Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences


The objective of this study was to determine change in individual and aggregate attitudes of the members of two subspecialty surgery teams (cardiac and vascular) in six domains (teamwork climate, safety climate, job satisfaction, stress recognition, perception of management, and working conditions) following medical team simulation and debriefing exercises. The study was a pre-post partially randomized controlled, quasi-experimental study that took place in a 545-bed hospital with a high-volume cardiovascular surgery program. Participants included interdisciplinary team members caring for cardiac and vascular surgery patients.

Main outcome measures included change in responses to safety attitudes questionnaires (SAQs) administered before, 1 week after, and 6 weeks after medical team simulation and debriefing exercises. Statistically significant changes were observed in several domains and occurred at various points during the study period. Consistent with the design of team simulation, the greatest positive effect was observed in the teamwork climate domain. An apparent spill-over positive effect was also observed in control group members, which implies the potential for team simulation exercises to have an effect beyond individual participants, extending change into the broader culture of an organization. Additionally, SAQ scores were analyzed to identify domains at risk for adverse effects on patient safety, creating further opportunity for interventions to improve the organization's safety culture.

Access Setting

Dissertation-Open Access