title: Building the evidence on simulation validity: comparison of anesthesiologists' communication patterns in real and simulated cases.
abstract: BACKGROUND
  Effective teamwork is important for patient safety, and verbal communication underpins many dimensions of teamwork. The validity of the simulated environment would be supported if it elicited similar verbal communications to the real setting. The authors hypothesized that anesthesiologists would exhibit similar verbal communication patterns in routine operating room (OR) cases and routine simulated cases. The authors further hypothesized that anesthesiologists would exhibit different communication patterns in routine cases (real or simulated) and simulated cases involving a crisis.
  
  
  METHODS
  Key communications relevant to teamwork were coded from video recordings of anesthesiologists in the OR, routine simulation and crisis simulation and percentages were compared.
  
  
  RESULTS
  The authors recorded comparable videos of 20 anesthesiologists in the two simulations, and 17 of these anesthesiologists in the OR, generating 400 coded events in the OR, 683 in the routine simulation, and 1,419 in the crisis simulation. The authors found no significant differences in communication patterns in the OR and the routine simulations. The authors did find significant differences in communication patterns between the crisis simulation and both the OR and the routine simulations. Participants rated team communication as realistic and considered their communications occurred with a similar frequency in the simulations as in comparable cases in the OR.
  
  
  CONCLUSIONS
  The similarity of teamwork-related communications elicited from anesthesiologists in simulated cases and the real setting lends support for the ecological validity of the simulation environment and its value in teamwork training. Different communication patterns and frequencies under the challenge of a crisis support the use of simulation to assess crisis management skills.
authors.affiliation: From the Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences (J.W., C.S.W.), Simulation Centre for Patient Safety ( J.T., K.H.), Department of Anaesthesiology (E.D., A.F.M.), University of Auckland, Auckland New Zealand; Human Factors Group, Simulation Training, Air New Zealand (R.H.), Auckland, New Zealand; Medicine Education and Student Office, Faculty of Medicine (B.S.), University of New South Wales, Sydney, Australia; Department of Medicine, University of Otago (C.F.), Christchurch, New Zealand.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weller
authors.forename: Robert
authors.initials: R
authors.lastname: Henderson
authors.forename: Craig S
authors.initials: CS
authors.lastname: Webster
authors.forename: Boaz
authors.initials: B
authors.lastname: Shulruf
authors.forename: Jane
authors.initials: J
authors.lastname: Torrie
authors.forename: Elaine
authors.initials: E
authors.lastname: Davies
authors.forename: Kaylene
authors.initials: K
authors.lastname: Henderson
authors.forename: Chris
authors.initials: C
authors.lastname: Frampton
authors.forename: Alan F
authors.initials: AF
authors.lastname: Merry
mesh_terms: D000368:Aged; D000776:Anesthesiology / Q000379:methods*; D003142:Communication; D003419:Crisis Intervention; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D010535:Laparoscopy; D009520:New Zealand; D009872:Operating Room Technicians; D009873:Operating Rooms; D010348:Patient Care Team; D016544:Patient Simulation; D010820:Physicians; D018401:Sample Size; D011795:Surveys and Questionnaires; D014741:Video Recording