaborative approach to developing healthcare students as future interprofessional team members and a recommendation suggested by the Institute of Medicine (IOM).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e IPE has been defined as members or students of two or more professions associated with health or social care, engaged in learning with, from, and about each other.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e IPE provides an ability to share skills and knowledge between professions and allows for a better understanding, shared values, and respect for the roles of other healthcare professionals.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e These skills can bring out effective and targeted clinical efforts for improving quality and safety of the care provided by these teams. Training the upcoming healthcare professionals to thrive in such a collaborative environment will help in improved healthcare outcomes for patients.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e In order to get a broad spectrum of interprofessional stakeholders, including health profession educators, academic and health system leaders, clinical specialists, funders, planners, and policymakers, to take an interest in a collaborative model, certain measures are needed to gauge the impact of IPE beyond the classroom and simulation in real clinical practice.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eObstetric emergency (OB-ED) is a sub-specialized ED unit in most tertiary care hospitals including those in Pakistan. Although OB-EDs are exclusively devoted to the urgent care needs of pregnant and postpartum women. The wide variety of medical and surgical complications associated with pregnancy and postpartum\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e, entail that these services cannot be singlehandedly provided by obstetric and gynecologist (OBGYN) specialist healthcare cadre. It must encompass within itself a wider range of healthcare professionals including not only doctors from various disciplines like internal medicine, general surgery, anesthetists, infectious diseases\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, psychiatric services\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e but other cadres of health professionals from various fields like those from, transfusion units\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, nursing \u0026amp; midwifery OR \u0026amp; lab technicians and biochemical and forensic laboratories. Obstetric care is not only limited to the pregnant woman but expands to include the baby and the entire family. When a pregnant woman lands in an OB-ED, it is critical to establish interprofessional and interdepartmental collaboration and coordination to prioritize the well-being of both the baby and the mother.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e The versatility and complexity of the healthcare needs of the patients drives the need to refine IPE and Interprofessional collaborative Practices (IPCP) for effective service delivery. Effective interprofessional teams understand the concepts of other professions, have knowledge about them, and can appreciate and enhance each other\u0026rsquo;s skills in healthcare delivery.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Teamwork is an essential prerequisite of clinical care which is effective when the members can sincerely and frankly voice their opinions about each other\u0026rsquo;s professional performance and are willing to engage in healthy and direct discussions about each other\u0026rsquo;s professions and roles to enhance the quality of patient care.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e During provision of healthcare by interprofessional groups (especially in emergency situations), lack of teamwork, communication and partnership can result in suboptimal patient care incidents, leading to inefficient institutional systems.\u003c/p\u003e \u003cp\u003eThere is limited data available for Pakistan\u0026rsquo;s basic and comprehensive emergency obstetrics and newborn care.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Interactive education, targeted simulated skill-based training, and advocacy have provided scientific evidence in enhancing interprofessional and interdisciplinary communication and collaboration for optimum patient care in OB-EDs.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e The most readily studied and scientifically supported model to examine obstetric emergency care is the \u0026ldquo;three delays'' model\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Previously it was presumed that the first two delays \u0026ndash; outside of the hospital \u0026ndash; will have a greater impact on overall maternal mortality. It has been established that the third delay also significantly contributes to maternal mortality.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Among other factors adding up to the third delay, miscommunication and inadequate interprofessional collaboration was identified as a significant contributor to suboptimal care. Healthcare providers experienced that the communication between care providers at different levels \u0026ndash; such as communication of on-floor midwifery staff, obstetricians with senior decision-making obstetricians and with the anesthetist needs to be better streamlined.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e In view of the existing evidence and global practices, this study explores whether interprofessional education can improve the knowledge, skills, and behavior/perception for better teamwork among healthcare providers working in obstetrics and gynecology emergencies and and identifies experiences of healthcare providers learning through interprofessional education for management of various emergency cases in OBGYN about their teamwork approach and attitude in Pakistan.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eWe employed a mixed-method approach (concurrent embedded) to compare the scores of healthcare professionals (related to OBGYN emergency) on pre and posttest using TeamSTEPPS Teamwork Perception Questionnaire (TTPQ) before and after interprofessional education sessions and to explore the perceptions \u0026amp; experiences of participants regarding their attitude transformation in clinical teamwork after interprofessional education sessions.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQuantitative\u003c/strong\u003e \u003cp\u003eWe conducted a quasi-experimental study to evaluate the educational intervention by scoring the participants on a valid assessment tool (TTPQ) both before and after the teaching sessions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQualitative\u003c/strong\u003e \u003cp\u003e We used a qualitative exploratory design to understand the values and perceptions of participants regarding their experience and perceptions about developing better teamwork skills and attitude after interprofessional education. All interviews were audio recorded with permission of the respondents. The transcripts were sent to the interviewees for member checking to confirm all ideas and responses.