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Simulation-Based Team Leadership Training Improves Team Leadership During Actual Trauma Resuscitations

A Randomized Controlled Trial

Fernandez, Rosemarie MD1,2; Rosenman, Elizabeth D. MD3; Olenick, Jeffrey MA4; Misisco, Anthony MA4; Brolliar, Sarah M. BS3; Chipman, Anne K. MD, MS3; Vrablik, Marie C. MD, MCR3; Kalynych, Colleen MSH, EdD5; Arbabi, Saman MD, MPH6; Nichol, Graham MD, MPH3,7; Grand, James PhD8; Kozlowski, Steve W. J. PhD4; Chao, Georgia T. PhD9

doi: 10.1097/CCM.0000000000004077
Clinical Investigation: PDF Only
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Objectives: Trauma resuscitations are complex critical care events that present patient safety-related risk. Simulation-based leadership training is thought to improve trauma care; however, there is no robust evidence supporting the impact of leadership training on clinical performance. The objective of this study was to assess the clinical impact of simulation-based leadership training on team leadership and patient care during actual trauma resuscitations.

Design: Randomized controlled trial.

Setting: Harborview Medical Center (level 1 trauma center).

Subjects: Seventy-nine second- and third-year residents were randomized and 360 resuscitations were analyzed.

Interventions: Subjects were randomized to a 4-hour simulation-based leadership training (intervention) or standard orientation (control) condition.

Measurements and Main Results: Participant-led actual trauma resuscitations were video recorded and coded for leadership behaviors and patient care. We used random coefficient modeling to account for the nesting effect of multiple observations within residents and to test for post-training group differences in leadership behaviors while controlling for pre-training behaviors, Injury Severity Score, postgraduate training year, and days since training occurred. Sixty participants completed the study. There was a significant difference in post-training leadership behaviors between the intervention and control conditions (b1 = 4.06, t (55) = 6.11, p < 0.001; intervention M = 11.29, SE = 0.66, 95% CI, 9.99–12.59 vs control M = 7.23, SE = 0.46, 95% CI, 6.33–8.13, d = 0.92). Although patient care was similar between conditions (b = 2.00, t (55) = 0.99, p = 0.325; predicted means intervention M = 62.38, SE = 2.01, 95% CI, 58.43–66.33 vs control M = 60.38, SE = 1.37, 95% CI, 57.69–63.07, d = 0.15), a test of the mediation effect between training and patient care suggests leadership behaviors mediate an effect of training on patient care with a significant indirect effect (b = 3.44, 95% CI, 1.43–5.80). Across all trauma resuscitations leadership was significantly related to patient care (b1 = 0.61, SE = 0.15, t (273) = 3.64, p < 0.001).

Conclusions: Leadership training resulted in the transfer of complex skills to the clinical environment and may have an indirect effect on patient care through better team leadership.

1Center for Experiential Learning and Simulation, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL.

2Department of Emergency Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, FL.

3Department of Emergency Medicine, University of Washington, Seattle, WA.

4Department of Psychology, Michigan State University, East Lansing, MI.

5Department of Emergency Medicine, Office of Educational Affairs, University of Florida College of Medicine – Jacksonville, Jacksonville, FL.

6Department of Surgery, University of Washington, Seattle, WA.

7Department of Medicine, University of Washington, Seattle, WA.

8Department of Psychology, University of Maryland, College Park, MD.

9Department of Management, Michigan State University, East Lansing, MI.

This work was completed at University of Washington (enrollment, data collection, coding), the University of Florida (data analysis, data interpretation, and manuscript preparation), Michigan State University (coding, statistical analysis), and the University of Maryland (data analysis).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by grant from the Agency for Healthcare Research and Quality (1R18HS022458-01A1) and the Department of Defense (W81XWH-18-1-0089).

Drs. Fernandez’s, Rosenman’s, Chipman’s, and Vrablik’s institutions received funding from the Agency for Healthcare Research and Quality (AHRQ), the Department of Defense (DoD), and State of Washington Department of Labor and Industry. Dr. Fernandez received funding from Physio-Control (speaker fees), and she received support for article research from AHRQ, the DoD Congressionally Directed Medical Research Program, and the Washington State Department of Labor and Industries to conduct research. Dr. Rosenman’s institution received funding from the Society for Academic Emergency Medicine Foundation. She reports personal payment from Physio-Control for speaker fees. Mr. Olenick’s institution received funding from AHRQ, Army Research Institute for the Behavioral and Social Sciences, and the DoD. Mr. Misisco disclosed that his graduate research assistant funding was paid for via Dr. Chao’s AHRQ and DoD subcontracts from Spring 2018 to Summer 2018, and he received funding from Michigan State University graduate assistant funding, University at Albany Educational Opportunities Program tutor funding, University at Albany, The State University of New York, and Jackson National Life. Dr. Vrablik’s institution received funding from Washington University. Dr. Kalynych’s institution received funding from the National Institutes of Health (NIH) and DoD, and she received support for article research from the NIH. Dr. Nichol’s institution received funding from National Heart, Lung, Blood Institute, DoD, Abiomed, Zoll Medical, and GE Healthcare; he disclosed that she receives salary support from the University of Washington, via the Leonard A. Cobb Medic One Foundation Endowed Chair in Prehospital Emergency Care; he is a consultant to GE Healthcare and Zoll Circulation, a subsidiary of Zoll Medical Corp; and he has assigned a provisional patent for a combination product to modify reperfusion injury to the University of Washington. Dr. Grand’s institution received funding from Army Research Institute for the Behavioral and Social Sciences and DoD Congressionally Directed Medical Research Program. Dr. Kozlowski received funding from University of Washington; he received grants from the AHRQ, the Army Research Institute for the Behavioral and Social Sciences, the National Aeronautics and Space Administration, and the National Science Foundation, and the University of Maryland for speaker fees; he received funding from travel for presentations, policy, or professional association positions from the American Psychological Association, Association for Computing Machinery, European Association for Work & Organizational Psychology, ETH Zurich, Rice University, Society for Industrial & Organizational Psychology, Technical University Delft, and Zhejiang Gongshang University; and he disclosed he has an editorial position with Oxford University Press. Dr. Chao's institution received funding from the AHRQ and DoD, which were awarded to the University of Washington with a subcontract issued to Michigan State University. Dr. Chao's institution also received funding from the Army Research Institute for the Behavioral and Social Sciences and from the National Science Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest

For information regarding this article, E-mail: fernandez.r@ufl.edu

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