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Jurd C, Barr J. Leadership factors for cardiopulmonary resuscitation for clinicians in-hospital; behaviours, skills and strategies: A systematic review and synthesis without meta-analysis. J Clin Nurs 2024. [PMID: 38757400 DOI: 10.1111/jocn.17215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
AIM To identify leadership factors for clinicians during in-hospital cardiopulmonary resuscitation. DESIGN Systematic review with synthesis without meta-analysis. METHODS The review was guided by SWiM, assessed for quality using CASP and reported with PRISMA. DATA SOURCES Cochrane, EMBASE, PubMed, Medline, Scopus and CINAHL (years of 2013-2023) and a manual reference list search of all included studies. RESULTS A total of 60 papers were identified with three major themes of useful resuscitation leadership; 'social skills', 'cognitive skills and behaviour' and 'leadership development skills' were identified. Main factors included delegating effectively, while being situationally aware of team members' ability and progress during resuscitation, and being empathetic and supportive, yet 'controlling the room' using a hands-off style. Shared decision-making to reduce cognitive load for one leader was shown to improve effective teamwork. Findings were limited by heterogeneity of studies and inconsistently applied tools to measure leadership. CONCLUSION Traditional authoritarian leadership styles are not wanted by team members with preference for shared leadership and collaboration. Balancing this with the need for team members to see leaders in 'control of the room' brings new challenges for leaders and trainers of resuscitation. IMPLICATIONS FOR NURSING PROFESSION All clinicians need effective leadership skills for cardiopulmonary resuscitation in-hospital. Nurses provide first response and ongoing leadership for cardiopulmonary resuscitation. Nurses typically display suitable skills that align with useful resuscitation leader factors. IMPACT What were the main findings? Collaboration rather than an authoritarian approach to leadership is preferred by team members. Nurses are suitable to 'control the room'. Restricting resuscitation team size will manage disruptive behaviour of team members. TRIAL REGISTRATION PROSPERO Registration: CRD42022385630. PATIENT OF PUBLIC CONTRIBUTION No patient of public contribution.
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Affiliation(s)
- Catherine Jurd
- Darling Downs Hospital and Health Service, Kingaroy Hospital, Kingaroy, Queensland, Australia
- Charles Darwin University, Casuarine, Brinkin, Northern Territory, Australia
| | - Jennieffer Barr
- Charles Darwin University, Casuarine, Brinkin, Northern Territory, Australia
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Erasmus L, Redfern A, Smit L. Competencies of junior medical doctors in managing seriously ill and injured children: time to rethink our current training approach? J Trop Pediatr 2023; 69:fmad025. [PMID: 37672804 DOI: 10.1093/tropej/fmad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND The correct treatment of very ill and injured children is critical, yet little is known about the competencies of South African (SA) junior doctors in managing these children. METHODS This survey documents SA junior doctors' reported resuscitation training opportunities, experience, skills and knowledge. RESULTS A total of 118 doctors (interns, medical officers and registrars) from paediatric departments affiliated with 7 medical schools, participated. Resuscitations were not rare events with 71% (84/118) reporting participation in >10 resuscitations during the preceding 2 years. Yet a third of doctors have not attended an accredited resuscitation training course within the last 2 years; 34% (12/35) medical officers and 29% (18/63) registrars, respectively, with 42% (49/118) of all participants never receiving any formal resuscitation training during employment. Feedback on performance is not standard practice with only 8% (10/118) reporting consistent debriefing after a resuscitation. Although 72% (85/118) reported their resuscitation knowledge as adequate, 56% (66/118) passed the knowledge test. CONCLUSION This study recognized missed learning opportunities in junior doctors' training, assessment, debriefing and knowledge which may adversely affect the quality of care in managing paediatric emergencies. This has implications for departmental and post-graduate training programmes.