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting and Population\u003c/h2\u003e \u003cp\u003eThe study was conducted from January 2022 to April 2022 and included six groups of healthcare professionals, including Obstetricians/ Gynecologists (OBGYN), anesthetists, midwives, Operating Room (OR) nurses, anesthesia technicians, and emergency physicians, working in Jinnah Postgraduate Medical Centre (JPMC) in Karachi, Pakistan. These groups of professionals were selected to create interprofessional teams of relevant service providers in a simulated setting of OBGYN emergency. The objective of enhancing knowledge, skills and attitudes for teamwork by interprofessional teaching sessions was best achieved by focusing on the population that worked there (OB-ED) actually.\u003c/p\u003e \u003cp\u003eJPMC is the largest public sector hospital of the metropolis. The obstetric emergency department (OB-ED) is one of the busiest departments of the institution that receives complex referred cases, needing urgent multidisciplinary coordinated care, henceforth considered a suitable study site.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size and Randomization\u003c/h2\u003e \u003cp\u003eFor the quantitative component, a total of 60 participants, 10 from each professional group, were included in the study through purposive sampling technique. All participants were selected from different backgrounds, experience level, gender, age groups and profession to aid in generalizing the results of the study. For qualitative interviews, participants were purposely selected for the In-Depth Interviews (IDIs) and through simple random sampling (lottery method) for the Focus Group Discussions (FGDs).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eQuantitative\u003c/strong\u003e \u003cp\u003ePre and post tests were conducted before and after the teaching intervention in a simulated situation by role plays on three different case scenarios on obstetric emergency, reporting of adverse events and medical disorders in OBGYN. Each group was assessed on all three cases. All participants were divided into five groups with twelve people from various professional backgrounds in each group (n\u0026thinsp;=\u0026thinsp;60). The pre and post tests were conducted for each group without mixing of participants. All groups were assessed by three assessors through TTPQ and an average of the three scores were awarded to each participant and group.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFor the intervention, teaching sessions on TeamSTEPPS modules were conducted in a blended format (online and face-to-face) to build teamwork knowledge, skills and improve attitudes. The educational intervention included six teaching sessions, one per week, developed by one obstetric faculty, one midwifery faculty and one ER physician, and reviewed by a medical educationist. The topics covered in teaching sessions were introduction and overview to healthcare teams with emphasis in collaborative care in OB-ED, including team function, communication in interprofessional teams, leadership in healthcare, situation monitoring, and mutual support. Participants were taught through case scenarios, interactive discussions and role plays in simulated settings on various patient interactions. Each session was followed by formative assessment/feedback at the end.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQualitative\u003c/strong\u003e \u003cp\u003eDuring week 5 and 6 of the study, we conducted four FGDs with various professionals groups and six IDIs with one person from each professional background. All interviews were either conducted online or face to face in the faculty office of OBGYN department, using a semi structured interview guide with open ended questions. The time taken for each interview and focus group discussion was around 25\u0026ndash;30 minutes. The interview guide was piloted by using it on faculty members of various professions at the same hospital to evaluate the usefulness and clarity of various questions.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Processing and Analysis\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eQuantitative\u003c/strong\u003e \u003cp\u003eAll the data was recorded on Statistical Software for Social Sciences (SPSS), version 22. The frequencies and percentages were calculated for categorical variables like gender, profession, years in clinical practice etc. Mean and standard deviation were calculated to show the overall test scores. The Cronbach alpha was computed to check inter-consistency between the questions on the applied model of TTPQ. Pretest and post test scores of the participants were evaluated by paired samples t test and all p-values were two sided and considered significant if p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQualitative\u003c/strong\u003e \u003cp\u003eManual analysis of the interviews was done for complete understanding and sense. Line by line readings were done from transcribed narratives and relevant statements were grouped into codes by two researchers for ensuring rigor in the study. The text data was further coded under these open codes to make sub codes and therefore compared with each other to make axial codes. These axial codes were then discussed and merged by both researchers with consensus to build themes.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cstrong\u003eQuantitative\u003c/strong\u003e \u003cp\u003eForty-two participants opted for the course while the rest were nominated by relevant departments. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows demographic characteristics of all participants enrolled for the teaching intervention of the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (60%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;35 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (53.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;35 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (28.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears in Clinical Practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSession attended\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInstitute\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (38.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSemi-Private\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe overall pre-assessment of Cronbach\u0026rsquo;s alpha was 78.1% and posttest was 89.1%, indicating reliability of the questionnaire, as shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInter-reliability among the questions (TTPQ)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTTPQ Model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCronbach 's Alpha\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-Assessment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-Assessment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeam Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.796\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSituation Monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMutual Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe overall TTPQ mean pre and post test scores for all included professionals are presented in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, showing that the highest score was achieved by the emergency physicians.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean pre and post test scores among different professions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePretest Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost test Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eTTPQ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObstetrician / Gynecologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e73.10\u0026thinsp;\u0026plusmn;\u0026thinsp;9.