title: Evaluating teamwork in a simulated obstetric environment.
abstract: BACKGROUND
  The National Confidential Enquiry into Maternal Deaths identified "lack of communication and teamwork" as a leading cause of substandard obstetric care. The authors used high-fidelity simulation to present obstetric scenarios for team assessment.
  
  
  METHODS
  Obstetric nurses, physicians, and resident physicians were repeatedly assigned to teams of five or six, each team managing one of four scenarios. Each person participated in two or three scenarios with differently constructed teams. Participants and nine external raters rated the teams' performances using a Human Factors Rating Scale (HFRS) and a Global Rating Scale (GRS). Interrater reliability was determined using intraclass correlations and the Cronbach alpha. Analyses of variance were used to determine the reliability of the two measures, and effects of both scenario and rater profession (R.N. vs. M.D.) on scores. Pearson product-moment correlations were used to compare external with self-generated assessments.
  
  
  RESULTS
  The average of nine external rater scores showed good reliability for both HFRS and GRS; however, the intraclass correlation coefficients for a single rater was low. There was some effect of rater profession on self-generated HFRS but not on GRS. An analysis of profession-specific subscores on the HFRS revealed no interaction between profession of rater and profession being rated. There was low correlation between externally and self-generated team assessments.
  
  
  CONCLUSIONS
  This study does not support the use of the HFRS for assessment of obstetric teams. The GRS shows promise as a summative but not a formative assessment tool. It is necessary to develop a domain specific behavioral marking system for obstetric teams.
authors: Department of Anesthesia, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. pam.morgan@utoronto.ca
authors: Pamela J
authors: PJ
authors: Morgan
authors: Richard
authors: R
authors: Pittini
authors: Glenn
authors: G
authors: Regehr
authors: Carol
authors: C
authors: Marrs
authors: Michèle F
authors: MF
authors: Haley
mesh_terms: D000328:Adult; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D009774:Obstetrics; D010348:Patient Care Team; D016544:Patient Simulation; D011785:Quality Assurance, Health Care; D012647:Self-Assessment