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Affiliation(s)
- Louisa Erasmus
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Andrew Redfern
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Liezl Smit
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
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Saba PS, Canonico ME, Gambaro A, Gazale G, Piga S, Santomauro M, Roscio G. Systematic basic and advanced resuscitation training in medical students and fellows: a proposal from the Working Group on Cardiovascular Urgences and Emergencies of the Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2023; 24:e128-e133. [PMID: 37186563 DOI: 10.2459/jcm.0000000000001421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Sudden cardiac arrest is a leading cause of death in Europe. High-quality cardiopulmonary resuscitation (CPR) and guidelines compliance of rescuers have been associated with better outcomes after cardiac arrest. However, wide variability in attempting bystander CPR manoeuvres has been reported. Educational programmes for teaching CPR to medical students and fellows are highly advisable in this context. However, there is no homogeneity regarding the CPR education offered by academic institutions. We surveyed 208 Italian medical students and 162 fellows in cardiology regarding the educational offer and needs in CPR. Among the 11 medical schools surveyed, 8 (73%) offer basic (BLS) courses but only 3 (38%) with formal certification of 'BLS provider', while none offers advanced (ACLS/ALS) courses. Among the 30 specialization schools in cardiology surveyed, 10 (33%) offer a BLS course (6 with formal certification of 'BLS provider'), and 8 (27%) offer an ACLS/ALS course (5 with formal certification). Only a minority of students and fellows perceive themselves as highly proficient either in BLS or ACLS/ALS, although most of the fellows were involved at least once in rescuing a cardiac arrest. The present position paper analyses and suggests the strategies that should be adopted by Italian medical and specialization schools to spread the CPR culture and increase the long-standing retention of CPR-related technical and nontechnical skills.
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Affiliation(s)
- Pier Sergio Saba
- Clinical and Interventional Cardiology, Azienda Ospedaliero-Universitaria di Sassari, Sassari
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Alessia Gambaro
- Department of Cardiology, Azienda Ospedaliera Universitaria di Verona, Verona
| | - Giovanni Gazale
- Center for Sports Medicine and Cardiology- Azienda Sanitaria Locale 1, Sassari
| | - Stefania Piga
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria di Sassari, Sassari
| | - Maurizio Santomauro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Giancarlo Roscio
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, University of Rome Sapienza, Rome, Italy
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Kerins J, Keay R, Smith SE, Tallentire VR. Assessing team behaviours and time to defibrillation during simulated cardiac arrest: a pilot study of internal medicine trainees. Simul Healthc 2022. [DOI: 10.54531/cope7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding team behaviours leading to successful outcomes in resuscitation could help guide future training. Guidelines recommend defibrillation for shockable rhythm cardiac arrests within 2 minutes. This observational pilot study aimed to determine whether teamwork behaviours among medical trainees differed when time to defibrillation (TTD) was less than 2 minutes, versus 2 minutes or more.
Following ethical approval, groups of six internal medicine trainee (IMT) doctors in Scotland formed an
Twenty-three videos involving 138 trainees were scored using the TEAM tool. Scores ranged from 19–39.5/44 (mean 28.2). Mean TTD was 86.2 seconds (range 24–224), with 17/23 teams achieving defibrillation in under 2 minutes. Those achieving fast TTD achieved higher TEAM scores, and the result was statistically significant (30.1 ± 5.0 vs 22.9 ± 3.3,
This observational pilot study found that improved team performance, as measured by the TEAM tool, was associated with faster defibrillation by IMT doctors in simulated cardiac arrest. It highlighted the importance of adaptability as a team behaviour associated with successful performance, which is of interest to those involved in training high stakes emergency teams.
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Affiliation(s)
- Joanne Kerins
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Rona Keay
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Samantha E Smith
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Victoria R Tallentire
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
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Keay R, Kerins J, Tallentire V. 84 Using the Team Tool in High-Fidelity Immersive Simulation for Internal Medicine Trainees: Assessing Leadership of Cardiac Arrest Scenarios. Simul Healthc 2021. [DOI: 10.54531/zsjx2498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Non-technical skills (NTS) play a crucial role in cardiac arrest resuscitation performance, both in simulated and clinical environments This observational pilot study aimed to explore the leadership and team-working behaviours of IMT1 doctors in a simulated cardiac arrest scenario, to identify strengths and areas for improvement to focus future training.The Scottish national IMT1 boot camp involves a variety of high-fidelity immersive simulation scenarios across the 3-day course. Trainees are in groups of six with one IMT taking a lead role in each scenario. This study assessed a scenario of shockable rhythm cardiac arrest. All group participants are involved as the cardiac arrest team, with the original ‘hot seat’ participant expected to take the role of team leader, unless otherwise agreed by the team. The scenario is followed by a facilitated debrief around leadership in cardiac arrest.Following ethical approval from NHS Education for Scotland and written participant consent, videos of the cardiac arrest scenario were observed by the research team. Leadership and team behaviours were scored using the validated Team Emergency Assessment Measure (TEAM) Seventeen videos involving 102 trainees were reviewed and scored using the TEAM tool. The average overall TEAM score was 6.19/10. Scores for each of the 11 NTS domains ranged from 2.13/4 to 3.25/4. IMT1s scored highly on adapting to changing situations and monitoring and reassessing, but poorly on team leader displaying direction and command and leader maintaining a global perspective. When leadership scores were high, overall team performance was also high. General observations from field notes found the team often did not allocate a leader until cardiac arrest occurred. The leader often struggled to remain hands-off with a lack of assertiveness and poor communication between the leader and team. One hundred and fourteen IMT1s completed a pre- and post-course questionnaire. Average pre-course confidence in cardiac arrest team leadership was 3.8/7, and among the lowest of all situations rated. This improved to 5.35/7 post-course, but compared with other situations, remained low.This pilot study found leadership to be a key component in managing cardiac arrest for IMT1s, influencing overall team performance. Particular areas for improvement include hands-off leadership, leader assertiveness and whole team communication, which could be the focus of future educational interventions. Scenario participation and facilitated debrief improved overall confidence, but further focussed leadership and team training is required as IMT1s transition into the leadership role.
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Janssens S, Simon R, Beckmann M, Marshall S. Shared Leadership in Healthcare Action Teams: A Systematic Review. J Patient Saf 2021; 17:e1441-e1451. [PMID: 29870514 DOI: 10.1097/pts.0000000000000503] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this review were to consolidate the reported literature describing shared leadership in healthcare action teams (HCATs) and to review the reported outcomes related to leadership sharing in healthcare emergencies. METHODS A systematic search of the English language literature before November 2017 was performed using PsycINFO, MEDLINE, PubMed, CINAHL, and EMBASE. Articles describing sharing of leadership functions in HCATs were included. Healthcare teams performing routine work were excluded. Studies were reviewed for type of leadership sharing and sharing-related outcomes. RESULTS Thirty-three articles met the inclusion criteria. A variety of shared leadership models were described across the following three categories: spontaneous collaboration, intuitive working relations, and institutionalized practices. While leadership sharing has the potential for both positive and negative influences on team performance, only six articles reported outcomes potentially attributable to shared leadership. CONCLUSIONS Despite strong evidence for a positive relationship between shared leadership and team performance in other domains, there is limited literature describing shared leadership models in HCATs. The association between shared leadership and team performance in HCATs is a rich area for further investigation.
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Bennett CE. Not Who, but Rather How: The Ideal Resuscitation Team Leader. Mayo Clin Proc Innov Qual Outcomes 2021; 5:817-819. [PMID: 34458679 PMCID: PMC8379376 DOI: 10.1016/j.mayocpiqo.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Azimirad M, Magnusson C, Wiseman A, Selander T, Parviainen I, Turunen H. Identifying teamwork-related needs of the medical emergency team: Nurses' perspectives. Nurs Crit Care 2021; 27:804-814. [PMID: 34216412 DOI: 10.1111/nicc.12676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/26/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of medical emergency team (MET) in managing deteriorating patients and enhancing patient safety is greatly affected by teamwork. AIMS To identify teamwork-related needs of the MET from MET nurses' perspectives. To assess the associations between MET nurses' perceptions of teamwork and their work experience and education. STUDY DESIGN A quantitative, descriptive correlational design. METHODS Registered intensive care unit (ICU) nurses (n = 50) who were members of the MET in an acute tertiary care hospital answered a modified version of the team assessment questionnaire in 2017. Data were analysed using descriptive statistics, the Kruskal-Wallis test, and the univariate analysis of variance method. The reporting of this study adheres to the strengthening the reporting of observational studies (STROBE) guidelines. RESULTS Participants showed least agreement with the items presenting leadership skills (mean = 2.6, SD = 0.68). Approximately 50% nurses disagreed that the MET had adequate resources, training, and skills. The majority of nurses (80%) felt that their responsibilities as a MET member interfered with taking care of their own ICU patients. Many nurses (64%) felt that they did not have a voice in MET's decision-making process. Approximately 50% nurses felt that they were not recognized for their individual contribution, and they were uncertain regarding MET's policies for dealing with conflicts. The amounts of MET nurses' work experience and education were associated with MET skills and function, respectively. CONCLUSION Key teamwork elements of the MET that need improvements include decision-making and conflict resolution skills, valuing team members, and team leadership. Practicing shared mental models, implementing the TeamSTEPPS curricula at hospitals for training ICU nurses, and simulation-based team-training programmes may be beneficial in improving teamwork of MET members. RELEVANCE TO CLINICAL PRACTICE This study revealed key teamwork elements of the MET that need improvements. Our findings may contribute to improve teamwork, thereby optimizing MET function, and enhancing patient outcomes.
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Affiliation(s)
- Mina Azimirad
- Department of Nursing Science, University of Eastern Finland (UEF), Kuopio, Finland
| | - Carin Magnusson
- Duke of Kent Building, School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Surrey, UK
| | - Allison Wiseman
- College of Health & Life Sciences, Brunel University London, Uxbridge, UK
| | | | | | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland (UEF), Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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Armstrong P, Peckler B, Pilkinton-Ching J, McQuade D, Rogan A. Effect of simulation training on nurse leadership in a shared leadership model for cardiopulmonary resuscitation in the emergency department. Emerg Med Australas 2020; 33:255-261. [PMID: 32856402 DOI: 10.1111/1742-6723.13605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Empowering a senior nurse in a shared leadership role has been proposed as a more efficient set up for the cardiac arrest team in ED. In this model, a senior nurse leads the cardiac arrest algorithm which allows cognitive off-loading of the lead emergency physician. The emergency physician is then more available to perform tasks such as echocardiography and exclude reversible causes. Simulation provides an opportunity for training and practice of this shared leadership model. We hypothesised that a structured simulation training programme that focused on implementing a nurse and doctor shared leadership model for cardiopulmonary resuscitation (CPR), would improve leadership and teamwork quality in the setting of cardiac arrest as measured by a Trauma Non-technical Skills (T-NOTECHS) teamwork scale. METHODS Fifteen senior ED nurses participated in this pre-interventional post-observational study. Training consisted of a didactic course on team leadership and crisis resource management (CRM) followed by 4 × 10-min resuscitation scenarios with a structured debrief focusing on team leadership skills and CRM. The primary outcome was measured on scenarios 1 and 4 using a modified T-NOTECHS teamwork scale. RESULTS A statistically significant increase in the T-NOTECHS scale was detected for the measures of leadership (P = 0.0028), CRM (P = 0.0001), adherence to New Zealand Resuscitation Council ALS algorithm (P = 0.0088) and situational awareness (P = 0.0002). CONCLUSION The present study shows that a short simulation training programme improved nurse leadership and teamwork performance in the setting of a shared leadership model for CPR in the ED which could easily be replicated in other departments.
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Affiliation(s)
- Patrick Armstrong
- Wellington Emergency Department, Wellington Regional Hospital, Wellington, New Zealand
| | - Brad Peckler
- Wellington Emergency Department, Wellington Regional Hospital, Wellington, New Zealand
| | - Jodie Pilkinton-Ching
- Wellington Emergency Department, Wellington Regional Hospital, Wellington, New Zealand
| | - David McQuade
- Wellington Emergency Department, Wellington Regional Hospital, Wellington, New Zealand
| | - Alice Rogan
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
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Rixon A, Wilson S, Hussain S, Terziovski M, Judkins S, White P. Leadership challenges of directors of emergency medicine: An Australasian Delphi study. Emerg Med Australas 2019; 32:258-266. [DOI: 10.1111/1742-6723.13402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/11/2019] [Accepted: 09/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Rixon
- Department of Business Technology and EntrepreneurshipSwinburne University of Technology Melbourne Victoria Australia
| | - Samuel Wilson
- Department of Management and MarketingSwinburne University of Technology Melbourne Victoria Australia
| | - Sairah Hussain
- Department of Business Technology and EntrepreneurshipSwinburne University of Technology Melbourne Victoria Australia
| | - Mile Terziovski
- Department of Business Technology and EntrepreneurshipSwinburne University of Technology Melbourne Victoria Australia
| | - Simon Judkins
- Australasian College for Emergency Medicine Melbourne Victoria Australia
| | - Peter White
- Australasian College for Emergency Medicine Melbourne Victoria Australia
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Spitzer CR, Evans K, Buehler J, Ali NA, Besecker BY. Code blue pit crew model: A novel approach to in-hospital cardiac arrest resuscitation. Resuscitation 2019; 143:158-164. [PMID: 31299222 DOI: 10.1016/j.resuscitation.2019.06.290] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/24/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mortality from in-hospital cardiac arrests remains a large problem world-wide. In an effort to improve in-hospital cardiac arrest mortality, there is a renewed focus on team training and operations. Here, we describe the implementation of a "pit crew" model to provide in-hospital resuscitation care. METHODS In order to improve our institution's code team organization, we implemented a pit crew resuscitation model. The model was introduced through computer-based modules and lectures and was reemphasized at our institution-based ACLS training and mock code events. To assess the effect of our model, we reviewed pre- and post-pit crew implementation data from five sources: defibrillator downloads, a centralized hospital database, mock codes, expert-led debriefings, and confidential surveys. Data with continuous variables and normal distribution were analyzed using a standard two-sample t-test. For yes/no categorical data either a Z-test for difference between proportions or Chi-square test was used. RESULTS There were statistically significant improvements in compression rates post-intervention (mean rate 133.5 pre vs. 127.9 post, two-tailed, p = 0.02) and in adequate team communication (33% pre vs. 100% post; p = 0.05). There were also trends toward a reduction in the number of shockable rhythms that were not defibrillated (32.7% pre vs. 18.4% post), average time to shock (mean 1.96 min pre vs. 1.69 min post), and overall survival to discharge (31% pre vs. 37% post), though these did not reach statistical significance. CONCLUSION Implementation of an in-hospital, pit crew resuscitation model is feasible and can improve both code team communication as well as key ACLS metrics.