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e168.70\u0026thinsp;\u0026plusmn;\u0026thinsp;22.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnesthetist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e68.10\u0026thinsp;\u0026plusmn;\u0026thinsp;9.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e178.00\u0026thinsp;\u0026plusmn;\u0026thinsp;16.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e31.60\u0026thinsp;\u0026plusmn;\u0026thinsp;10.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e167.60\u0026thinsp;\u0026plusmn;\u0026thinsp;10.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e41.50\u0026thinsp;\u0026plusmn;\u0026thinsp;10.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e173.90\u0026thinsp;\u0026plusmn;\u0026thinsp;12.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnesthesia technician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e51.80\u0026thinsp;\u0026plusmn;\u0026thinsp;17.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e129.50\u0026thinsp;\u0026plusmn;\u0026thinsp;13.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e84.00\u0026thinsp;\u0026plusmn;\u0026thinsp;15.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e158.00\u0026thinsp;\u0026plusmn;\u0026thinsp;13.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe professionals from all included fields were assessed by the TTPQ subscales showing a significant difference found in most of the subscales between pre and post-test scores (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as presented in Tables \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e to 9.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre and posttest assessment of Obstetrician / Gynecologist by TTPQ sub scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTPQ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePretest Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost test Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eObstetrician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeam Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSituation Monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMutual Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre and posttest assessment of Anesthetist by TTPQ sub scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTPQ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePretest Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost test Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAnesthetist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeam Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSituation Monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMutual Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre and posttest assessment of Midwife by TTPQ sub scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTPQ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePretest Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost test Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeam Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSituation Monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMutual Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre and posttest assessment of OR Nurse by TTPQ sub scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTPQ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePretest Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost test Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eOR Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeam Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSituation Monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMutual Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre and posttest assessment of Anesthesia technician by TTPQ sub scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTTPQ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePretest Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePost test Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAnesthesia technician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTeam Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSituation Monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMutual Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ctbody\u003e\u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;9: Pre and posttest assessment of Emergency Physician by TTPQ sub scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTTPQ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ePretest Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003ePost test Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c2\" namest=\"c1\" rowspan=\"5\"\u003e \u003cp\u003eEmergency Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTeam Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e2.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSituation Monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMutual Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eQualitative:\u003c/h2\u003e \u003cp\u003eThe thematic analysis identified five overarching themes and 20 codes in total, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e(I) Motivated and Empowered\u003c/h2\u003e \u003cp\u003eParticipants gave positive remarks as team members for the IPE sessions to learn teamwork in an acute care setting. This theme is further divided into four codes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e(a) Compelling direction\u003c/h2\u003e \u003cp\u003eThe respondents mentioned that the exact nature of the scenarios like the ones in real life made them feel compelled to work in the right direction. Simulated scenarios with the team members from various professional backgrounds made them work together for improved patient outcomes.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWe were grouped in a way that all needs were being met in time. This resulted in working for better patient care through decisions in a timely manner.\u0026rdquo;\u003c/em\u003e (OR Nurse)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e(b) Sense of Meaning\u003c/h2\u003e \u003cp\u003eThe respondents shared that they were meaningfully contributing to the given situations as per the need of the cases.\u003c/p\u003e \u003cp\u003eOne participant mentioned, \u003cem\u003e\u0026ldquo;The feeling that every group member can contribute according to the needs of the patient under appropriate leadership of the team gives a real sense that we are also essential to the group\u0026rsquo;s success.\u0026rdquo;\u003c/em\u003e (Midwife)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e(c) Diversity\u003c/h2\u003e \u003cp\u003eTeam members conveyed positive perceptions for diversity in the professional teams dealing the emergency cases. Comments by respondents having greater clinical experience in the field were even more positive for having groups made in an inclusive manner.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The sense that all the help required can be sought was so satisfying. The combination of the group was felt as just right and rich due to representation from all areas. This gave satisfaction that the team is there to handle challenges of different types.