Qualitative Study of Emergency Medicine Residents' Perspectives of Trauma Leadership Development.

Background: Trauma team leadership is a core skill for the practice of emergency medicine (EM). In this study our goal was to explore EM residents' perception of their trauma leadership skill development through formal and informal processes and to understand factors that may impact the development and implementation of trauma leadership skills. Methods: Using qualitative semi-structured interviews, we explored the leadership experiences of 10 EM residents ranging from second to fourth postgraduate year. Interviews were conducted between July 26-October 31, 2019 and were audio-recorded, transcribed, and de-identified. We analyzed data using qualitative content analysis. Results: Residents discussed three main themes: 1) sources of leadership development; 2) challenges with simultaneously assuming a dual leader-learner role; and 3) contextual factors that impact their ability to assume the leadership role, including the professional hierarchy in the clinical environment, limitations in the physical environment, and gender bias. Conclusion: This study describes the complex factors and experiences that contribute to the development and implementation of trauma team leadership skills in EM residents. This includes three primary sources of leadership development, the dual role of leader and learner, and various contextual factors. Research is needed to understand how these factors and experiences can be leveraged or mitigated to improve resident leadership training outcomes.

Developing adaptive performance: A conceptual model to guide simulation-based training design.

Objectives: Effective emergency department care requires individuals and teams to adapt to changes in patient condition, team factors, environmental issues, and system-level challenges. Adaptability is often listed as an important skill for emergency medicine physicians; however, conceptual models describing the processes involved in adaptive performance have not been translated for health care settings. Similarly, educators have not described training design strategies that support the development of adaptive performance. Methods: We examined the team science and health care literatures for key concepts in adaptive performance, health care team performance, and diagnostic decision-making. Using expert consensus, we integrated these concepts to develop the team adaptive performance model and to identify training design approaches that support the development of adaptability. Results: We identify nine training principles supported by the team adaptive performance model and the adaptive learning system. Each training principle is accompanied by recommendations and mechanisms for implementation in emergency medicine simulation-based education. Conclusion: Training experiences can be designed to target processes that support adaptive performance.

Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.

OBJECTIVE: Team leadership facilitates teamwork and is important to patient care. It is unknown whether physician gender-based differences in team leadership exist. The objective of this study was to assess and compare team leadership and patient care in trauma resuscitations led by male and female physicians. METHODS: We performed a secondary analysis of data from a larger randomized controlled trial using video recordings of emergency department trauma resuscitations at a Level 1 trauma center from April 2016 to December 2017. Subjects included emergency medicine and surgery residents functioning as trauma team leaders. Eligible resuscitations included adult patients meeting institutional trauma activation criteria. Two video-recorded observations for each participant were coded for team leadership quality and patient care by 2 sets of raters. Raters were balanced with regard to gender and were blinded to study hypotheses. We used Bayesian regression to determine whether our data supported gender-based advantages in team leadership. RESULTS: A total of 60 participants and 120 video recorded observations were included. The modal relationship between gender and team leadership (ß = 0.94, 95% highest density interval [HDI], -.68 to 2.52) and gender and patient care (ß = 2.42, 95% HDI, -2.03 to 6.78) revealed a weak positive effect for female leaders on both outcomes. Gender-based advantages to team leadership and clinical care were not conclusively supported or refuted, with the exception of rejecting a strong male advantage to team leadership. CONCLUSIONS: We prospectively measured team leadership and clinical care during patient care. Our findings do not support differences in trauma resuscitation team leadership or clinical care based on the gender of the team leader.

A general response process theory for situational judgment tests.

Situational judgment tests (SJTs) have emerged as a staple of assessment methodologies for organizational practitioners and researchers. Despite their prevalence, many questions regarding how to interpret respondent choices or how variations in item construction and instruction influence the nature of observed responses remain. Existing conceptual and empirical efforts to explore these questions have largely been rooted in reflexive psychometric measurement models that describe participant responses as indicative of (usually multiple) latent constructs. However, some have suggested that a key to better understanding SJT responses lies in unpacking the judgment and decision-making processes employed by respondents and the psychological and contextual factors that shape how those processes play out. To this end, the present article advances an integrative and generalizable process-oriented theory of SJT responding. The framework, labeled situated reasoning and judgment (SiRJ), proposes that respondents engage in a series of conditional reasoning, similarity, and preference accumulation judgments when deciding how to evaluate and respond to an SJT item. To evaluate the theory's plausibility and utility, the SiRJ framework is translated into a formal computational model and results from a simulation study are analyzed using neural network and Bayesian survival analytic techniques that demonstrate its capability to replicate existing and new empirical effects, suggest insights into SJT interpretation and development, and stimulate new directions for future research. An interactive web application that allows users to explore the computational model developed for SiRJ (https://grandjam.shinyapps.io/sirj) as well as all reported data and the full model/simulation code (https://osf.io/uwdfm/) are also provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Development and Empirical Testing of a Novel Team Leadership Assessment Measure: A Pilot Study Using Simulated and Live Patient Encounters.