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Affiliation(s)
- Carleen R Spitzer
- Division of Pulmonary, Critical Care, and Sleep Medicine, 201 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210, United States.
| | - Kimberly Evans
- Quality & Patient Safety, 630 Ackerman Rd., 2nd Floor, Rm F2050, Columbus, OH 43202, United States.
| | - Jeri Buehler
- Education, Development and Resources, 660 Ackerman Rd., Columbus, OH 43218, United States.
| | - Naeem A Ali
- University Hospital, Division of Pulmonary, Critical Care, and Sleep Medicine, 168 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, United States.
| | - Beth Y Besecker
- Division of Pulmonary, Critical Care, and Sleep Medicine, 201 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210, United States.
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Rosenman ED, Bullard MJ, Jones KA, Welsh L, Brolliar SM, Levine BR, Grand JA, Fernandez R. Development and Empirical Testing of a Novel Team Leadership Assessment Measure: A Pilot Study Using Simulated and Live Patient Encounters. AEM EDUCATION AND TRAINING 2019; 3:163-171. [PMID: 31008428 PMCID: PMC6457354 DOI: 10.1002/aet2.10321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/20/2018] [Accepted: 01/02/2019] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Elizabeth D. Rosenman
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWA
| | - Mark J. Bullard
- Department of Emergency MedicineCarolinas Medical CenterAtrium HealthCharlotteNC
| | - Kerin A. Jones
- Department of Emergency MedicineWayne State UniversityDetroitMI
| | - Laura Welsh
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWA
| | - Sarah M. Brolliar
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWA
| | | | - James A. Grand
- Department of PsychologyUniversity of MarylandCollege ParkMD
| | - Rosemarie Fernandez
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWA
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Larsen T, Beier-Holgersen R, Østergaard D, Dieckmann P. Training residents to lead emergency teams: A qualitative review of barriers, challenges and learning goals. Heliyon 2018; 4:e01037. [PMID: 30603684 PMCID: PMC6304469 DOI: 10.1016/j.heliyon.2018.e01037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/14/2018] [Accepted: 12/07/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE An investigation to determine any consensus in opinions and views in the literature about challenges or barriers in training leadership for emergencies. SUMMARY OF BACKGROUND DATA Leadership in emergencies is reported as being very important for patient outcome. A systematic review failed in 2016 to find any focused leadership training. In the literature, the research has described and focused on developing tools to evaluate leadership. METHOD Articles identified in the systematic review combined with other reviews and opinions were included to incorporate experiences, perceptions and emotions connected with leadership training in emergency situations. Two qualitative content analyses were conducted. The first analysis searched for opinions about leadership and leadership training in emergencies. The method was abductive - inductive qualitative content analysis. The second analysis searched, on the basis of an article written in 1986, statements about challenges regarding leadership training in all articles. This method was directed qualitative content analysis. FINDINGS In total 40 articles covering the years 1986-2016 were analysed. An explicit need for workable leadership training of team leaders in emergencies was identified. The importance of the teamleader in emergencies was repeatedly stressed by 31/40 articles, leadership training is needed or required was stated by 30/40 articles, 27/40 articles described the emergency situation as stressful, complex, chaotic or unpredictable, 17/40 described the importance of self-confidence by the teamleader, and 8/40 described that the situation was perceived as creating concern, anxiety or panic. CONCLUSIONS The literature recommends finding a solution to teach residents to gain courage and confidence in stressful surroundings. The literature recommends finding a way to work with body language, non-verbal communication, attitude and appearance in order to radiate credibility in a setting separated from medical knowledge.