\u0026rdquo;\u003c/em\u003e (Obstetrician)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e(d) Overcoming challenges and breaking Silos\u003c/h2\u003e \u003cp\u003eAll providers expressed that efforts for the training and education of health care professionals were conducted very rarely; however, it was still perceived positively by everyone. They stated that such training has supported them in facing difficult situations in clinical simulated settings with better understanding and feeling that help can be sought.\u003c/p\u003e \u003cp\u003eOne participant commented, \u003cem\u003e\u0026ldquo;We usually seek help from our obstetrics colleagues in duties but being able to ask help and guidance from other professionals like emergency physicians and anesthesia team members was a good experience. I felt as if the trend of a rigid connection is being broken and replaced by a flexible way of structuring communication effectively.\u0026rdquo;\u003c/em\u003e (Midwife)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e(II) Role identification\u003c/h2\u003e \u003cp\u003e During performance of given tasks in the simulated situations, participants gave great value to structured instructions and tools, description of responsibilities without ambiguity. Four codes were identified under this theme.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e(a) Clear responsibility\u003c/h2\u003e \u003cp\u003eThe participants perceived uniformly that the clear identification of roles and responsibilities was obvious in these educational sessions in simulation. This was felt to be worth practicing in their practical lives.\u003c/p\u003e \u003cp\u003eA respondent mentioned, \u003cem\u003e\u0026ldquo;We were very sure on how to communicate, whom to call and what to be expected from us. Everything was just clear before the actual performance. This made us be clear about the exact input expected from me or us as individuals and a team to do what is meant to be done.\u0026rdquo;\u003c/em\u003e (OT technician)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e(b) Accountability\u003c/h2\u003e \u003cp\u003e The perception of being accountable for the roles and actions was also being uniformly felt and perceived as a positive experience for improving quality of patient care during these sessions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The group members and leaders were vigilant during the tasks. We had briefings and debriefings throughout to make us accountable for the job we had to do. If that part was not done well the group and the patient will suffer. This feeling made us very particular to perform well.\u0026rdquo;\u003c/em\u003e (Anesthetist)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e(c) Structured and effective communication\u003c/h2\u003e \u003cp\u003eThis was a strong feeling by the majority of the respondents rather a very common statement by most of them. They conveyed structured as well as clear communication in a professional manner was the key to success in emergency situations.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The communication was very instrumental. Using various tools and practicing them appropriately were great experiences during the acute situations. I think we should all be teaching this way right from basic clinical years. This part was most significant in my opinion.\u0026rdquo;\u003c/em\u003e (Obstetrician)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e(d) Human resource management\u003c/h2\u003e \u003cp\u003eThe interviewees stated very strongly about this aspect that having a diverse, willing to work and appropriately trained team from various healthcare professional cadres is sufficient to deal with tasks at hand even in relatively scarce human resources in a clinical setting.\u003c/p\u003e \u003cp\u003eA participant stated, \u003cem\u003e\u0026ldquo;The teams were gathered to perform a clear task. They were willing to accept limitations and ask for help and support when necessary.\u0026rdquo;\u003c/em\u003e (Emergency Physician)\u003c/p\u003e \u003cp\u003eAnother participant mentioned, \u003cem\u003e\u0026ldquo;Many professionals were present and everyone was willing and motivated to work. We felt we could ask for support from each other and could multitask. Human resources should be trained and managed well. This can change the working environment and related stress.\u0026rdquo;\u003c/em\u003e (Obstetrician)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e(III) Shared Mindset\u003c/h2\u003e \u003cp\u003eThe groups felt that during simulations sharing of ideas and feelings was being accepted in a non-threatening manner. Most of them felt that a plan was properly shared, and they were able to implement the policies and protocols well. This theme is further classified into four codes:\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e(a) Mutual respect and trust\u003c/h2\u003e \u003cp\u003eThe respondents felt that everyone brings a different set of skills and personality traits. The participants perceived that teamwork, if done appropriately, can develop an environment of mutual respect and trust. They said that the feeling that you are valued, and your expertise are needed for patient care satisfies oneself.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The team showing respect and trust can do far better than criticizing negatively. This sense needs to be inculcated from the very initial years of training. We did not perform well in cases where the members were not trusting each other.\u0026rdquo;\u003c/em\u003e (Anesthetist)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e(b) Common goal\u003c/h2\u003e \u003cp\u003e The research participants felt a common goal of better patient outcome especially in an emergency situation was significant during the sessions. They thought it was a driving force to keep the team focused.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Patient centered approach is the must. All professionals are taught patient care and autonomy in their curriculum. If we all keep the patient in the center considering ourselves as care providers the problems can be solved. The idea of a common Goal is necessary to be built into the minds of all team members. The refresher training means a lot for it.\u0026rdquo;\u003c/em\u003e (Midwife)\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e(c) Solidarity\u003c/h2\u003e \u003cp\u003eThe interviewees in individual as well as group discussions were narrating the perception of feeling united for a cause clearly. They felt if healthcare providers are trained well in interprofessional sessions the group dynamics work perfectly.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The combined briefings and huddles of the teams made understanding of tasks at hand easier. It united us clearly at the time of real working practice.\u0026rdquo;\u003c/em\u003e (Obstetrician)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e(d) Supportive behaviors\u003c/h2\u003e \u003cp\u003eThe narratives stated that supporting the team members\u0026rsquo; specially offering support to those with lesser experience can improve the team culture greatly.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It appeared as learning together made all the providers work towards the cause and be supportive when required by other colleagues. The focus and commitment were all shared .The plans made ahead of the task cleared us when we need to jump in if someone is unable to perform optimally.\u0026rdquo;\u003c/em\u003e (OR Technician)\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e(IV) Effective leadership\u003c/h2\u003e \u003cp\u003eLeadership skills development as well as practice was clearly stated in the discussion as a vital and facilitating factor. They all believed that being a true healthcare leader is mandatory to interprofessional teamwork. The responsibility of a team leader for empowering members and motivational mechanisms made the goals to be achieved easier. This theme is further classified into four codes:\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003e(a) Strategic thinking\u003c/h2\u003e \u003cp\u003eLeadership strategies were felt as key factors to successful performance during the analysis of data.\u003c/p\u003e \u003cp\u003eOne participant shared, \u003cem\u003e\u0026ldquo;The perception and desire for work to get more effective outcomes is enhanced when we think strategically as leaders.\u0026rdquo;\u003c/em\u003e (Emergency nurse)\u003c/p\u003e \u003cp\u003eAnother stated, \u003cem\u003e\u0026ldquo;Every healthcare professional has to be a strategic leader and be open to interchange the role when deemed necessary. Planning and putting thoughts to action can get things done easily.\u0026rdquo;\u003c/em\u003e (Anesthetist)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003e(b) Developing each other\u003c/h2\u003e \u003cp\u003eThe respondents from non-physician groups specifically laid stress on mutual development by healthcare leaders for improved team performance and considered it can be instrumental for clinical care.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;To improve care delivery, all team members need to be vigilant and see where the coworkers need to be strengthened. This should happen in a respectful, non-threatening manner. Coordination neglect can be devastating. We can contribute immensely by developing the team members towards excellence. A healthcare leader needs to practice it repeatedly.\u0026rdquo;\u003c/em\u003e (OR nurse)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e(c) Self-awareness\u003c/h2\u003e \u003cp\u003eThe data revealed the feelings of interviewees for self-awareness as a significant ability for teamwork and as leader of the team.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Ability for better decision making depends on the actual trait of knowing your emotions and weaknesses and how they will affect my actions especially in challenging scenarios of high stakes. It requires developing insights into our own emotions and their impact on others to be able to control other people\u0026rsquo;s actions when working in teams.\u0026rdquo;\u003c/em\u003e (Emergency Physician)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e(d) Team Building Skills\u003c/h2\u003e \u003cp\u003eThe respondents from all the professional backgrounds emphasized the dedicated need by leaders for team building and empowering all team members.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Leaders need to guide by example. The steep needs of service delivery can be met when the more qualified team members of healthcare try to fill in the critical gaps by other professionals by building morals, trust and competencies of their co members.\u0026rdquo;\u003c/em\u003e (Obstetrician)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e(V) Collaborative learning\u003c/h3\u003e\n\u003cp\u003eAll professionals mentioned that having a desire to learn while working together results in better and combined learning. One can memorize the events along with professional relationship experience further resulting in deeper understanding of thus gained knowledge. This theme is further classified into four codes:\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003e(a) Reflecting on practice\u003c/h2\u003e \u003cp\u003eThe feelings during interviews and discussions were expressed by respondents for a strong perception about reflecting on practice. They conveyed that mindful reflection on your learning was enhanced by the experience of working in interprofessional teams. It lets them feel what they need to work on further, especially when they do a comparative analysis of their own work performance.\u003c/p\u003e \u003cp\u003eA respondent said, \u0026ldquo;Professional development results in better performance. Reflecting on the learning experience in interprofessional teams was perceived as developing myself in a positive direction.\u0026rdquo; (Anesthetist)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003e(b) Mentoring Mutually\u003c/h2\u003e \u003cp\u003e All the interviewees felt when they learnt together it was a better learning experience for everyone, Each and every participant felt they were able to learn from each other. It gave them a feeling of strong peer support.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eThe group members were ready to not only conceptualize the taught material but at the same time were very willing to teach the co members. This mutual mentoring resulted in critical thinking and better decision making in less time effectively\u003c/em\u003e.\u0026rdquo; (OR nurse)\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003e(c) Common goals\u003c/h2\u003e \u003cp\u003eThe interprofessional education sessions made the participants realize that the goal is common to achieve better patient care in a timely fashion. This can be satisfying for patients and families, care providers and the institutions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The patient was the center of care. Their quality of care was the common aim. This was the bond which through the combined sessions got stronger.\u0026rdquo;\u003c/em\u003e (Obstetrician)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003e(d) Task shifting\u003c/h2\u003e \u003cp\u003e It was a common statement by the majority of the participants that the sharing of tasks as per competency of the colleagues can improve teamwork as well as manage work efficiently.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The tougher tasks were equally shared and even the task allocation to other colleagues made the complicated cases be solved in a less stressful manner. While in Simulations needing critical care the anesthetists were relying on his anesthesia technician teams for monitoring and delivery of medication which gave them time to be more focused on patients' response to the clinical management provided.\u0026rdquo;\u003c/em\u003e (Anesthetist)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study substantially contribute to the literature in providing quantitative and qualitative evidence that interprofessional teaching and learning activities not only improved providers\u0026rsquo; perspectives on subscales of team function, leadership, situation monitoring, mutual support, and communication but also indirectly contributes to enhanced patient outcomes in terms of quality of care, patient safety, and conflict-resolution in OBGYN emergency settings. The theme of overcoming challenges focused on enhanced conflict management and accountability through interprofessional collaboration. Maintaining secure, high-quality treatment in obstetric operating rooms demands interprofessional cooperation, especially between midwives and doctors.