Complex problem solving is challenging and a high-level cognitive process for individuals. When analyzing complex problem solving in teams, an additional, new dimension has to be considered, as teamwork processes increase the requirements already put on individual team members. After introducing an idealized teamwork process model, that complex problem solving teams pass through, and integrating the relevant teamwork skills for interdependently working teams into the model and combining it with the four kinds of team processes (transition, action, interpersonal, and learning processes), the paper demonstrates the importance of fulfilling team process demands for successful complex problem solving within teams. Therefore, results from a controlled team study within complex situations are presented. The study focused on factors that influence action processes, like coordination, such as emergent states like collective orientation, cohesion, and trust and that dynamically enable effective teamwork in complex situations. Before conducting the experiments, participants were divided by median split into two-person teams with either high (n = 58) or low (n = 58) collective orientation values. The study was conducted with the microworld C3Fire, simulating dynamic decision making, and acting in complex situations within a teamwork context. The microworld includes interdependent tasks such as extinguishing forest fires or protecting houses. Two firefighting scenarios had been developed, which takes a maximum of 15 min each. All teams worked on these two scenarios. Coordination within the team and the resulting team performance were calculated based on a log-file analysis. The results show that no relationships between trust and action processes and team performance exist. Likewise, no relationships were found for cohesion. Only collective orientation of team members positively influences team performance in complex environments mediated by action processes such as coordination within the team. The results are discussed in relation to previous empirical findings and to learning processes within the team with a focus on feedback strategies.

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ObjectivesThe purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student’s behaviour, attitudes, and performance during simulated patient treatment.MethodsSeventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints.ResultsNon-technical skills concerning situation awareness (p<.01, r=0.5) and teamwork (p<.01, r=0.45) improved from simulation I to II in the NTS group. Decision making improved in both groups (NTS: p<.01, r=0.39; control: p<.01, r=0.46). The attitude ‘handling errors’ improved significantly in the NTS group (p<.05, r=0.34). Perceived stress decreased from simulation I to II in both groups. Medical endpoints and patients´ outcome did not differ significantly between the groups in simulation II.ConclusionsThis study highlights the effectiveness of a single brief seminar on non-technical skills to improve student’s non-technical skills. In a next step, to improve student’s handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum.

Background:Drug use beyond the licence (off-label use, off-label drug use) is a common practice in palliative care and respective recommendations can often be identified in the literature. It is both risky and offers opportunities at the same time and, therefore, requires special attention in clinical practice.Aim:To determine the prevalence of off-label drug use in palliative care and to identify, evaluate and critically appraise studies describing the clinical practice, healthcare professionals’ awareness, knowledge and attitudes towards off-label-use and management strategies.Design:Systematic literature review following the guidance of the Centre for Reviews and Dissemination.Data sources:Medline, Embase, Web of Science and Current Contents Connect were searched in July 2018 as well as hand searches. The reference lists of pertinent studies were screened for further relevant publications, and citation tracking was performed.Results:Eight studies met the inclusion criteria. Due to the variety in study designs and settings, no meta-analysis or meaningful statistical analysis was possible and a narrative synthesis of the data was performed. Frequency of off-label drug use ranged from 14.5% to 35%. Up to 97% of palliative care units did not have any policy or guidance on handling off-label drug use. About 20% of prescribers never obtain consent in the context of off-label use.Conclusion:Off-label use is common in palliative care with up to one-third of prescriptions affected. Challenges are often related to obtaining informed consent. Little is known about the decision-making process. More information and guidance for the prescribers are needed to enable safe handling of drugs outside their licence in palliative care.

Purpose This paper aims to explore the influence of collective orientation (CO) on coordination and team performance for interdependently working teams while controlling for person-related and team variables. Design/methodology/approach A total of 58 two-person-teams participated in a simulation-based firefighting task. The laboratory study took 2 h for each team. The effects of CO in tasks of increasing complexity were investigated under the consideration of control variables, and the relations between CO, coordination and team performance were assessed using a multivariate latent growth curve modeling approach and by estimating indirect effects in simple mediation models. Findings Team members high on CO performed significantly better than low-scoring members. The effect of CO on team performance was independent from an increasing task complexity, whereas the effect of CO on coordination was not. The effect of CO on team performance was mediated by coordination within the team, and the positive relation between CO and performance persists when including group efficacy into the model. Research limitations/implications As CO is a modifiable person-related variable and important for effective team processes, additional research on factors influencing this attitude during work is assumed to be valuable. Practical implications CO is especially important for highly interdependently working teams in high-risk-organizations such as the fire service or nuclear power plants, where errors lead to severe consequences for human beings or the environment. Originality/value No other studies showed the importance of CO for coordination and team performance while considering teamwork-relevant variables and the interdependence of work.