Objective. To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Study Setting. Nine teaching and community hospital EDs. Study Design. A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course TM (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Data Collection. Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. Principal Findings. A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training ( p 5 .012). Subjective workload was not affected by the intervention ( p 5 .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group ( p 5 .039). In the experimental group, the ED staffs' attitudes toward teamwork increased ( p 5 .047) and staff assessments of institutional support showed a significant increase ( p 5 .040). Conclusion. Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.

Objective: To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum. Setting: Level 1 trauma center and academic emergency medicine training program. Participants: Emergency department (ED) staff including nurses, technicians, emergency medicine residents, and attending physicians. Intervention : ED staff who had recently received didactic training in the Emergency Team Coordination Course (ETCCH) also received an 8 hour intensive experience in an ED simulator in which three scenarios of graduated difficulty were encountered. A comparison group, also ETCC trained, was assigned to work together in the ED for one 8 hour shift. Experimental and comparison teams were observed in the ED before and after the intervention. Design: Single, crossover, prospective, blinded and controlled observational study. Teamwork ratings using previously validated behaviorally anchored rating scales (BARS) were completed by outside trained observers in the ED. Observers were blinded to the identification of the teams. Results: There were no significant differences between experimental and comparison groups at baseline. The experimental team showed a trend towards improvement in the quality of team behavior (p = 0.07); the comparison group showed no change in team behavior during the two observation periods (p = 0.55). Members of the experimental team rated simulation based training as a useful educational method. Conclusion: High fidelity medical simulation appears to be a promising method for enhancing didactic teamwork training. This approach, using a number of patients, is more representative of clinical care and is therefore the proper paradigm in which to perform teamwork training. It is, however, unclear how much simulator based training must augment didactic teamwork training for clinically meaningful differences to become apparent.T eamwork training has made a fundamental impact on error reduction and human performance improvement in a number of commercial areas such as aviation 1 2 and other major industries. Aviation provides a good example of how simulation experts and human factors psychologists have collaborated to produce flight simulators that are intended to train and test both crew technical and human interaction skills. Medicine has had a long history of training and testing caregiver clinical skills and performance that is primarily individually oriented. As a result of traditional training and norms, physicians in particular tend to function autonomously. Some clinical tasks are easily simulated and are measurable in environments such as those used in Advanced Cardiac Life Support (ACLS) and Advanced Trauma Life Support (ATLS) courses. Less importance has been assigned to training and assessing teamwork skills. Despite the prominent role that teams play in delivering health care, opportunities to formally practise teamwork skills and receive expert feedback do not exist. A recent Institute of Medicine report 3 reminds u...

The effective reduction of medical errors depends on an environment of safety for patients in both clinically-based and systems-oriented arenas. Formal teamwork training is proposed as a systems approach that will achieve these ends. In a study conducted by Dynamics Research Corporation, weaknesses and error patterns in Emergency Department teamwork were assessed, and a prospective evaluation of a formal teamwork training intervention was conducted. Improvements were obtained in five key teamwork measures, and most importantly, clinical errors were significantly reduced.

Safety climate indicators can vary substantially among anesthesia practice groups. Scale scores and responses to specific questions can suggest practices for improvement. Overall safety climate is probably not a good criterion for assessing the impact of simulation-based CRM training. Training alone was insufficient to alter engrained behaviors in the absence of further reinforcing actions.