BACKGROUND: Team leadership is critical to health care resuscitation team performance. There has been increased focus on competency in team leadership behaviors; however, there is still variability in how team leadership is assessed within emergency medicine. The objective of this study was to develop and pilot a novel team leadership assessment measure for emergency medicine resuscitation teams. METHODS: Team leadership dimensions and associated behaviors were identified through a systematic literature review and expert consensus. Included behaviors were used to create behaviorally anchored rating scales, which were then revised based on subject matter expert ratings. Four raters from three different academic institutions observed 30 video-recorded resuscitations (20 simulated and 10 actual patient care resuscitations). Mean leadership scores were calculated. Intraclass coefficients (ICCs) were calculated for each item and for overall leadership scores. Leader scores for the simulation-based scenarios were compared to external variables including level of training, team process, clinical performance, and team situational awareness. The study was conducted from July 2017 through June 2018. RESULTS: Leadership scores ranged from 2.23 to 4.30 (mean [±SD] = 3.18 [±0.50]). The ICC for the overall score was 0.79 for all observations, 0.87 for simulation-based observations, and 0.24 for the patient care observations. Team leadership scores on simulation-based observations did not correlate with available external variables. CONCLUSIONS: We developed a novel team leadership assessment measure for emergency medicine resuscitation teams with supporting validity evidence, including content validity and response process. The measure demonstrated acceptable inter-rater reliability when applied to simulation-based medical resuscitations; however, this did not translate to trauma resuscitations in the actual patient care setting.

Making Research Evaluation More Transparent: Aligning Research Philosophy, Institutional Values, and Reporting.

There is a growing interest in changing the culture of psychology to improve the quality of our science. At the root of this interest is concern over the reproducibility of key findings. A variety of large-scale replication attempts have revealed that several previously published effects cannot be reproduced, whereas other analyses indicate that the published literature is rife with underpowered studies and publication bias. These revelations suggest that it is time to change how psychological science is carried out and increase the transparency of reporting. We argue that change will be slow until institutions adopt new procedures for evaluating scholarly activity. We consider three actions that individuals and departments can take to facilitate change throughout psychological science: the development of individualized research-philosophy statements, the creation of an annotated curriculum vitae to improve the transparency of scholarly reporting, and the use of a formal evaluative system that explicitly captures behaviors that support reproducibility. Our recommendations build on proposals for open science by enabling researchers to have a voice in articulating (and contextualizing) how they would like their work to be evaluated and by providing a mechanism for more detailed and transparent reporting of scholarly activities.

From Outcome to Process Focus: Fostering a More Robust Psychological Science Through Registered Reports and Results-Blind Reviewing.

A variety of alternative mechanisms, strategies, and "ways of doing" have been proposed for improving the rigor and robustness of published research in the psychological sciences in recent years. In this article, we describe two existing but underused publication models-registered reporting (RR) and results-blind reviewing (RBR)-that we believe would contribute in important ways to improving both the conduct and evaluation of psychological research. We first outline the procedures and distinguishing features of both publication pathways and note their value for promoting positive changes to current scientific practices. We posit that a significant value of RR and RBR is their potential to promote a greater focus on the research process (i.e., how and why research is conducted) relative to research outcomes (i.e., what was observed or concluded from research). We conclude by discussing what we perceive to be five common beliefs about RR and RBR practices and attempt to provide a balanced perspective of the realities likely to be experienced with these systems.

Changing Systems Through Effective Teams: A Role for Simulation.

Teams are the building blocks of the healthcare system, with growing evidence linking the quality of healthcare to team effectiveness, and team effectiveness to team training. Simulation has been identified as an effective modality for team training and assessment. Despite this, there are gaps in methodology, measurement, and implementation that prevent maximizing the impact of simulation modalities on team performance. As part of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes," we explored the impact of simulation on various aspects of team effectiveness. The consensus process included an extensive literature review, group discussions, and the conference "workshop" involving emergency medicine physicians, medical educators, and team science experts. The objectives of this work were to: 1) explore the antecedents and processes that support team effectiveness, 2) summarize the current role of simulation in developing and understanding team effectiveness, and 3) identify research targets to further improve team-based training and assessment, with the ultimate goal of improving healthcare systems.

