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Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support...
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Context 1
... structure of our integrated model is based on a theoretical reasoning. Adaptive application of the three coordination mechanisms affects team members' action regulation to obtain an ideal result [19]. According to the structure of the action process [29], our model exposes the requirement for CPR teams to first orientate themselves within the clinical situation (eg, by monitoring the patient), conceptualize a treatment procedure (eg, plan whether to attempt defibrillation depending on the assessment of the initial rhythm), orchestrate and execute the appropriate actions (eg, first defibrillation and then check breathing), and evaluate and modify strategy (eg, heart rate check) (Fig. 2, four elements of outer ...
Context 2
... in a dynamic organization and a linkage between the three main coordination mechanisms revealed in this review: planning, leadership, and communication. The inductive part of our reasoning process consisted in the definition of our three topic categories-planning, leadership, and communi- cation-based on the coordination mechanism(s) mainly focused by the authors of each study included in this review. The deductive part in the screening consisted of pertinent teamwork frameworks-eg, 'Big Five' of Teamwork [27], the Structure of Teamwork Behaviors [28], or the FEMP IPO model of group coordination [16]-in order to confirm our defined topic categories as coordination mechanisms affect- ing team performance. In fact, planning, leadership and communication are interrelated coordination mechanisms empirically confirmed as performance influencing mecha- nisms in all types of team tasks. As planning, leadership and communication are coordination mechanisms which cannot be completely regarded as disjunct, we postulated a partial interrelation between them. The interrelation is based to the facts that, effective communication is needed for transmitting plans, planning is defined as a function of leadership and in turn communication is needed to be an effective leader. In our model the interrelations of planning, leadership and commu- nication are represented by the overlapping of the inner circles ( Fig. 2, inner core). Excerpts from articles included in this review, which are highlighted in the next paragraphs, clarify these ...
Context 3
... sum, by inter-connecting the coordination mechanisms and each of the ART phases and explicitly stating that the four phases of the CPR action cycle are iterative, we underline that, depending on the subtask at hand, teams providing CPR repeatedly run through these action phases. In order to accomplish these phases, teams constantly have the aforementioned 3 interrelated coordination mechanisms at their disposal: planning, leadership and communication. These 3 coordination mechanisms are equally important to succeed in CPR, but according to the ART, each phase is characterized by particular coordination demands. Thus, our model depicts the interrelated coordination mechanisms (Fig. 2, inner core) and the iterative CPR coordination demands (Fig. 2, outer ring) to accomplish each ...
Context 4
... sum, by inter-connecting the coordination mechanisms and each of the ART phases and explicitly stating that the four phases of the CPR action cycle are iterative, we underline that, depending on the subtask at hand, teams providing CPR repeatedly run through these action phases. In order to accomplish these phases, teams constantly have the aforementioned 3 interrelated coordination mechanisms at their disposal: planning, leadership and communication. These 3 coordination mechanisms are equally important to succeed in CPR, but according to the ART, each phase is characterized by particular coordination demands. Thus, our model depicts the interrelated coordination mechanisms (Fig. 2, inner core) and the iterative CPR coordination demands (Fig. 2, outer ring) to accomplish each ...
Context 5
... integrative coordination mechanism model (Fig. 2) summarizes the literature findings. This model is a combination of a deductive and inductive reasoning process, Randomized controlled studies, meta-analyzes and systematic reviews of randomized controlled studies which are directly related to our research question: identifying and quantifying the link between team coordination and clinically relevant medical ...
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Introduction
Early defibrillation is an important factor of survival in cardiac arrest. However, novice resuscitators often struggle with cardiac arrest patients. We investigated factors leading to delayed defibrillation performed by final-year medical students within a simulated bystander cardiac arrest situation.
Methods
Final-year medical stude...
Citations
... Hence, many HEMS organizations and hospitals alike emphasize the importance of leadership skills during their recruitment process, and provide leadership training, which may include formal licenced courses or onbase scenario training using simple mannequins [2,4,[9][10][11][12]. However, it is unknown how development of these skills can best be facilitated in order to improve proficiency. ...
... Both processes may have a direct impact on leadership skills by reinforcing a shared mental model that emphasizes the importance of leadership as a component of effective teamwork. These results highlight the significance of training as a crucial factor for predicting and improving leadership skills and are in line with previous literature [4,8,12,22,25]. Of note, the observed positive effect of leadership skills training was independent of team composition, team size, base specialty, patient exposure or years of experience, as none of these factors were related to any of the 12 leadership subdomain scores. Thus, ongoing training in leadership skills may be beneficial, irrespective of level of experience. ...
Backgrounds
Team leadership skills of physicians working in high-performing medical teams are directly related to outcome. It is currently unclear how these skills can best be developed. Therefore, in this multi-national cross-sectional prospective study, we explored the development of these skills in relation to physician-, organization- and training characteristics of Helicopter Emergency Medicine Service (HEMS) physicians from services in Europe, the United States of America and Australia.
Methods
Physicians were asked to complete a survey regarding their HEMS service, training, and background as well as a full Leader Behavior Description Questionnaire (LBDQ). Primary outcomes were the 12 leadership subdomain scores as described in the LBDQ. Secondary outcome measures were the association of LBDQ subdomain scores with specific physician-, organization- or training characteristics and self-reported ways to improve leadership skills in HEMS physicians.
Results
In total, 120 HEMS physicians completed the questionnaire. Overall, leadership LBDQ subdomain scores were high (10 out of 12 subdomains exceeded 70% of the maximum score). Whereas physician characteristics such as experience or base-specialty were unrelated to leadership qualities, both organization- and training characteristics were important determinants of leadership skill development. Attention to leadership skills during service induction, ongoing leadership training, having standards in place to ensure (regular) scenario training and holding structured mission debriefs each correlated with multiple LBDQ subdomain scores.
Conclusions
Ongoing training of leadership skills should be stimulated and facilitated by organizations as it contributes to higher levels of proficiency, which may translate into a positive effect on patient outcomes.
Trial registration
Not applicable.
... 4,6 There is emerging evidence that on-scene leadership has a positive impact on the quality of CPR delivered. [13][14][15] Team leaders are responsible for leading the overall resuscitation effort during cardiac arrest by making high-level decisions, such as determining the cause of cardiac arrest and deciding on the clinical treatment plan. 16 However, ALS scenarios expose on-scene leaders with levels of cognitive burden exceeding their ability to achieve the highest possible performance. ...
Background
An out-of-hospital cardiac arrest requires early recognition, prompt and quality clinical interventions, and coordination between different clinicians to improve outcomes. Clinical team leaders and clinical teams have high levels of cognitive burden. We aimed to investigate the effect of a dedicated Cardio-Pulmonary Resuscitation (CPR) Quality Officer role on team performance.
Methods
This multi-centre randomised control trial used simulation in universities from the UK, Poland, and Norway. Student Paramedics participated in out-of-hospital cardiac arrest scenarios before randomisation to either traditional roles or assigning one member as the CPR Quality Officer. The quality of CPR was measured using QCPR® and Advanced Life Support (ALS) elements were evaluated.
Results
In total, 36 teams (108 individuals) participated. CPR quality from the first attempt (72.45%, 95% confidence interval [CI] 64.94 to 79.97) significantly increased after addition of the CPR Quality role (81.14%, 95% CI 74.20 to 88.07, p = 0.045). Improvement was not seen in the control group. The time to first defibrillation had no significant difference in the intervention group between the first attempt (53.77, 95% CI 36.57–70.98) and the second attempt (48.68, 95% CI 31.31–66.05, p = 0.84). The time to manage an obstructive airway in the intervention group showed significant difference (p = 0.006) in the first attempt (168.95, 95% CI 110.54–227.37) compared with the second attempt (136.95, 95% CI 87.03–186.88, p = 0.1).
Conclusion
A dedicated CPR Quality Officer in simulated scenarios improved the quality of CPR compressions without a negative impact on time to first defibrillation, managing the airway, or adherence to local ALS protocols.
... The studies were initially carried out in anesthesiology [4] and are being expanded to many other areas, such as obstetrics [5], pediatrics [6] and emergency medicine [7,8]. There are very few specific references to simulation-based training in the area of primary care [9][10][11][12], and those in which CRM training is implemented are out-of-hospital care for individuals with cardiac arrest [13] and trauma [14]. ...
