Defining Team Performance for Simulation-based Training: Methodology, Metrics, and Opportunities for Emergency Medicine

REVIEW OF THE LITERATURE

Metrics Assessing Specialty-specific Team Work.Metrics Assessing Generic Team Work.LOSA, OTAS, ANTS,CATS (see p.1092 for details)

1) proposes a scientifically based methodology for SBT design and evaluation, 2) reviews existing team performance metrics in health care along with recommendations, and 3) focuses on leadership as a target for SBT because it has a high likelihood to improve many team processes and ultimately performance

GoalThis consensus paper: 1) proposes a scientifically based methodology for SBT design and evaluation, 2) reviews existing team performance metrics in health care along with recommendations, and 3) focuses on leadership as a target for SBT team training, because it has a high likelihood to improve many team processes and ultimately performance.

Teamwork is dynamic and complex, requiring an evaluation strategy that is dynamic as well.More research is needed to develop high-performing metrics.

They describe 4 principles for developing simulation based training.Principle 1: Establish the Team-based Competencies to be Assessed and Trained—The Learning Outcomes.Principle 2: Provide Opportunities for Guided Teamwork Practice—Carefully Craft ScenariosPrinciple 3: Measure Team Performance—Diagnose Teamwork Strengths and Weaknesses.Principle 4: Develop Robust Debriefing Protocols— Link Feedback to Learning Outcomes.Concerning team performance metrics:Generic teamwork skills:CATS- Communication and team skills – developed for healthcare professionalsSpecific: Description of a stepwise approach to develop specialty-specific team performance metrics (pg 1093, table 3).There is no one size fits all, criterion standard team performance metric in health care, but much research is being directed toward identifying those that are theoretically relevant and scientifically sound, capture competencies, focus on observable behaviors, and provide meaningful information that facilitates improved performance and outcomesHow well metrics currently in use assess team performancedepends on: 1) what is being measured and under what circumstances—during real clinical events or simulated scenarios; 2) instrument design and how well the tool captures the behavior in question; 3) the frequency of measurement; 4) the evaluator’s expertise in team performance and their understanding andfamiliarity with the instrument; and 5) the interpretation of the information gathered and the feedback providedto team members.SBT for leadershipHave clear teaching goals. Debriefing is importantCreating leadership scenario’s – SMARTER methodology provides a framework for scenario development.Include decisions in the scenarioTeamwork is dynamic and complex, requiring an evaluation strategy that is dynamic as well. While no criterion standard metric or measure exists, there is a solid methodology for developing tools designed to assessthe attributes sought.

The health care community is interested in improving teamwork. Yet, numerous well-intentioned programs may fail to achieve the desired outcomes in team performance. We address the need for teamwork-focused SBT in EM and detail a process for its development.