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Affiliation(s)
- Ture Larsen
- Simulation Unit (SimNord), Department of Administration, Nordsjællands Hospital, Denmark
| | | | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
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A search for training of practising leadership in emergency medicine: A systematic review. Heliyon 2018; 4:e00968. [PMID: 30761367 PMCID: PMC6286301 DOI: 10.1016/j.heliyon.2018.e00968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/11/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022] Open
Abstract
Objective This systematic review examines the medical, psychological and educational literature for training in practising leadership of a team leader in emergencies. The objectives of this paper are (1) describe how literature addresses operational training in practising leadership for the emergency medical team-leader (2) enhance understanding of leadership training in the medical environment. Background Worldwide, medical supervisors find it difficult to get students to rise to the occasion as leaders of emergency teams. It appears that many residents feel unprepared to adopt the role as a leader in emergencies. Method A systematic review was conducted (May-December 2016) in accordance with the PRISMA 2009 Checklist. A literature search was conducted against a set of inclusion criteria. Databases searched included PubMed, Psycinfo (via Ovid), and ERIC. Results 27 articles covering the period 1986-2016 were analysed. Four sources of data were identified: Intervention studies practising leadership, intervention studies on simulation and leadership assessment, observation studies assessing leadership, interview/survey studies about the need for leadership training. No workable training in practising leadership in emergencies for doctors was found. The majority of the research projects focused on various different types of taxonomies. Conclusions No consistent and workable leadership training for the emergency medical teamleader was identified. One study for paramedics succeeded in training empowering leadership skills. For many years multiple taxonomies and leadership assessment tools have been developed but failed to come to terms with workable leadership training. The literature describes lack of leadership as highly detrimental to performance during a critical, clinical situation.
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Larsen T, Beier-Holgersen R, Dieckmann P, Østergaard D. Conducting the emergency team: A novel way to train the team-leader for emergencies. Heliyon 2018; 4:e00791. [PMID: 30263972 PMCID: PMC6156909 DOI: 10.1016/j.heliyon.2018.e00791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Worldwide, medical supervisors find it difficult to get students to rise to the occasion when called upon to act as leaders of emergency teams: many residents/rescuers feel unprepared to adopt the leadership role. The challenge is to address the residents very strong emotions caused by the extremely stressful context. No systematic leadership training takes this aspect into account. AIM The overall aim of the course is to investigate whether, in an emergency, a clinical team leader could apply a conductor's leadership skills. BACKGROUND An orchestral conductor is a specialist in practicing leadership focusing on non-verbal communication. The conductor works with highly trained specialists and must lead them to cooperate and put his interpretation into effect. The conductor works purposefully in order to appear calm, genuine and gain authority. METHOD A conductor and a consultant prepared a course for residents, medical students and nurses, n = 61. Ten × two course days were completed. The exercises were musical and thus safe for the students as there were no clinical skills at stake. The programme aimed to create stress and anxiety in a safe learning environment. CONCLUSION The transfer of a conductor's skills improved and profoundly changed the participating students', nurses' and residents' behaviour and introduced a method to handle anxiety and show calmness and authority. PERSPECTIVES If this course in leadership is to be introduced as a compulsory part of the educating of doctors, the ideal time would be after clinical skills have been acquired, experience gained and routines understood in the clinic.
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Affiliation(s)
- Ture Larsen
- Simulation Unit (SimNord), Department of Administration, Kvalitetsafdelingen, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Randi Beier-Holgersen
- Department of Gastrointestinal Surgery, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev Hospital, Herlev Ringvej 75, 25 etage, 2730 Herlev, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev Hospital, Herlev Ringvej 75, 25 etage, 2730 Herlev, Copenhagen, Denmark
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Romig M, Duval-Arnould J, Winters BD, Newton H, Sapirstein A. Intensivist Presence at Code Events Is Associated with High Survival and Increased Documentation Rates. Crit Care Clin 2018; 34:259-266. [DOI: 10.1016/j.ccc.2017.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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