Table 1.

Lessons Learned

Lesson Learned	Experiential Evidence	Literature Evidence
Each student needs to be actively engaged in an exercise to get maximum individual and team value.	Changes in Crisis on Flight 1974 after TWD 2007 significantly increased student evaluations.	[55–64]
Faculty need appreciable training as well.	Faculty facilitators and debriefers who missed the 2-h group training felt much less prepared to teach the course (even after one-on-one review of the syllabus with the course director).	[65–67]
The order of sequential exercises is important and should support scaffolding of desired KSA.	Reorganization of TWD 2008 to assure that all students had Williams Medical Center before Ward Rounds significantly improved student ratings of the former exercise.	[66, 68]
Simulation-based training, especially of large student cohorts, is very faculty and support staff intensive.	TWD 2010 required 10 faculty facilitators, 12 faculty debriefers, 8 educational support staff, and 32 standardized patients/passengers for 7.75 contact hours for 101 students.	[69, 70]
Student preparation, especially for role play exercises, is critical to student learning and satisfaction.	Student comments and ratings of handouts and the course were lower in TWD 2007 and 2008 before greater effort was made to emphasize weekend study of their roles.	[71, 72]
Iterative curricular design based on students’ course evaluations is effective at improving an integrated course.	Tables S2 and S3.
A comprehensive teamwork training exercise can be delivered successfully to new medical students.	Tables S2 and S3.