A Simulation-based Approach to Measuring Team Situational Awareness in Emergency Medicine: A Multicenter, Observational Study.

OBJECTIVES: Team situational awareness (TSA) is critical for effective teamwork and supports dynamic decision making in unpredictable, time-pressured situations. Simulation provides a platform for developing and assessing TSA, but these efforts are limited by suboptimal measurement approaches. The objective of this study was to develop and evaluate a novel approach to TSA measurement in interprofessional emergency medicine (EM) teams. METHODS: We performed a multicenter, prospective, simulation-based observational study to evaluate an approach to TSA measurement. Interprofessional emergency medical teams, consisting of EM resident physicians, nurses, and medical students, were recruited from the University of Washington (Seattle, WA) and Wayne State University (Detroit, MI). Each team completed a simulated emergency resuscitation scenario. Immediately following the simulation, team members completed a TSA measure, a team perception of shared understanding measure, and a team leader effectiveness measure. Subject matter expert reviews and pilot testing of the TSA measure provided evidence of content and response process validity. Simulations were recorded and independently coded for team performance using a previously validated measure. The relationships between the TSA measure and other variables (team clinical performance, team perception of shared understanding, team leader effectiveness, and team experience) were explored. The TSA agreement metric was indexed by averaging the pairwise agreement for each dyad on a team and then averaging across dyads to yield agreement at the team level. For the team perception of shared understanding and team leadership effectiveness measures, individual team member scores were aggregated within a team to create a single team score. We computed descriptive statistics for all outcomes. We calculated Pearson's product-moment correlations to determine bivariate correlations between outcome variables with two-tailed significance testing (p < 0.05). RESULTS: A total of 123 participants were recruited and formed three-person teams (n = 41 teams). All teams completed the assessment scenario and postsimulation measures. TSA agreement ranged from 0.19 to 0.9 and had a mean (±SD) of 0.61 (±0.17). TSA correlated with team clinical performance (p < 0.05) but did not correlate with team perception of shared understanding, team leader effectiveness, or team experience. CONCLUSIONS: Team situational awareness supports adaptive teams and is critical for high reliability organizations such as healthcare systems. Simulation can provide a platform for research aimed at understanding and measuring TSA. This study provides a feasible method for simulation-based assessment of TSA in interdisciplinary teams that addresses prior measure limitations and is appropriate for use in highly dynamic, uncertain situations commonly encountered in emergency department systems. Future research is needed to understand the development of and interactions between individual-, team-, and system (distributed)-level cognitive processes.

Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay.

BACKGROUND: A subset of high-risk procedures present significant safety threats due to their (1) infrequent occurrence, (2) execution under time constraints and (3) immediate necessity for patient survival. A Just-in-Time (JIT) intervention could provide real-time bedside guidance to improve high-risk procedural performance and address procedural deficits associated with skill decay. OBJECTIVE: To evaluate the impact of a novel JIT intervention on transvenous pacemaker (TVP) placement during a simulated patient event. METHODS: This was a prospective, randomised controlled study to determine the effect of a JIT intervention on performance of TVP placement. Subjects included board-certified emergency medicine physicians from two hospitals. The JIT intervention consisted of a portable, bedside computer-based procedural adjunct. The primary outcome was performance during a simulated patient encounter requiring TVP placement, as assessed by trained raters using a technical skills checklist. Secondary outcomes included global performance ratings, time to TVP placement, number of critical omissions and System Usability Scale scores (intervention only). RESULTS: Groups were similar at baseline across all outcomes. Compared with the control group, the intervention group demonstrated statistically significant improvement in the technical checklist score (11.45 vs 23.44, p<0.001, Cohen's d effect size 4.64), the global rating scale (2.27 vs 4.54, p<0.001, Cohen's d effect size 3.76), and a statistically significant reduction in critical omissions (2.23 vs 0.68, p<0.001, Cohen's d effect size -1.86). The difference in time to procedural completion was not statistically significant between conditions (11.15 min vs 12.80 min, p=0.12, Cohen's d effect size 0.65). System Usability Scale scores demonstrated excellent usability. CONCLUSION: A JIT intervention improved procedure perfromance, suggesting a role for JIT interventions in rarely performed procedures.

