Team Physiological Dynamics: A Critical Review

TEAMs go VR-validating the TEAM in a virtual reality (VR) medical team training

BACKGROUND

Inadequate collaboration in healthcare can lead to medical errors, highlighting the importance of interdisciplinary teamwork training. Virtual reality (VR) simulation-based training presents a promising, cost-effective approach. This study evaluates the effectiveness of the Team Emergency Assessment Measure (TEAM) for assessing healthcare student teams in VR environments to improve training methodologies.

METHODS

Forty-two medical and nursing students participated in a VR-based neurological emergency scenario as part of an interprofessional team training program. Their performances were assessed using a modified TEAM tool by two trained coders. Reliability, internal consistency, and concurrent validity of the tool were evaluated using intraclass correlation coefficients (ICC) and Cronbach's alpha.

RESULTS

Rater agreement on TEAM's leadership, teamwork, and task management domains was high, with ICC values between 0.75 and 0.90. Leadership demonstrated strong internal consistency (Cronbach's alpha = 0.90), while teamwork and task management showed moderate to acceptable consistency (alpha = 0.78 and 0.72, respectively). Overall, the TEAM tool exhibited high internal consistency (alpha = 0.89) and strong concurrent validity with significant correlations to global performance ratings.

CONCLUSION

The TEAM tool proved to be a reliable and valid instrument for evaluating team dynamics in VR-based training scenarios. This study highlights VR's potential in enhancing medical education, especially in remote or distanced learning contexts. It demonstrates a dependable approach for team performance assessment, adding value to VR-based medical training. These findings pave the way for more effective, accessible interdisciplinary team assessments, contributing significantly to the advancement of medical education.

From Teams to Teamness: Future Directions in the Science of Team Cognition

OBJECTIVE

We review the current state-of-the-art in team cognition research, but more importantly describe the limitations of existing theories, laboratory paradigms, and measures considering the increasing complexities of modern teams and the study of team cognition.

BACKGROUND

Research on, and applications of, team cognition has led to theories, data, and measures over the last several decades.

METHOD

This article is based on research questions generated in a spring 2022 seminar on team cognition at Arizona State University led by the first author.

RESULTS

Future research directions are proposed for extending the conceptualization of teams and team cognition by examining dimensions of teamness; extending laboratory paradigms to attain more realistic teaming, including nonhuman teammates; and advancing measures of team cognition in a direction such that data can be collected unobtrusively, in real time, and automatically.

CONCLUSION

The future of team cognition is one of the new discoveries, new research paradigms, and new measures.

APPLICATION

Extending the concepts of teams and team cognition can also extend the potential applications of these concepts.

How and Why People Synchronize: An Integrated Perspective

Academic AbstractInterpersonal synchrony, the alignment of behavior and/or physiology during interactions, is a pervasive phenomenon observed in diverse social contexts. Here we synthesize across contexts and behaviors to classify the different forms and functions of synchrony. We provide a concise framework for classifying the manifold forms of synchrony along six dimensions: periodicity, discreteness, spatial similarity, directionality, leader-follower dynamics, and observability. We also distill the various proposed functions of interpersonal synchrony into four interconnected functions: reducing complexity and improving understanding, accomplishing joint tasks, strengthening social connection, and influencing partners' behavior. These functions derive from first principles, emerge from each other, and are accomplished by some forms of synchrony more than others. Effective synchrony flexibly adapts to social goals and more synchrony is not always better. Our synthesis offers a shared framework and language for the field, allowing for better cross-context and cross-behavior comparisons, generating new hypotheses, and highlighting future research directions.

Team Situation Awareness, Cohesion, and Autonomic Synchrony

OBJECTIVE

This study evaluated the causal relationships among situation awareness (SA), cohesion, and autonomic synchrony (SE) within teams. SA is often a team effort and should be more accurate in better-functioning teams.

BACKGROUND

Cohesive teams perform better overall, although the relationship appears reciprocal; the relationship to SA has not been considered previously. SE is a collective neurocognitive activity that has been connected to team coordination, communication, and performance in some circumstances.

METHOD

In this experiment, 71 undergraduates, organized into 16 teams, played two matches of a first-person shooter computer game and completed self-report measures of cohesion and SA. SE was determined through time series analysis of electrodermal responses using the driver-empath framework.

RESULTS

Empaths and those who came from more synchronized teams reported less cohesion in the team. Granger causality regression showed reciprocal relations among SA, SE, and cohesion that were both positive and negative after controlling for match difficulty.

CONCLUSION

The cohesion-SA relationship is similar to the reciprocal cohesion-performance relationship. SE plays an important and independent role in both the social and cognitive aspects of team behavior. It is possible, furthermore, that individuals who are more attuned to their co-workers reported a more accurate, and less obliging, social situation.

APPLICATION

Results are applicable to situations requiring teamwork in a dynamic environment.

Using interbrain synchrony to study teamwork: A systematic review and meta-analysis

It has been proposed that interbrain synchrony (IBS) may help to elucidate the neural mechanisms underpinning teamwork. As hyperscanning studies have provided abundant findings on IBS in team environments, the current review aims to synthesize the findings of hyperscanning studies in a way that is relevant to the teamwork research. A systematic review was conducted. Included studies were classified according to the IPO (i.e. input, process, output) model of teamwork. Three multi-level meta-analyses were performed to quantify the associations between IBS and the three IPO variables. The methodology followed PRISMA guidelines and the protocol was pre-registered (https://osf.io/7h8sa/). Of the 229 studies, 41 were included, representing 1326 teams. The three meta-analyses found statistically significant positive effects, indicating a positive association between IBS and the three IPO teamwork variables. This study provides evidence that IBS is a relevant measure of the teamwork process and argues for the continued use of IBS to study teamwork.

Physiological evidence of stress reduction during a summer Antarctic expedition with a significant influence of previous experience and vigor

Antarctica provides a unique environment for studying human adaptability, characterized by controlled conditions, limited sensory stimulation, and significant challenges in logistics and communication. This longitudinal study investigates the relationship between stress indicators, with a specific focus on mean sleep heart rate, during a COVID-19 quarantine and subsequent 83 days long summer Antarctic expedition at the J. G. Mendel Czech Antarctic Station. Our novel approach includes daily recordings of sleep heart rate and weekly assessments of emotions, stress, and sleep quality. Associations between variables were analyzed using the generalized least squares method, providing unique insights into nuances of adaptation. The results support previous findings by providing empirical evidence on the stress reducing effect of Antarctic summer expedition and highlight the importance of previous experience and positive emotions, with the novel contribution of utilizing physiological data in addition to psychological measures. High-frequency sampling and combination of psychological and physiological data addresses a crucial gap in the research of stress. This study contributes valuable knowledge to the field of psychophysiology and has implications for expedition planners, research organizations, teams in action settings, pandemic prevention protocols, global crises, and long-duration spaceflight missions. Comprehensive insights promote the well-being and success of individuals in extreme conditions.

A Typology for the Application of Team Coordination Dynamics Across Increasing Levels of Dynamic Complexity

OBJECTIVE

This review and synthesis examines approaches for measuring and assessing team coordination dynamics (TCD). The authors advance a system typology for classifying TCD approaches and their applications for increasing levels of dynamic complexity.

BACKGROUND

There is an increasing focus on how teams adapt their coordination in response to changing and uncertain operational conditions. Understanding coordination is significant because poor coordination is associated with maladaptive responses, whereas adaptive coordination is associated with effective responses. This issue has been met with TCD approaches that handle increasing complexity in the types of TCD teams exhibit.

METHOD

A three-level system typology of TCD approaches for increasing dynamic complexity is provided, with examples of research at each level. For System I TCD, team states converge toward a stable, fixed-point attractor. For System II TCD, team states are periodic, which can appear complex, yet are regular and relatively stable. In System III TCD, teams can exhibit periodic patterns, but those patterns change continuously to maintain effectiveness.

RESULTS

System I and System II are applicable to TCD with known or discoverable behavioral attractors that are stationary across mid-to long-range timescales. System III TCD is the most generalizable to dynamic environments with high requirements for adaptive coordination across a range of timescales.

CONCLUSION

We outline current challenges for TCD and next steps in this burgeoning field of research.

APPLICATION

System III approaches are becoming widespread, as they are generalizable to time- and/or scale-varying TCD and multimodal analyses. Recommendations for deploying TCD in team settings are provided.

(Mis)align: a simple dynamic framework for modeling interpersonal coordination

As people coordinate in daily interactions, they engage in different patterns of behavior to achieve successful outcomes. This includes both synchrony-the temporal coordination of the same behaviors at the same time-and complementarity-the coordination of the same or different behaviors that may occur at different relative times. Using computational methods, we develop a simple framework to describe the interpersonal dynamics of behavioral synchrony and complementarity over time, and explore their task-dependence. A key feature of this framework is the inclusion of a task context that mediates interactions, and consists of active, inactive, and inhibitory constraints on communication. Initial simulation results show that these task constraints can be a robust predictor of simulated agents' behaviors over time. We also show that the framework can reproduce some general patterns observed in human interaction data. We describe preliminary theoretical implications from these results, and relate them to broader proposals of synergistic self-organization in communication.

Exploring objective measures for assessing team performance in healthcare: an interview study

Introduction

Effective teamwork plays a critical role in achieving high-performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach.

Methods

A total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question.

Results

The findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures.

Discussion

The study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research.

A Methodological Framework to Study Change in Team Cognition Under the Dynamical Hypothesis

The dynamical hypothesis claims that cognitive systems, such as teams, are dynamical systems (i.e., an interdependent collection of individuals and their technology that change together over time). Following this hypothesis, team researchers have adopted dynamical approaches to better understand the team cognitive processes and states that form team cognition, as well as how they emerge over time. One approach focuses on team coordination dynamics, which examines the coupling of signals between interacting individuals in various modalities, and has been shown to reflect aspects of team functioning including team cognition. However, how changes in team coordination relate to high-level team cognitive processes and states, as well as important events, are not yet fully understood. To this end, we advance a methodological framework for researching team cognition under the dynamical hypothesis. Subsequently, we provided an empirical case-study application of this framework. Thereby, this work contributes methodologically and empirically to a deeper understanding of team cognition, the dynamical hypothesis, and the synergy between them.

Measuring teamwork for training in healthcare using eye tracking and pose estimation

Teamwork is critical for safe patient care. Healthcare teams typically train teamwork in simulated clinical situations, which require the ability to measure teamwork via behavior observation. However, the required observations are prone to human biases and include significant cognitive load even for trained instructors. In this observational study we explored how eye tracking and pose estimation as two minimal invasive video-based technologies may measure teamwork during simulation-based teamwork training in healthcare. Mobile eye tracking, measuring where participants look, and multi-person pose estimation, measuring 3D human body and joint position, were used to record 64 third-year medical students who completed a simulated handover case in teams of four. On one hand, we processed the recorded data into the eye contact metric, based on eye tracking and relevant for situational awareness and communication patterns. On the other hand, the distance to patient metric was processed, based on multi-person pose estimation and relevant for team positioning and coordination. After successful data recording, we successfully processed the raw videos to specific teamwork metrics. The average eye contact time was 6.46 s [min 0 s - max 28.01 s], while the average distance to the patient resulted in 1.01 m [min 0.32 m - max 1.6 m]. Both metrics varied significantly between teams and simulated roles of participants (p < 0.001). With the objective, continuous, and reliable metrics we created visualizations illustrating the teams' interactions. Future research is necessary to generalize our findings and how they may complement existing methods, support instructors, and contribute to the quality of teamwork training in healthcare.

Physiological Synchrony Predict Task Performance and Negative Emotional State during a Three-Member Collaborative Task

Evaluation of team performance in naturalistic contexts has gained popularity during the last two decades. Among other human factors, physiological synchrony has been adopted to investigate team performance and emotional state when engaged in collaborative team tasks. A variety of methods have been reported to quantify physiological synchrony with a varying degree of correlation with the collaborative team task performance and emotional state, reflected in the inconclusive nature of findings. Little is known about the effect of the choice of synchrony calculation methods and the level of analysis on these findings. In this research work, we investigate the relationship between outcomes of different methods to quantify physiological synchrony, emotional state, and team performance of three-member teams performing a collaborative team task. The proposed research work employs dyadic-level linear (cross-correlation) and team-level non-linear (multidimensional recurrence quantification analysis) synchrony calculation measures to quantify task performance and the emotional state of the team. Our investigation indicates that the physiological synchrony estimated using multidimensional recurrence quantification analysis revealed a significant negative relationship between the subjectively reported frustration levels and overall task performance. However, no relationship was found between cross-correlation-based physiological synchrony and task performance. The proposed research highlights that the method of choice for physiological synchrony calculation has direct impact on the derived relationship of team task performance and emotional states.

Group‐based flow: The influence of cardiovascular synchronization and identifiability

Previous work has demonstrated the role of group-based flow in group performance and experience, but the physiological correlates of these relations are largely unknown. We examined the relation between cardiovascular synchronization, self-reported flow, and performance in a three-person online gaming task. We included measures of Heart Rate (HR), Pre-Ejection Period (PEP), and Cardiac Output (CO) as indices of task engagement and challenge (vs. threat) motivation. Group members were identifiable (i.e., visible) or anonymous during the game. Results indicated that PEP (as a marker of task engagement) and within-group synchronization in PEP, predicted flow, and that synchronization in PEP mediated the relation between group performance and experienced flow. The anonymity vs. identifiability of group members did not play a role in these effects. Results are discussed in terms of implications for flow theory, group dynamics, and physiological synchrony.

