title: Speaking across the drapes: communication strategies of anesthesiologists and obstetricians during a simulated maternal crisis.
abstract: BACKGROUND
  Organizational behavior and management fields have long realized the importance of teamwork and team-building skills, but only recently has health care training focused on these critical elements. Communication styles and strategies are a common focus of team training but have not yet been consistently applied to medicine. We sought to determine whether such communication strategies, specifically "advocacy" and "inquiry," were used de novo by medical professionals in a simulation-based teamwork and crisis resource management course. Explicit expression of a jointly managed clinical plan between providers, a strategy shown to improve patient safety, was also evaluated.
  
  
  METHODS
  Forty-four of 54 videotaped performances of an ongoing team-building skills course were viewed and analyzed for presence of advocacy and/or inquiry that related to information or a plan; inclusion criteria were participation of a nonconfederate obstetrician and an anesthesiologist. Verbal statement of a jointly managed clinical plan was also recorded.
  
  
  RESULTS
  Anesthesiologists advocated information in 100% of cases and advocated their plans in 93% of cases but inquired information in 30% of cases and inquired about the obstetricians' plans in 11% of cases. Obstetricians advocated information in 73% of cases, advocated their plans in 73% of cases, inquired information in 75% of cases, and inquired about the anesthesiologists' plans in 59% of cases. An explicitly stated joint team plan was formed in 45% of cases.
  
  
  CONCLUSIONS
  Anesthesiologists advocated more frequently than obstetricians, while obstetricians inquired and advocated in more balanced proportions. However, fewer than half of the teams explicitly agreed on a joint plan. Increasing awareness of communication styles, and possibly incorporating these skills into medical training, may help teams arrive more efficiently at jointly managed clinical plans in crisis situations.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. rminehart@partners.org
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Minehart
authors.forename: May C M
authors.initials: MC
authors.lastname: Pian-Smith
authors.forename: Toni B
authors.initials: TB
authors.lastname: Walzer
authors.forename: Roxane
authors.initials: R
authors.lastname: Gardner
authors.forename: Jenny W
authors.initials: JW
authors.lastname: Rudolph
authors.forename: Robert
authors.initials: R
authors.lastname: Simon
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Raemer
mesh_terms: D000758:Anesthesia / Q000523:psychology*; D002983:Clinical Competence; D003142:Communication; D004501:Education, Medical; D005260:Female; D006801:Humans; D008404:Massachusetts; D009774:Obstetrics / Q000193:education*; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration*; D016544:Patient Simulation; D011247:Pregnancy; D011248:Pregnancy Complications; D013663:Teaching / Q000379:methods; D014743:Videotape Recording