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e In addition to that, this study highlighted how simulated scenarios with the team members from various professional backgrounds made a combined thinking process to work for improved patient outcomes. Global studies have collected evidence that explicitly supports the use of interprofessional simulation-based training in the management of obstetric crisis. Despite the triage for critical cases in obstetric emergencies, they can nonetheless be fatal, necessitating prompt response, shared decision-making, and clinical expertise.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMoreover, simulation-based strategic education with the cadre of providers in this study also reported significantly enhanced team function and situation monitoring skills which are critical in early identification of a clinical problem. Further in qualitative assessments, collaborative practice towards a common goal was a majorly highlighted theme. Since OBGYN emergencies are demanding and unpredictable, it can cause an ethical conundrum. They call for quick decisions that may be beyond the staff's training and experience\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. When compared to developed nations where poor maternal/neonatal consequences are often attributed to poor administration, many facilities in developing countries fail to control the OB crisis due to insufficiently qualified staff.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e As per the reports of the surveillance body about obstetric malpractice in one western institution, communication barriers were held accountable for 31% of adverse episodes.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e These challenges were also highlighted in the qualitative analysis of this study. \u0026ldquo;Ineffective communication\u0026rdquo; was reported as a disruptor in patient care. Deficient basic knowledge of the subject and poor English language skills were few factors identified by participants other than doctors to hamper their ability to contribute efficiently to the crisis This necessitates a focus on distinct communication ensuring the team members have understood the task at hand clearly.\u003c/p\u003e \u003cp\u003eFurthermore, interpersonal teamwork and communication skills should be fostered across various domains including nursing, midwifery, medical, and other maternity healthcare providers owing to the prompt need for information reciprocation to deal with distinct purposes.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Shaw-Battista et al. have cited the positive outcomes of virtual learning modules, case-based seminars, and hands-on training workshops employed on their trainees to perform better under perceptive clinical supervision and obstetric crisis.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Similarly, this study helped identify provider motivation with a sense of meaning towards patient care and enabled them to identify roles with clear responsibilities through effective communication, in an environment of shared trust and respect under effective leadership as critical parameters resulting in improved teamwork. The recent work of Avery and colleagues in IPE intervention for midwifery students and OBGYN residents reported enhanced overall ability to collaborate, valued teamwork and team experiences, learned to communicate better with one another, and showed mutual respect toward one another\u0026rsquo;s scope of practice.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The qualitative results of this study are also comparable to the work of Avery and colleagues, as our participants also experienced confidence in team work, mutual respect towards participants of other professions, and collaborative learning, with improved TTPQ scores on mutual support for all groups.\u003c/p\u003e \u003cp\u003eLastly, the findings from the FGDs highlighted how interprofessional education intervention motivated the participants and empowered them to work collaboratively with a shared mindset and clearly assigned roles. They were compelled to perform in one direction and a common goal \u0026ndash; optimum patient care \u0026ndash; through structured and effective communication via strategic planning and effective leadership. These professionals are required to be skilled top players in their own discipline, and they must also be effective team players. Over the past few years, healthcare teams have faced several challenges, including managing a pandemic globally while continuing to provide regular and preventive healthcare, attempting to eliminate inequalities and racism, educating the forthcoming generation of healthcare professionals, and combatting long-term public humanitarian crises, such as violence and mental disorders health concurrently. These subjects call for interprofessional cooperation and unanimous ingenuity. The COVID-19 pandemic stands as a classic example of needing collaboration of a variety of professionals, including doctors, public health specialists, respiratory technicians, nurses, and environmental services, among many others.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e The pandemic has somehow compelled different professions of healthcare to come together to perform as a team in times of adversity. As highlighted in this study, this can effectively be achieved through shared mindsets, involving mutual respect for individuals of all professions and extended supportive behaviors. The results of this study will serve as a prototype for cultivating an environment of interprofessional training and collaboration in various similar hospital settings. It will help build strategies to implement interprofessional teaching and training sessions by utilizing the lessons learned through circumstantial and contextual evidence. It may help sensitize providers towards the needs and demands of patients with multidisciplinary complaints and broaden the horizon of their management approach to include all biological, psychological, and social aspects of patient care. The ultimate goal of this research is to enhance patient care and patient satisfaction with the better quality of care in our health system. Pertinent to the scenario of OB-ED, improved knowledge, skills, and behavior can translate into improved patient satisfaction which may ultimately translate into improved maternal mortality indicators.\u003c/p\u003e \u003cp\u003eIn relation to our study, context specificity emerges as an important limitation. Our current study is mostly compared with the findings of western research, primarily based in the UK, USA, and Canada, owing to inadequate work on this subject in Pakistan. The small sample size and shorter duration of this study is the other limiting factor. Strength of study is a mixed method approach for deeper understanding of the findings. The findings can be used to upscale the approach for teaching the providers in a national context. The knowledge generated can be used for implementation research for the future.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eInefficient communication and leadership challenges are among the leading sources of medical errors and ineffective patient care.