Developing Team Cognition: A Role for Simulation.

STATEMENT: Simulation has had a major impact in the advancement of healthcare team training and assessment. To date, most simulation-based training and assessments focus on the teamwork behaviors that impact team performance, often ignoring critical cognitive, motivational, and affective team processes. Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article, we synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition.

Using Simulation as an Investigational Methodology to Explore the Impact of Technology on Team Communication and Patient Management: A Pilot Evaluation of the Effect of an Automated Compression Device.

INTRODUCTION: This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management. METHODS: Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support-based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team. RESULTS: At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6-181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5-123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1-4.3 vs. 2.0; IQR, 1.4-2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3-222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1-397.2 seconds). CONCLUSIONS: Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.

Brain drain? An examination of stereotype threat effects during training on knowledge acquisition and organizational effectiveness.

Stereotype threat describes a situation in which individuals are faced with the risk of upholding a negative stereotype about their subgroup based on their actions. Empirical work in this area has primarily examined the impact of negative stereotypes on performance for threatened individuals. However, this body of research seldom acknowledges that performance is a function of learning-which may also be impaired by pervasive group stereotypes. This study presents evidence from a 3-day self-guided training program demonstrating that stereotype threat impairs acquisition of cognitive learning outcomes for females facing a negative group stereotype. Using hierarchical Bayesian modeling, results revealed that stereotyped females demonstrated poorer declarative knowledge acquisition, spent less time reflecting on learning activities, and developed less efficiently organized knowledge structures compared with females in a control condition. Findings from a Bayesian mediation model also suggested that despite stereotyped individuals "working harder" to perform well, their underachievement was largely attributable to failures in learning to "work smarter." Building upon these empirical results, a computational model and computer simulation is also presented to demonstrate the practical significance of stereotype-induced impairments to learning on the development of an organization's human capital resources and capabilities. The simulation results show that even the presence of small effects of stereotype threat during learning/training have the potential to exert a significant negative impact on an organization's performance potential. Implications for future research and practice examining stereotype threat during learning are discussed. (PsycINFO Database Record

The dynamics of team cognition: A process-oriented theory of knowledge emergence in teams.

Team cognition has been identified as a critical component of team performance and decision-making. However, theory and research in this domain continues to remain largely static; articulation and examination of the dynamic processes through which collectively held knowledge emerges from the individual- to the team-level is lacking. To address this gap, we advance and systematically evaluate a process-oriented theory of team knowledge emergence. First, we summarize the core concepts and dynamic mechanisms that underlie team knowledge-building and represent our theory of team knowledge emergence (Step 1). We then translate this narrative theory into a formal computational model that provides an explicit specification of how these core concepts and mechanisms interact to produce emergent team knowledge (Step 2). The computational model is next instantiated into an agent-based simulation to explore how the key generative process mechanisms described in our theory contribute to improved knowledge emergence in teams (Step 3). Results from the simulations demonstrate that agent teams generate collectively shared knowledge more effectively when members are capable of processing information more efficiently and when teams follow communication strategies that promote equal rates of information sharing across members. Lastly, we conduct an empirical experiment with real teams participating in a collective knowledge-building task to verify that promoting these processes in human teams also leads to improved team knowledge emergence (Step 4). Discussion focuses on implications of the theory for examining team cognition processes and dynamics as well as directions for future research. (PsycINFO Database Record

Leveraging Social Science-Healthcare Collaborations to Improve Teamwork and Patient Safety.

Effective teamwork is critical to the provision of safe, effective healthcare. High functioning teams adapt to rapidly changing patient and environmental factors, preventing diagnostic and treatment errors. While the emphasis on teamwork and patient safety is relatively new, significant team-related foundational and implementation research exists in disciplines outside of healthcare. Social scientists, including, organizational psychologists, have expertise in the study of teams, multi-team units, and organizations. This article highlights guiding team science principles from the organizational psychology literature that can be applied to the study of teams in healthcare. The authors' goal is to provide some common language and understanding around teams and teamwork. Additionally, they hope to impart an appreciation for the potential synergy present within clinician-social scientist collaborations.

Evaluation of a computer-based educational intervention to improve medical teamwork and performance during simulated patient resuscitations.

