Developing Expert Medical Teams: Toward an Evidence‐based Approach

Abstract

Current health care literature cites communication breakdown and teamwork failures as primary threats to patient safety. The unique, dynamic environment of the emergency department (ED) and the complexity of patient care necessitate the development of strong interdisciplinary team skills among emergency personnel. As part of the 2008 Academic Emergency Medicine Consensus Conference on ''The Science of Simulation in Healthcare,'' our workshop group identified key theory and evidence-based recommendations for the design and implementation of team training programs. The authors then conducted an extensive review of the team training literature within the domains of organizational psychology, aviation, military, management, and health care. This review, in combination with the workshop session, formed the basis for recommendations and need for further research in six key areas: 1) developing and refining core competencies for emergency medicine (EM) teams; 2) leadership training for emergency physicians (EPs); 3) conducting comprehensive needs analyses at the organizational, personnel, and task levels; 4) development of training platforms to maximize knowledge transfer; 5) debriefing and provision of feedback; and 6) proper implementation of simulation technology. The authors believe that these six areas should form an EM team training research platform to advance the EM literature, while leveraging the unique team structures present in EM to expand team training theory and research. 1,2 EM teams combine members with specialized skill sets that require coordinated response to unexpected events. 3 In such types of teams, it is clear that success depends not only on individual performance, but also on the ability of the team to function in a coordinated, effective manner. 4 While the importance of developing team skills is recognized, there are currently no clear guidelines for designing and implementing team training programs.A significant component of military and aviationbased team training occurs in simulators. As a result, team training and simulation-based training (SBT) have become almost synonymous. 5 The health care literature reports several uses of simulation for team training. [6][7][8][9] In this article, we present several issues that are germane to the development and study of team training in EM. Our goal is to 1) present a focused review of the EM team training literature, as well as from the aviation and organizational psychology fields; 2) demonstrate how studies and theoretical models from other domains can advance EM-based team training; and 3) postulate how the unique teams that practice in emergency ª

Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82

“…Fernandez and colleagues summarize the key components that are necessary for an effective team training program in the context of simulation (Fernandez et al 2008):…”

Teamwork and Leadership in Cardiopulmonary Resuscitation

“…Further, it allows practice of situations that occur infrequently, but where rapid application of necessary skills and knowledge is crucial, such as in cardiac arrest. Video-assisted debriefing allows additional training benefit by providing immediate, objective postperformance review rather than relying on recollection of events (16).…”

Human factors in resuscitation: Lessons learned from simulator studies

“…Furthermore, video-assisted debriefing allows providers to review performance without time-pressure or relying on recollection of events, and thus seems to be very well suited for training purposes. [13] Besides training, simulators also offer good possibilities for research, because one can create identical study situations as well as experimentally controlled variations. Although most research done in simulators still concentrates on the evaluation of technical skills,[14] simulators are particularly well suited for research on human factors.…”