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This report is one of several provided by the Mellonics Systems Development Division of Litton Systems, Inc., to the Army Research Institute for the Behavioral and Social Sciences (ARI) under Contract DAHC 19-77-C-0011. ARI Research in marksmanship training systems development is conducted as an inhouse effort augmented by contracts with organizations selected as having unique capabilities for research in the area. The Mellonics effort supports the Training Effectiveness Analyeis (TEA) research being conducted by the Fort Benning ARI Field Unit involving the effectiveness of training for basic rifle rsrksmanship skills. Previous TEA efforts have resulted in eight reports pertaining to marknmanship. This effort provides data concerning the performance quality of typical service rifle/ammunition combinations and compares theoretical information with the actual performance of typical service rifles. Simplified and more efficient techniques of teaching basic marksmanship skills are tested and the relative contribution of various fundamental factors to shooting performance are investigated. The reaearch was coordinated with the United States Army Infantry School, the provonent agency for M16AI rifle marksmanship training program development. Appreciation is extended to the U. S. Army Marksmansip Training Unit for making test facilities and personnel available to support this test. The project was conducted as part of Army Project 2Q763743A773, FY 78 aud FY 79 Work Program. It was directly responsive to the requirements of FORSCOM, USAIS and TRADOC. 05OSPHkIDI4R Tec ical ector V ADEQUACY OF XI6AI RIFLE PKERODIUICE AND 1T8 INFLICATIONS FOR NL&RKSMANSDIP TRAINING BRIEF Requirement: To determine the quality of firing performance for the typical MI6AI rifle and test theoretical training and ballistics information. To develop a better understanding of the Man/Weapon interface and develop simplified and impr•oved training procedures. Procedure-Research objectives were organized into nine different firing tests. During the period 7 March to 13 April 1979, some 5000 rounds of anmunition were fired through 60 MI6AI rifles at Fort Benning, Georgia. Findings: The typical M16AI rifle is capable of effectively engaging personnel size targets out to a range of 300 m when standard serviceability checks are augmented with firing tests to assure weapons quality. Theoretical information pertaining to zero procedures and bullet trajectory is accurate. Using the long range sight and adjusting bullet impact to point of aim at 25 m produces a 250 m battle sight zero. This procedure also provides for meaningful skill practice on the 25 m range. The rimi ire adapter is not adequate for attaining a weapons zero and results in an increased shot group size. Various types of external stress on the rifle (hasty sling, bipod, etc.) have a significant effect on the strike of thR bullets. Some forms of firer error currently receiving emphasis, e.g., sight misalignment, have minimum effect on the strike of the bullet. Utilization of Findings: The info...

This practitioner paper describes a variety of training development, assessment, and implementation issues and solutions that emerged from our research to develop behavior-based teamwork training for healthcare providers. These lessons-learned are based on our experiences in adapting aviation crew resource management (CRM) training for healthcare providers in the specialty areas of emergency care and labor and delivery. The discussion covers (a) issues surrounding training content and delivery, (b) methodological issues in conducting training evaluations, and (c) institutional characteristics, cultural change, and sustaining the behavioral intervention.The thesis of this paper is that "teamwork training" entails much more than the delivery of a training course to a departmental staff, in that successful teamwork outcomes require organizational preparations and changes prior to the training, a cultural change in the department or unit as a result of the training, implementation strategies extending through the staff who are trained and into upper management of the healthcare organization, and sustainment strategies to retrain and reinforce key concepts and behaviors.Health care is generally provided by teams, but formal teamwork training has not been embraced by healthcare organizations to improve teamwork processes. Both commercial and military CRM programs have been recognized as a significant human factors contribution to the reduction of "human error" in aviation (Leedom & Simon, 1995;Salas, Fowlkes, Stout, Milanovich, & Prince, 1999) and are cited as a potential contribution to the current healthcare industry goal of reducing medical errors (Kohn, Corrigan, & Donaldson, 1999; Markowitz, 200 1). At the organizational level, the typical aviation CRM program consists of two components. The training component teaches flight personnel the communication and coordination behaviors that constitute the teamwork process, and imparts the rationale for engaging in resource management. The management component includes policies and procedures to institutionalize teamwork processes, support for the training infrastructure to train teamwork, and evaluation methods to ensure proficiency.for our adaptation of teamwork training for healthcare providers. Our research program retained the training, management, and evaluation elements and introduced the program at the level of emergency departmentsThis aviation CRM training model provided the basis (EDs). This focus at the department level had outcomes, issues, and suggested improvements that are enumerated in the following findings. TRAINING CONTENT AND DELIVERYThe delivery and application of the Emergency Team Coordination Course (ETCCTM) was divided into three phases: site planning and preparation, teamwork training, and teamwork implementation. Site planning consisted of (a) a communication campaign to introduce staff and higher level management to the ED'S impending change to a teamwork structure, (b) a schedule for team training and subsequent teamwork roll-out, (c) determi...

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