This was a prospective observational study based on clinical simulation courses taught in 2017 at the IDEhA Simulation Center of Alcorcón Foundation University Hospital. Two courses in metabolic emergencies (MEs) and respiratory emergencies (REs) were offered to primary care physicians all over Spain. The main objective was to teach nontechnical skills (crisis resource management). Using a modified five-level Kirkpatrick–Phillips education evaluation model, level I (reaction, K1), level II (learning, K2) and level III (behavioral change, K3) changes were evaluated through surveys at the end of the courses and one year later. Thirty courses were held (15 ME courses and 15 RE courses) with 283 primary care physicians. The overall satisfaction (K1) was high: ME courses, 9.5/10; RE courses, 9.6/10. More than 80% of the participants rated the organization, resources, content, debriefing and scenarios as excellent, with no significant differences between the two courses. After one year (156 responses), the respondents for both courses reported that they would repeat the training annually (K2), encourage debriefing with colleagues (K3) and have modified some aspects of their workplace (K3), citing improvements in procedures and in the organization of the health team as the most important. After the ME course, few participants, i.e., 5 (6%), reported providing improved care to patients; after the RE course, 15 (19%) participants reported providing improved care; the difference between groups was significant (p < 0.05). Compared with the ME course, the RE course imparted greater knowledge about patient safety (K2) (38 (49%) vs. 24 (31%) (p < 0.05)) and more useful tools for daily clinical practice (K3) (67% vs. 56.4%) and resulted in participants paying more attention to personal performance and to colleagues when working as a team (K2) (64% vs. 50%). Clinical simulation courses are highly valued and potentially effective for training primary care physicians in patient safety and CRM tools. Future studies with objective measures of long-term impact, behavior in the workplace (K3) and benefits to patients (K4) are needed. Based on the results of our study, the areas that are important are those aimed at improving procedures and the organization of health teams.
... By guiding the ATLS, ALS, or EPLS algorithms' execution, participants honed their decision-making capabilities, specifically in cardiac arrest scenarios where efficient leadership can be the difference between life and death. The COVID-19 pandemic underscored the undeniable value of adept leadership during medical emergencies, [17][18][19] reinforcing the urgency to sharpen these competencies. 20 Ensuring the authenticity and interactivity of these telesimulation sessions was paramount. ...
Objective
The coronavirus disease (COVID-19) pandemic necessitated alternative methods to ensure the continuity of medical education. Our study explores the efficacy and acceptability of a digital continuous medical education initiative for medical residents during this challenging period.
Methods
From September to December 2020, 47 out of 60 enrolled trainee doctors participated in this innovative digital Continuous Medical Education (CME) approach. We utilized the Script Concordance Test to bolster clinical reasoning skills. Three simulation scenarios, namely Advanced Trauma Life Support (ATLS), Advanced Life Support (ALS), and European Paediatric Life Support (EPLS), were transformed into interactive online sessions via Zoom™. Participant feedback was also collected through a survey.
Results
Consistent Script Concordance Testing (SCT) scores among participants indicated the effectiveness of the online training module. Feedback suggested a broad acceptance of this novel training approach. However, discrepancies observed between formative SCT scores, and summative Multiple-Choice Questions (MCQ) assessments highlighted areas for potential refinement.
Conclusions
Our findings showcase the resilience and adaptability of medical education amidst challenges like the global pandemic. The success of methodologies such as SCT, endorsed by prestigious bodies like the European Resuscitation Council and the American Heart Association, suggests their potential in preparing health care professionals for emergent situations. This research offers valuable insights for shaping future online CME strategies.
... On the micro level, the patterning of interaction in groups comes into focus and how these dynamics relate to relevant other factors like group performance, team member satisfaction etc. Healthcare teams exhibit dynamics on both levels, the meso level of the dynamics of the team as a whole as well as the micro level of interaction patterns. For example, guideline-oriented teamwork as it is prevalent in resuscitation teams entrains the dynamics of the group as a whole, measurable by the degree of guideline adherence (Fernandez Castelao et al., 2015). Another example is an interaction pattern on the micro level who assumed that groups shift from behaviors focused primarily on the task to behaviors relating to the socio-emotional requirements of the group (Bales, 1950). ...
... Further combinations of theoretical perspectives are conceivable: combining the functional with the conflict-power-status perspective may enrich our understanding of crucial relational aspects improving or undermining team effectiveness (Janss et al., 2012;. Combining the functional with the temporal perspective (Fernandez Castelao et al., 2015) to find out how effective and less effective behavioral patterns emerge and can be supported or avoided may be fruitful, e.g., by training or intervention. Similarly, the social identity perspective may fit well to the conflict-power-status and functional perspectives for exploring the effects of stereotyping on team and leadership effectiveness as well as on patient safety (Weller et al., 2014;Pattni et al., 2017;Minehart et al., 2020). ...
The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.
... Some of these conditions complicate Cardiac Arrest which has an unknown outcome. In this regard, Castelao, Boos, Ringer et al. [4] noted that a well-coordinated and executed Cardiopulmonary Resuscitation (CPR) contributes to a better Cardiac Arrest outcome. Thus, effective CPR requires a psychologically healthy, skilled, and composed resuscitation team. ...