OBJECTIVES: To determine the impact of a low-resource-demand, easily disseminated computer-based teamwork process training intervention on teamwork behaviors and patient care performance in code teams. DESIGN: A randomized comparison trial of computer-based teamwork training versus placebo training was conducted from August 2010 through March 2011. SETTING: This study was conducted at the simulation suite within the Kado Family Clinical Skills Center, Wayne State University School of Medicine. PARTICIPANTS: Participants (n = 231) were fourth-year medical students and first-, second-, and third-year emergency medicine residents at Wayne State University. Each participant was assigned to a team of four to six members (nteams = 45). INTERVENTIONS: Teams were randomly assigned to receive either a 25-minute computer-based training module targeting appropriate resuscitation teamwork behaviors or a placebo training module. MEASUREMENTS: Teamwork behaviors and patient care behaviors were video recorded during high-fidelity simulated patient resuscitations and coded by trained raters blinded to condition assignment and study hypotheses. Teamwork behavior items (e.g., "chest radiograph findings communicated to team" and "team member assists with intubation preparation") were standardized before combining to create overall teamwork scores. Similarly, patient care items ("chest radiograph correctly interpreted"; "time to start of compressions") were standardized before combining to create overall patient care scores. Subject matter expert reviews and pilot testing of scenario content, teamwork items, and patient care items provided evidence of content validity. MAIN RESULTS: When controlling for team members' medically relevant experience, teams in the training condition demonstrated better teamwork (F [1, 42] = 4.81, p < 0.05; ηp = 10%) and patient care (F [1, 42] = 4.66, p < 0.05; ηp = 10%) than did teams in the placebo condition. CONCLUSIONS: Computer-based team training positively impacts teamwork and patient care during simulated patient resuscitations. This low-resource team training intervention may help to address the dissemination and sustainability issues associated with larger, more costly team training programs.

Going DEEP: guidelines for building simulation-based team assessments.

BACKGROUND: Whether for team training, research or evaluation, making effective use of simulation-based technologies requires robust, reliable and accurate assessment tools. Extant literature on simulation-based assessment practices has primarily focused on scenario and instructional design; however, relatively little direct guidance has been provided regarding the challenging decisions and fundamental principles related to assessment development and implementation. OBJECTIVE: The objective of this manuscript is to introduce a generalisable assessment framework supplemented by specific guidance on how to construct and ensure valid and reliable simulation-based team assessment tools. The recommendations reflect best practices in assessment and are designed to empower healthcare educators, professionals and researchers with the knowledge to design and employ valid and reliable simulation-based team assessments. OVERVIEW: Information and actionable recommendations associated with creating assessments of team processes (non-technical 'teamwork' activities) and performance (demonstration of technical proficiency) are presented which provide direct guidance on how to Distinguish the underlying competencies one aims to assess, Elaborate the measures used to capture team member behaviours during simulation activities, Establish the content validity of these measures and Proceduralise the measurement tools in a way that is systematically aligned with the goals of the simulation activity while maintaining methodological rigour (DEEP). SUMMARY: The DEEP framework targets fundamental principles and critical activities that are important for effective assessment, and should benefit healthcare educators, professionals and researchers seeking to design or enhance any simulation-based assessment effort.

A measure of and predictors for veterinarian trust developed with veterinary students in a simulated companion animal practice.

OBJECTIVE: To gain a better understanding of the role of interpersonal trust in veterinarian-client interactions during routine health-care visits, develop a measure of trust uniquely suited to the context of veterinary medicine, and interpret the actions, beliefs, and perceptions that capture client trust toward veterinarians. DESIGN: Correlational study. SAMPLE: 103 veterinary students and 19 standardized clients with pets from a college of veterinary medicine at a large public Midwestern university. PROCEDURES: measure of trust specific to veterinarian-client interactions was constructed on the basis of preexisting conceptualizations of the construct and administered to veterinary students and standardized clients following interactions in 2 medical scenarios in a high-fidelity simulated animal health clinic. Exploratory and confirmatory factor analytic techniques were used to validate the measure of trust, and hierarchic linear modeling was used to explore indicators of standardized client trust perceptions in one of the scenarios. RESULTS: Factor analysis revealed that the measure captured 2 perceptions indicative of trust in veterinary contexts: professionalism and technical candor. Students who had behaviors reflecting these factors as well as those who were perceived as more technically competent were seen as more trustworthy by standardized clients. CONCLUSIONS AND CLINICAL RELEVANCE: The development of trustworthy relationships between clients and veterinarians is important to the continued growth and success of the profession. By identifying characteristics of veterinarian trustworthiness and developing related measurement tools, proactive approaches to monitoring veterinarian-client relations can be implemented and incorporated into veterinary training and practice programs to identify areas for improvement.