Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations (original) (raw)
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AEM education and training, 2018
The objective was to examine emergency medicine (EM) residents' perceptions of gender as it intersects with resuscitation team dynamics and the experience of acquiring resuscitation leadership skills. This was an exploratory, qualitative study using grounded theory and a purposive sample of postgraduate year (PGY) 2-4 EM residents who function as resuscitation team leaders in two urban EM programs. One-on-one interviews were conducted by a single experienced researcher. Audiotaped interviews were transcribed and deidentified by two research assistants. A research team composed of a PhD educational researcher, a research nurse, an MPH research assistant, and an EM resident reviewed the transcripts and coded and analyzed data using MAXQDA v12. Themes and coding schema were discussed until consensus was reached. We used member checking to assess the accuracy of our report and to confirm that the interpretations were fair and representative. Theme saturation was reached after interv...
Contingent Leadership and Effectiveness of Trauma Resuscitation Teams
Journal of Applied Psychology, 2005
This research investigated leadership and effectiveness of teams operating in a high-velocity environment, specifically trauma resuscitation teams. On the basis of the literature and their own ethnographic work, the authors proposed and tested a contingency model in which the influence of leadership on team effectiveness during trauma resuscitation differs according to the situation. Results indicated that empowering leadership was more effective when trauma severity was low and when team experience was high. Directive leadership was more effective when trauma severity was high or when the team was inexperienced. Findings also suggested that an empowering leader provided more learning opportunities than did a directive leader. The major contribution of this article is the linkage of leadership to team effectiveness, as moderated by relatively specific situational contingencies. 1 The ethnographic study reported on 44 interviews and 103 hr of observation during which 62 resuscitations took place. Preliminary results are described in .
Trauma and Emergency Care, 2016
Background: A modified non-technical skills scale for trauma (T-NOTECHS) for assessment of leadership skills in trauma resuscitations has been described in surgical literature. The utility of this tool with Pediatric Emergency Medicine (PEM) providers has not been explored. The objectives of this study were to assess the utility of the T-NOTECHS scoring tool in the pediatric setting and identify barriers to leading a thorough and efficient trauma evaluation. Methods: We conducted a mixed-methods study utilizing video review and semi-structured interviews of PEM team leaders of Level 1 trauma resuscitations at a quaternary children's hospital. Resuscitation videos were scored using T-NOTECHS by 5 or more reviewers from different disciplines: PEM physicians, pediatric surgeons, and non-physicians including nurses and advanced practice providers (RN/APPs). Median scores were compared using intraclass correlation coefficients (ICC). A sample of subjects scored their own videos and participated in a semi-structured interview. Two coders conducted thematic analysis to identify perceived barriers in leading efficient trauma resuscitations, and member checking was completed. Results: Thirty trauma resuscitations were reviewed and analyzed; twenty-eight had complete data from all groups. T-NOTECHS scores were highest in the PEM self-review group, followed by surgeons and PEM physicians. RN/APPs scored leaders lowest. There was moderate to substantial ICC agreement between all groups. Four principal themes emerged as perceived barriers to leading efficient trauma resuscitations: communication issues, resource limitations, the role of learners, and a lack of standardization and consistency among providers. Conclusions: The T-NOTECHS score is a useful tool in evaluating PEM leadership competency during trauma resuscitations and demonstrates reliability amongst scores obtained from reviewer groups with varied trauma experience and training. Systematic interviews of team leaders can identify barriers and means to improve the quality and efficiency of Level 1 trauma evaluations.
The effect of a nurse team leader on communication and leadership in major trauma resuscitations
International Emergency Nursing, 2015
The effect of a nurse team leader on communication and leadership in major trauma resuscitations☆, International Emergency Nursing (2014), http://dx.doi.org/Phone: 02 9947 9865 Fax: 02 9947 9879 24 Email: Alana.clements@sesiahs.health.nsw.gov.au 25 26 Acknowledgement 27 The authors acknowledge Kerri Holzhauser for her assistance with survey design and 28 preliminary analyses and Pauline Calleja for sharing her trauma medical record audit. 29 30 Abstract 31
Team performance in the emergency room: assessment of inter-disciplinary attitudes
Resuscitation, 2001
In-hospital emergency medicine in central Europe relies on inter-disciplinary co-operation. To improve team performance in the emergency room (ER), a questionnaire for assessment of attitudes and judgements in resuscitation procedures was developed. A total of 43 items were evaluated according to a five-point Likert scale. With a response rate of 81%, 143 questionnaires were evaluated. Assessment of data was performed with regard to professional speciality and level in the medical hierarchy. Factorial analysis identified four main factors: Assessment of 'quality of performance' (F1), 'importance of structure' (F2), 'quality of team culture' (F3), and 'importance of hierarchy' (F4). Influences from the categories 'speciality' and 'hierarchy' and from the covariate 'gender' on these main factors were evaluated by two-factorial analysis of variance. For all four factors, 'speciality' produced significant differences. Surgeons accorded high values to F1 and low values to F2, whereas anaesthesiologists accorded low values to F1 and high values to F2. F3 showed a low ranking from within the ER nursing staff and the residents in internal medicine, whereas F4 received high scores by medical residents and staff members. For F1 and F3, there was a tendency towards hierarchy dependency, whereas no factor was influenced by gender. In conclusion, team performance in the ER is mainly influenced by different perceptions and attitudes of the different disciplines involved in the resuscitation process.
Critical Care Medicine, 2019
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 mo...
Western Journal of Emergency Medicine, 2021
Introduction: Leadership positions occupied by women within academic emergency medicine have remained stagnant despite increasing numbers of women with faculty appointments. We distributed a multi-institutional survey to women faculty and residents to evaluate categorical characteristics contributing to success and differences between the two groups. Methods: An institutional review board-approved electronic survey was distributed to women faculty and residents at eight institutions and were completed anonymously. We created survey questions to assess multiple categories: determination; resiliency; career support and obstacles; career aspiration; and gender discrimination. Most questions used a Likert five-point scale. Responses for each question and category were averaged and deemed significant if the average was greater than or equal to 4 in the affirmative, or less than or equal to 2 in the negative. We calculated proportions for binary questions. Results: The overall response ra...
Trauma teams and time to early management during in situ trauma team training
BMJ Open, 2016
Objectives: To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training. Design: In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma. Setting: An emergency room in an urban Scandinavian level one trauma centre. Participants: A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre. Primary outcome: HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model. Results: Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively). Conclusions: Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload.