title: Simulation-based crisis team training for multidisciplinary obstetric providers.
abstract: BACKGROUND
  The use of team training programs is promising with regards to their ability to impact knowledge, attitudes, and behavior about team skills. The purpose of this study was to evaluate a simulation-based team training program called Obstetric Crisis Team Training Program (OBCTT) (based on the original training program of Crisis Team Training) framed within a multilevel team theoretical model. We hypothesized that participation in OBCTT would positively impact 10 variables: individual's knowledge (about team process and obstetric emergency care); confidence and competence in handling obstetric emergencies; and participant attitudes (toward the utility of a rapid response team, simulation technology as a teaching methodology, the utility of team skills in the workplace, comfort in assuming team roles; and individual and team performance). Improvement of objectively measured team performance in a simulated environment was also assessed.
  
  
  METHODS
  Twenty-two perinatal health care professionals (attending physicians, nurses, resident, and nurse midwives) volunteered to participate in this pretest-posttest study design. All participants were given an online module to study before attending a 4-hour training session. Training consisted of participation in four standardized, simulated crisis scenarios with a female birthing simulator mannequin. Team simulations were video recorded. Debriefings were conducted after each simulation by having team members review the video and discuss team behaviors and member skills. Self-report measures of perinatal and team knowledge as well as several attitude surveys were given at the beginning and again at the end of the training session. A postsimulation attitude survey was administered immediately after the first and last simulation, and a course reaction survey was administered at the end of the training program. Objective task completion scores were computed after each simulation to assess performance.
  
  
  RESULTS
  There were significant (P<0.004) improvements in three of the outcome variables, after controlling for type I error with Bonferroni's correction; attitudes toward competence in handling obstetric emergencies (t=1.6), as well as individual (t=4.2), and team performance (t=4.1). The remaining 6 variables, attitude toward simulation technology, attitude toward the rapid response team; confidence in handling obstetric emergencies; utility of team skills in the workplace; comfort in assuming various team roles; and knowledge, were not statistically significant. Overall task completion from the first to the last simulation (XF, df=3, n=3, 8.2, P=0.042) substantially improved (P<0.05).
  
  
  CONCLUSIONS
  The crisis team training model is applicable to obstetric emergencies. Trainees exhibit a positive change in attitude; perception of individual and team performance, and overall team performance in a simulated environment. The ability of individuals to accurately assess their performance improved as a result of training.
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA. bdrober@emory.edu
authors.forename: Bethany
authors.initials: B
authors.lastname: Robertson
authors.forename: Lori
authors.initials: L
authors.lastname: Schumacher
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gosman
authors.forename: Ruth
authors.initials: R
authors.lastname: Kanfer
authors.forename: Maureen
authors.initials: M
authors.lastname: Kelley
authors.forename: Michael
authors.initials: M
authors.lastname: DeVita
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033183:Interdisciplinary Communication; D008875:Middle Aged; D009774:Obstetrics / Q000193:education*; D009873:Operating Rooms; D010348:Patient Care Team; D018743:Perinatal Care; D011247:Pregnancy; D015397:Program Evaluation; D013663:Teaching / Q000379:methods*; D014741:Video Recording