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Currently, education and health system authorities generally fail to consider the importance of workplace learning as an effective means of promoting collaborative practice throughout the learning continuum and hence, the need for collective realization and rectification in this matter. While acknowledging the historical, cultural, and societal roots of the challenges impacting interprofessional collaboration in clinical practice, we firmly believe that the sociological concerns (such as power, hierarchy, professional boundaries, and gender disparity) must be addressed if team-oriented training programs are to become a reality. We discovered several potential untapped directions for future research when gathering the theoretical foundations of interprofessional education and training. Even though numerous studies have highlighted the benefits of team training programs, more research is required to comprehend how to effectively develop and implement these programs, particularly diverse clinical units in different regions.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e The feasibility of other techniques, such as e-learning and hybrid learning can be experimented with and evaluated to enable the instillation of interprofessional knowledge at the level of the medical undergraduates.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBringing healthcare specialists and students of varied backgrounds together with obstetrics and gynecology residents in a mutual clinical setting has the potential to induce positive changes in the current paradigm of healthcare provision, particularly in prenatal, perinatal, and postnatal care. Operationalizing the objectives of interdisciplinary and interprofessional patient care necessitates an effective education and training program which concentrates concurrently on multiple prospects in line with each participant\u0026rsquo;s respective profession. From norm-setting, identifying incompatibilities, adapting to new information, and reciprocating with the established communication channels are important measures to be incorporated into the program format, making it possible to expose many aspects that are important in training and education programs.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Further investigations must be carried out to not only assess the interventions but also the inducible evolution in patient safety and mortality rates.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e "},{"header":"Declarations","content":"\u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eAvailability of data and material:\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analyzed for study are available from the corresponding author on reasonable request.\u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors would like to thank the staff of OBGYN Emergency Department of JPMC who participated in the study, JSMU MHPE class of 2018 for their encouragement to take up this challenging project and Professor Syeda Kausar Ali for her mentorship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors did not receive any funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan\u003c/p\u003e\n\u003cp\u003eHaleema Yasmin\u003c/p\u003e\n\u003cp\u003eDepartment of Anesthesia, Jinnah Postgraduate Medical Centre, Karachi, Pakistan\u003c/p\u003e\n\u003cp\u003eShoaib Malik\u003c/p\u003e\n\u003cp\u003eDepartment of Medical Education, Jinnah Sindh Medical University, Karachi, Pakistan\u003c/p\u003e\n\u003cp\u003eSyed Moyn Ali\u003c/p\u003e\n\u003cp\u003eDepartment of Health Professions Education, Liaquat National Hospital \u0026amp; Medical College, Karachi, Pakistan\u003c/p\u003e\n\u003cp\u003eSobia Ali\u003c/p\u003e\n\u003cp\u003eDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, 02215\u003c/p\u003e\n\u003cp\u003eAnum S. Hussaini\u003c/p\u003e\n\u003cp\u003eAPPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan\u003c/p\u003e\n\u003cp\u003eLubna Ansari Baig\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHY conceived the idea of the study, identified participants, developed and conducted the teaching sessions, pre and post tests, and qualitative interviews, and finalized the manuscript. SM assisted in the assessment process of the pre and post tests. MA assisted HY in developing content for the teaching sessions. SA and participated in field notes for the qualitative interviews and assessment process of the pre and post tests. ASH reviewed the material for the classroom sessions, prepared the manuscript and incorporated all the feedback. LAB reviewed the contents of role plays and instructions for the classroom sessions for the five core components taught to the IPE groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Dr. Haleema Yasmin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted after IRB approval from Jinnah Sindh Medical University (JSMU) and JPMC. Prior to participation in the study, all participants were explained about the protocol and procedures of the study\u0026nbsp;and were asked to provide informed, written and verbal consent. Anonymity of data was ensured by either putting numbers or initials on the results and interview data. No remuneration was offered to any participant. The interview recordings and the quantitative data were saved on a personal computer not accessible to the general public.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eBridges D, Davidson RA, Soule Odegard P, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Medical Education Online. 2011;16(1):6035.\u003c/li\u003e\n\u003cli\u003eCox M, Cuff P, Brandt B, Reeves S, Zierler B. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Journal of Interprofessional Care. 2016;30(1)\u003c/li\u003e\n\u003cli\u003eYang L, Yamamoto-Hanada K, Ishitsuka K, Ayabe T, Mezawa H, Konishi M, Shoda T, Sago H, Saito H, Ohya Y, Japan Environment and Children\u0026rsquo;s Study Group. Medical and surgical complications in pregnancy and obstetric labour complications in the Japan Environment and Children\u0026rsquo;s Study (JECS) cohort: a birth cohort study. Journal of Obstetrics and Gynaecology. 2020 Oct 2;40(7):918-24.\u003c/li\u003e\n\u003cli\u003eKumari A, Suri J, Mittal P. Descriptive audit of maternal sepsis in a tertiary care centre of North India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018 Jan 1;7(1):124-8\u003c/li\u003e\n\u003cli\u003eRochon-Terry G, Gruneir A, Seeman MV, Ray JG, Rochon P, Dennis CL, Grigoriadis S, Fung K, Kurdyak PA, Vigod SN. Hospitalizations and emergency department visits for psychiatric illness during and after pregnancy among women with schizophrenia. The Journal of clinical psychiatry. 2016 Apr 27;77(4):8345.\u003c/li\u003e\n\u003cli\u003eVaid P, Kapoor B, Kapoor M, Kapoor BB. Role of blood and blood components transfusion in obstetric emergencies. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2020 May 1;9(5):2029-35.\u003c/li\u003e\n\u003cli\u003eChagolla BA, Keats JP, Fulton JM. The importance of interdepartmental collaboration and safe triage for pregnant women in the emergency department. Journal of Obstetric, Gynecologic \u0026amp; Neonatal Nursing. 2013 Sep 1;42(5):595-605.\u003c/li\u003e\n\u003cli\u003eOrchard C, Bainbridge L, Bassendowski S, Stevenson K, Wagner SJ, Weinberg L, Curran V, Di Loreto L, Sawatsky-Girling B. A national interprofessional competency framework.\u003c/li\u003e\n\u003cli\u003eUtz B, Zafar S, Arshad N, Kana T, Gopalakrishnan S, Van Den Broek N. Status of emergency obstetric care in four districts of Punjab, Pakistan\u0026ndash;results of a baseline assessment. J Pak Med Assoc. 