Aim:
To describe the challenges for optimum resuscitation processes in Emergency Departments in Limpopo Province, South Africa.
Design:
A qualitative explorative research approach was adopted to explore the resuscitation team's experiences in Emergency Departments.
Method:
Five medical doctors and twelve professional nurses were purposively sampled to participate in the study. The depth of the information obtained from the participants determined the sample size. Data collected from semi-structured individual interviews were analyzed using thematic analysis. Data quality was ensured by applying four elements: credibility, transferability, dependability, and confirmability.
Results:
The study findings indicated diverse challenges for optimum resuscitation processes that include: A general shortage of emergency personnel, the lack of material resources and the unavailability of funds for payment of national and international trauma symposiums, the poor maintenance of emergency equipment, the lack of a continuous training program and the resuscitation team receiving different instructions from various team leaders about the standardized procedures and policies of the resuscitation process. The team leaders and managers often blamed, depreciated and disregarded the resuscitation team for failed resuscitation efforts. Public contribution: The study findings are a point of reference for the emergency resuscitation team and the department of health policymakers. Trained and well-equipped emergency resuscitation teams can improve the quality of life for patients with cardiac arrest.
... This may result from the fact that the leader of a three-person MRT must be engaged in manual intervention. Fernandez Castelao et al. [11] state that only by delegating tasks to individual team members can the leader maintain better CPR coordination. Our research showed a significant relation between conducting CPR in correct cycles and no delivering defibrillation in the case of PEA/asystole and earlier preparation of adrenaline. ...
... Studies have described cases of patients or medical personnel suffering serious injuries during defibrillation [20][21][22]. Perkins et al. [11] describe how during defibrillation, care must be taken that no-one is touching the person undergoing defibrillation, and that oxygen equipment be moved to a safe distance. Our research has shown that in individual years, defibrillation was conducted in dangerous conditions in between 8.17% and 15.56% of cases. ...
Background and Objectives: Conducting advanced life support (ALS) according to the guidelines of the European Resuscitation Council (ERC) requires medical personnel to implement the appropriate emergency actions. In particular, these actions include chest compressions, airway management, artificial ventilation, defibrillation and the administering of medicines. An appropriate training system enables members of medical response teams (MRT) to acquire the essential knowledge and skills necessary to correctly conduct cardiopulmonary resuscitation (CPR). One way to improve the quality of interventions by MRT personnel is participation in emergency medicine championships. Materials and Methods: The research analysed assessment cards for tasks carried out during the International Winter Championships in Emergency Medicine in the years 2013–2020. The assessed tasks were prepared and led by European Resuscitation Council instructors of advanced life support. During ten-minute scenarios of simulated sudden cardiac arrest (SCA) in adults, the judges assessed the compliance of procedures with current ERC guidelines. This research analysed the performance of 309 teams from Poland made up of paramedics from medical response units from all over the country. Results: In most cases, the study showed significant differences in the percentage of correctly performed procedures between years. Most often, the highest percentage of correctly performed procedures was recorded in 2019 and 2020. The lowest percentage of correctly performed procedures was most often recorded in 2013. In subsequent years, the percentage of use of tracheal intubation decreased (from 54.76% to 31.25%) in favour of an increase in the use of supraglottic airway device SAD (from 35.71% to 59.38%). Conclusions: The research has shown that in subsequent years of the Championships, the quality of the majority of assessed procedures carried out by members of MRT gradually improved. The research authors also observed that in subsequent years, the percentage of intubations decreased in favour of SAD.
... 7,8 The Ottawa GRS rates learners on a 7-point scale in the categories of overall performance, leadership skills, problemsolving skills, situational awareness skills, resource utilization skills, and communication skills and has been used to reliably evaluate CRM performance in simulations. 9,10 Prior research has shown that leadership training using these frameworks can improve a team's care of critical patients, 11 is valued by learners, 4 is beneficial to providers of all skill levels, 12 and leads to improved communication. 13 Other groups have specifically combined CRM-based didactics with simulation to improve leadership skills, which can be measured using CRM-based milestones and the Ottawa GRS. 3,4,6,7,14,15 The simulated setting offers a practical and realistic way for junior residents in particular to practice and improve their skills before becoming senior residents leading real-life resuscitation teams. ...
Introduction:
Throughout training, emergency medicine (EM) residents must learn to work within, and eventually lead, multidisciplinary teams in high-acuity dynamic situations. Most residents do not undergo formal resuscitation team leadership training but learn these skills through mentorship by and observation of senior physicians. We designed and implemented a formal simulation-based leadership training program for EM residents.
