Simulation-Based Team Leadership Training Improves Team Leadership During Actual Trauma Resuscitations: A Randomized Controlled Trial

Abstract

Objectives: Trauma resuscitations are complex critical care events that present patient safety-related risk. Simulation-based leadership training is thought to improve trauma care; however, there is no robust evidence supporting the impact of leadership training on clinical performance. The objective of this study was to assess the clinical impact of simulation-based leadership training on team leadership and patient care during actual trauma resuscitations. Design: Randomized controlled trial. Setting: Harborview Medical Center (level 1 trauma center). Subjects: Seventy-nine second- and third-year residents were randomized and 360 resuscitations were analyzed. Interventions: Subjects were randomized to a 4-hour simulation-based leadership training (intervention) or standard orientation (control) condition. Measurements and Main Results: Participant-led actual trauma resuscitations were video recorded and coded for leadership behaviors and patient care. We used random coefficient modeling to account for the nesting effect of multiple observations within residents and to test for post-training group differences in leadership behaviors while controlling for pre-training behaviors, Injury Severity Score, postgraduate training year, and days since training occurred. Sixty participants completed the study. There was a significant difference in post-training leadership behaviors between the intervention and control conditions (b1 = 4.06, t (55) = 6.11, p < 0.001; intervention M = 11.29, se = 0.66, 95% CI, 9.99–12.59 vs control M = 7.23, se = 0.46, 95% CI, 6.33–8.13, d = 0.92). Although patient care was similar between conditions (b = 2.00, t (55) = 0.99, p = 0.325; predicted means intervention M = 62.38, se = 2.01, 95% CI, 58.43–66.33 vs control M = 60.38, se = 1.37, 95% CI, 57.69–63.07, d = 0.15), a test of the mediation effect between training and patient care suggests leadership behaviors mediate an effect of training on patient care with a significant indirect effect (b = 3.44, 95% CI, 1.43–5.80). Across all trauma resuscitations leadership was significantly related to patient care (b1 = 0.61, se = 0.15, t (273) = 3.64, p < 0.001). Conclusions: Leadership training resulted in the transfer of complex skills to the clinical environment and may have an indirect effect on patient care through better team leadership.

Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams

“…One study was reported in two papers [49,50]. Fernandez et al (2020) [54] reported on the development of the intervention used in their study (Rosenman et al, 2019). All the manuscripts were published in English.…”

“…The retained studies were published between 2009 and 2020 (see Table 1). Studies were conducted in Australia [39], Belgium [55], France [56], Germany [40,57], New Zealand [41], United States [42][43][44][45][46][47][48][49][50][51][52]54], Singapore [58], and Taiwan [53]. Key study characteristics are presented in Table 1 and outlined below.…”

“…Studies were conducted in acute care in-patient settings including the operating room/postanesthesia care unit [40-42, 44, 51], emergency department [52,54], intensive care unit transport team [53], medical/surgical units [39,58], labour and delivery [48], and crisis/cardiac arrest [43,45,49,50,[55][56][57] The overall quantity of the nontechnical skills were different between the groups (p = 0.02).…”

“…Three studies [41,44,45] included a prepost design and only reported the total number of participants in the study. Researchers reported on studies with physicians only [40,41,52], medical residents/students/interns only [39,42,49,50,54,56], nursing and medical students [43], nurses only [44,48], nursing students only [55], and a mix of care providers [45,47,51,53,57,58]. Only one study reported on a mix of care providers and patients [46].…”

“…Gender of providers was reported in 13 studies [40, 42-45, 47, 48, 52, 54-58] with more women in eight studies [42,44,45,47,48,55,57,58], more men in two study [52,54], and approximately equal representation of men and women in three studies [40,43,56]. Gender of patients reported as approximately half for women [46] in one study and mostly men in one study [54]. Gender was not reported for providers in 6 studies [39,41,46,[49][50][51]53].…”