title: Team size impact on assessment of teamwork in simulation-based trauma team training.
abstract: Non-technical skills (teamwork) assessment is used to improve competence during training for interprofessional trauma teams. We hypothesized non-technical skills assessment is less reliable for large size teams, and evaluated team size effects during teamwork training. Small-teams (n = 5; 5-7 members) and Large-teams (n = 6; 8-9 members) participated in three simulation-based trauma team training scenarios. Following each scenario, teamwork was scored by participating trauma attending physicians (TA), non-participating critical care trauma nurses (CRN), and two expert teamwork debriefers (E), using the Trauma Nontechnical Skills Assessment tool (T-NOTECHS). Large-team scores by TA and CRN were higher than E scores (P < .003); small-team scores did not differ by rater. Small-team inter-observer agreement was substantial (ICC = 0.60); large-team agreement was low (ICC = 0.29). E and TA scores showed no concordance, whereas E and CRN scores showed poor concordance for large teams (ICC = 0.41, r = 0.53, P = .02). By contrast, correlation between E and TA (ICC = 0.52, r = 0.80, P < .001) as well as E and CRN (ICC = 0.57, and r = 0.65, P < .01) for small teams was high. Team size should be considered in team-training design, and when using teamwork rating instruments such as T-NOTECHS for assessment of simulated or actual trauma teams. Modified rating scales and enhanced training for raters of large groups versus small groups may be warranted.
authors.affiliation: Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea (YL).
authors.forename: Yong-Su
authors.initials: YS
authors.lastname: Lim
authors.affiliation: Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea (YL).
authors.forename: Susan
authors.initials: S
authors.lastname: Steinemann
authors.affiliation: Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea (YL).
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Berg
mesh_terms: D006801:Humans; D007400:Interprofessional Relations; D015588:Observer Variation; D010348:Patient Care Team / Q000458:organization & administration*; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D014194:Traumatology / Q000193:education*
keywords: Assessment; Interprofessional; Non-technical skills; Simulation; Teamwork; Training; Trauma