2015 May 1;65(5):480-5.\u003c/li\u003e\n\u003cli\u003eMcCoy EE, Weidner AK, Benson LS, Darney BG, Prager SW. Practice change following an interdepartmental training on early pregnancy loss management in the emergency department. Cogent Public Health. 2022 Dec 31;9(1):2052402.\u003c/li\u003e\n\u003cli\u003eMgawadere F, Unkels R, Kazembe A, van den Broek N. Factors associated with maternal mortality in Malawi: application of the three delays model. BMC pregnancy and childbirth. 2017 Dec;17(1):1-9.\u003c/li\u003e\n\u003cli\u003eKiruja J, Ess\u0026eacute;n B, Erlandsson K, Klingberg-Allvin M, Osman F. Healthcare providers experiences of comprehensive emergency obstetric care in Somaliland: An explorative study with focus on cesarean deliveries.\u003c/li\u003e\n\u003cli\u003eBowyer L. The confidential enquiry into maternal and Child health (CEMACH). Saving mothers\u0026rsquo; lives: reviewing maternal deaths to make motherhood safer 2003\u0026ndash;2005. The seventh report of the confidential enquiries into maternal deaths in the UK.\u003c/li\u003e\n\u003cli\u003eLentz GM, Mandel LS, Lee D, Gardella C, Melville J, Goff BA. Testing surgical skills of obstetric and gynecologic residents in a bench laboratory setting: validity and reliability. American journal of obstetrics and gynecology. 2001 Jun 1;184(7):1462-70.\u003c/li\u003e\n\u003cli\u003eFransen AF, van de Ven J, Banga FR, Mol BW, Oei SG. Multi‐professional simulation‐based team training in obstetric emergencies for improving patient outcomes and trainees\u0026apos; performance. Cochrane Database of Systematic Reviews. 2020(12).\u003c/li\u003e\n\u003cli\u003eCrofts JF, Mukuli T, Murove BT, Ngwenya S, Mhlanga S, Dube M, et al. Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe. Bulletin of the World Health Organization. 2015;93:347-51\u003c/li\u003e\n\u003cli\u003eShanafelt TD, Dyrbye LN, West CP, Sinsky CA. Potential impact of burnout on the US physician workforce. InMayo Clinic Proceedings 2016 Nov 1 (Vol. 91, No. 11, pp. 1667-1668). Elsevier.\u003c/li\u003e\n\u003cli\u003eMeri\u0026eacute;n AE, Van de Ven J, Mol BW, Houterman S, Oei SG. Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstetrics \u0026amp; Gynecology. 2010 May 1;115(5):1021-31.\u003c/li\u003e\n\u003cli\u003eBaker MJ, Durham CF. Interprofessional education: a survey of students\u0026rsquo; collaborative competency outcomes. Journal of Nursing Education. 2013 Dec 1;52(12):713-8.\u003c/li\u003e\n\u003cli\u003eWagner B, Meirowitz N, Shah J, Nanda D, Reggio L, Cohen P, et al. Comprehensive perinatal safety initiative to reduce adverse obstetric events. Journal for Healthcare Quality. 2012 Jan;34(1):6-15.\u003c/li\u003e\n\u003cli\u003ePlaat F, Wray S. Role of the anaesthetist in obstetric critical care. Best Practice \u0026amp; Research Clinical Obstetrics \u0026amp; Gynaecology. 2008 Oct 1;22(5):917-35.\u003c/li\u003e\n\u003cli\u003eForster AJ, Fung I, Caughey S, Oppenheimer L, Beach C, Shojania KG, van Walraven C. Adverse events detected by clinical surveillance on an obstetric service. Obstetrics \u0026amp; Gynecology. 2006 Nov 1;108(5):1073-83.\u003c/li\u003e\n\u003cli\u003eYoung MP, Gooder VJ, Oltermann MH, Bohman CB, French TK, James BC. The impact of a multidisciplinary approach on caring for ventilator-dependent patients. International Journal for Quality in Health Care. 1998 Feb 1;10(1):15-26.\u003c/li\u003e\n\u003cli\u003eFeitosa J, Fonseca A. Teamwork: education and training in healthcare. InComprehensive Healthcare Simulation: InterProfessional Team Training and Simulation 2020 (pp. 49-63). Springer, Cham.\u003c/li\u003e\n\u003cli\u003eStringer M, Suplee PD. Limited ultrasound technology: Uses, collaboration, and knowledge acquisition. Biomedical Instrumentation \u0026amp; Technology. 2007:39.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Interprofessional education, teamwork, skills, obstetrics/gynecology, emergency","lastPublishedDoi":"10.21203/rs.3.rs-3290625/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3290625/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eInterprofessional education is a collaborative approach to developing healthcare students as future interprofessional team members and a recommendation suggested by the Institute of Medicine. Complicated medical issues can be best tackled by interprofessional teams, especially when dealing with emergency cases. The study aims to compare the scores on pre and post tests using TeamSTEPPS Teamwork Perception Questionnaire (TTPQ) before and after the implementation of interprofessional education sessions and to explore the perception and attitude transformation of health care providers regarding their teamwork in clinical settings after those sessions.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThis mixed method (concurrent embedded) study was conducted at OBGYN department of Jinnah Postgraduate Medical Centre, Karachi, Pakistan from January to April 2022. We conducted a quasi-experimental study to evaluate the six interprofessional teaching sessions of six groups of healthcare professionals, including obstetricians/gynecologists, anesthetists, midwives, operating room nurses, anesthesia technicians, and emergency physicians working in OBGYN emergency in simulated setting based on common OBGYN case scenarios. Participants were scored on TTPQ, a valid assessment tool, both before and after the intervention took place. FGDs and IDIs were conducted in the fifth and sixth weeks of the intervention to understand the feelings, values and perceptions of participants about teamwork during and after attending the sessions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTotal 24 (40%) were males, 36 (60%) were females. The analysis revealed improvement in TTPQ subscales including team function, leadership, situation monitoring, mutual support, and communication (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Narratives from interviews identified effective communication and good leadership as core components and indicated that multiple factors can underpin IPE implementation. Results suggest that educational intervention can be challenging in real life unless all stakeholders are dedicated and committed to this approach. If rightly and inclusively implemented this approach, medical education can be very cost effective, pleasant, and critical for better patient outcomes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eInterprofessional education and training sessions were well accepted, suggesting indications of positive engagement towards teamwork. Participants expressed better grasp of teamwork skills, regarding all domains including leadership, management, and communication in obstetric crises.\u003c/p\u003e","manuscriptTitle":"Impact of Interprofessional Education for Enhanced Teamwork in OBGYN Emergency: Results from a mixed methods study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-27 14:42:12","doi":"10.21203/rs.3.rs-3290625/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f394bbef-07e7-479e-9f25-6a04295d161d","owner":[],"postedDate":"September 27th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-10-31T04:30:09+00:00","versionOfRecord":[],"versionCreatedAt":"2023-09-27 14:42:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3290625","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3290625","identity":"rs-3290625","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}