Westerink JHD, Rispens S. A Review of Using Wearable Technology to Assess Team Functioning and Performance

Wearable technology enables collecting continuous in situ data from multiple people in various modalities, which can enhance team research and support, as the dynamic coupling of signals between interacting individuals (i.e., team coordination dynamics) is believed to reflect underlying processes and states of team functioning and performance. We conducted a systematic review on existing literature to evaluate the prospective use of wearable technology in research and practice. Using the IMOI framework as an organizing tool, our review revealed considerable support linking team coordination dynamics in different modalities to team functioning and performance, but also explicated the field’s nascent status.

Exploring how healthcare teams balance the neurodynamics of autonomous and collaborative behaviors: a proof of concept

Team members co-regulate their activities and move together at the collective level of behavior while coordinating their actions toward shared goals. In parallel with team processes, team members need to resolve uncertainties arising from the changing task and environment. In this exploratory study we have measured the differential neurodynamics of seven two-person healthcare teams across time and brain regions during autonomous (taskwork) and collaborative (teamwork) segments of simulation training. The questions posed were: (1) whether these abstract and mostly integrated constructs could be separated neurodynamically; and, (2) what could be learned about taskwork and teamwork by trying to do so? The taskwork and teamwork frameworks used were Neurodynamic Information (NI), an electroencephalography (EEG) derived measure shown to be a neurodynamic proxy for the pauses and hesitations associated with individual uncertainty, and inter-brain EEG coherence (IBC) which is a required component of social interactions. No interdependency was observed between NI and IBC, and second-by-second dynamic comparisons suggested mutual exclusivity. These studies show that proxies for fundamental properties of teamwork and taskwork can be separated neurodynamically during team performances of ecologically valid tasks. The persistent expression of NI and IBC were not simultaneous suggesting that it may be difficult for team members to maintain inter-brain coherence while simultaneously reducing their individual uncertainties. Lastly, these separate dynamics occur over time frames of 15-30 s providing time for real-time detection and mitigation of individual and collaborative complications during training or live patient encounters.

Objective Measures of Surgeon Non-Technical Skills in Surgery: A Scoping Review

OBJECTIVE

The purpose of this study was to identify, synthesize, and discuss objective behavioral or physiological metrics of surgeons' nontechnical skills (NTS) in the literature.

BACKGROUND

NTS, or interpersonal or cognitive skills, have been identified to contribute to safe and efficient surgical performance; however, current assessments are subjective, checklist-based tools. Intraoperative skill evaluation, such as technical skills, has been previously utilized as an objective measure to address such limitations.

METHODS

Five databases in engineering, behavioral science, and medicine were searched following PRISMA reporting guidelines. Eligibility criteria included studies with NTS objective measurements, surgeons, and took place within simulated or live operations.

RESULTS

Twenty-three articles were included in this review. Objective metrics included communication metrics and measures from physiological responses such as changes in brain activation and motion of the eye. Frequencies of content-coded communication in surgery were utilized in 16 studies and were associated with not only the communication construct but also cognitive constructs of situation awareness and decision making. This indicates the underlying importance of communication in evaluating the NTS constructs. To synthesize the scoped literature, a framework based on the one-way communication model was used to map the objective measures to NTS constructs.

CONCLUSION

Objective NTS measurement of surgeons is still preliminary, and future work on leveraging objective metrics in parallel with current assessment tools is needed.

APPLICATION

Findings from this work identify objective NTS metrics for measurement applications in a surgical environment.

The Cognitive Relevance of a Formal Pre-incision Time-out in Surgery

Surgical time-outs are designed to promote situation awareness, teamwork, and error prevention. The pre-incision time-out in particular aims to facilitate shared mental models prior to incision. Objective, unbiased measures to confirm its effectiveness are lacking. We hypothesized that providers’ mental workload would reveal team psychophysiological mirroring during a formal, well-executed pre-incision time-out. Heart rate variability was collected during cardiac surgery cases from the surgeon, anesthesiologist, and perfusionist. Data were analyzed for six cases from patient arrival until sternal closure. Annotation of surgical phases was completed according to previously developed standardized process models of aortic valve replacement and coronary artery bypass graft procedures, producing thirteen total surgical phases. Statistical analysis revealed significant main effects. Tukey HSD post hoc tests revealed significant differences across provider roles within various phases, including Anesthesia Induction, Heparinization, Initiation of Bypass, Aortic Clamp and Cardioplegia, Anastomoses or Aortotomy, Separation from Bypass, and Sternal Closure. Despite these observed differences between providers over various surgical phases, the Pre-incision Time-out phase revealed almost negligible differences across roles. This preliminary work supports the utility of the pre-incision safety checklist to focus the attention of surgical team members and promote shared team mental models, measured via psychophysiological mirroring, using an objective mental workload measure. Future studies should investigate the relationship between psychophysiological mirroring among surgical team members and the effectiveness of the pre-incision time-out checklist.