Methods:
We developed a resuscitation team leadership curriculum in which 24 junior EM residents participated in an initial simulation of a critically ill patient before undergoing a didactic presentation regarding crisis resource management (CRM) principles. Residents applied those principles in three subsequent simulations. Faculty observers evaluated each case using EM Milestones, the Ottawa Global Rating Scale (GRS), and critical actions checklists. Residents then completed surveys evaluating their own leadership and communication skills before and after the course.
Results:
Scores from the Ottawa GRS, critical actions checklists, and several of the EM Milestones were significantly better in the latter three cases (after completing the CRM didactics) than in the first case. After completing this curriculum, residents felt that their ability to both lead resuscitations and communicate effectively with their team improved.
Discussion:
Implementation of the resuscitation team leadership curriculum improved EM residents' leadership performance in critically ill patient scenarios. The curriculum also improved residents' comfort in leading and communicating with a team. Similar formal leadership development curricula, especially when combined with simulation, may enhance EM physician training. Future studies will include other multidisciplinary team members to create a more realistic and inclusive learning environment.
... The importance of training human factors in cardiopulmonary resuscitation courses is well established (23)(24)(25). Resuscitation teams who applied human factors efficiently also performed better in technical resuscitation skills (26). If a team leader performs hands-on procedures, the whole team is less effective (27). ...
Aim
Human factors are essential for high-quality resuscitation team collaboration and are, therefore, taught in international advanced life support courses, but their assessment differs widely. In Europe, the summative life support course assessment tests mainly adhere to guidelines but few human factors. This randomized controlled simulation trial investigated instructors’ and course participants’ perceptions of human factors assessment after two different summative assessments.
Methods
All 5th/6th-year medical students who attended 19 advanced life support courses according to the 2015 European Resuscitation Council guidelines during one study year were invited to participate. Each course was randomized to either: (1) Simulated team assessment (one instructor simulates a team, and the assessed person leads this “team” through a cardiac-arrest scenario test); (2) Real team assessment (4 students form a team, one of them is assessed as the team leader; team members are not assessed and act only on team leader’s commands). After the summative assessments, instructors, and students rated the tests’ ability to assess human factors using a visual analog scale (VAS, 0 = no agreement, 10 = total agreement).
Results
A total of 227 students participated in the 1-day Immediate Life Support courses, 196 students in the 2-day Advanced Life Support courses, additionally 54 instructors were included. Instructors judged all human factors significantly better in real team assessments; students rated leadership and situational awareness comparable between both assessments. Assessment pass rates were comparable between groups.
Conclusion
Summative assessment in real teams was perceived significantly better to assess human factors. These results might influence current summative assessment practices in advanced life support courses.
... The importance of such leadership skills in the healthcare sector is evident Sabqat et al. BMC Medical Education (2022) 22:505 from several recent studies [3,4]. Thus, many leadership development programs for young clinicians exist in healthcare education. ...
Background
Experiential leadership development is well documented in the corporate sector, but those models cannot be applied as is, in the healthcare domain. The current study proposes a framework for the healthcare sector to enable experiential leadership development for young clinicians. The authors identify developmental assignments (DAs) and explore those characteristics [developmental assignment characteristics; DACs] therein that help develop leadership competencies in young clinicians.
Methods
As part of a qualitative exploratory study in Pakistan, the authors conducted 16 semi-structured interviews with senior clinicians in leadership positions with post-graduate residents under their supervision from different medical specialties. The participants were selected through purposive sampling, ensuring a maximum variation sample. Focusing on participants’ experiences and perspectives related to experience-driven leadership development, the authors used a multi-level theoretical framework for analysis.
Results
The thematic analysis resulted in 19 subthemes with four overarching themes for both objectives. The authors categorized the developmental assignments (DAs) into clinical, academic, and administrative assignments. These assignments can be utilized for leadership development by ensuring that they have the requisite characteristics built into their context and structure. These developmental assignment characteristics (DACs) can range from learner-driven to supervisor-driven. The learner-driven characteristics include autonomy, high levels of responsibilities, unfamiliar assignments, working across boundaries, managing diversity, making a commitment, and creating change. The supervisor-driven characteristics include briefing, debriefing, accountability, and learner-assignment matching. The authors also developed a learner-assignment matching (LAM) framework to guide supervisors in customizing and adjusting the level of each DAC in a DA.
Conclusion
A modern healthcare educational system can utilize studies like this to enable supervisors to develop required leadership skills in young clinicians along with clinical skills.
