title: The role of nontechnical skills in simulated trauma resuscitation.
abstract: OBJECTIVE
  Trauma team training provides instruction on crisis management through debriefing and discussion of teamwork and leadership skills during simulated trauma scenarios. The effects of team leader's nontechnical skills (NTSs) on technical performance have not been thoroughly studied. We hypothesized that team's and team leader's NTSs correlate with technical performance of clinical tasks.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Brigham and Women's Hospital, STRATUS Center for Surgical Simulation
  
  
  METHODS
  A total of 20 teams composed of surgical residents, emergency medicine residents, emergency department nurses, and emergency services assistants underwent 2 separate, high-fidelity, simulated trauma scenarios. Each trauma scenario was recorded on video for analysis and divided into 4 consecutive sections. For each section, 2 raters used the Non-Technical Skills for Surgeons framework to assess NTSs of the team. To evaluate the entire team's NTS, 2 additional raters used the Modified Non-Technical Skills Scale for Trauma system. Clinical performance measures including adherence to guidelines and time to perform critical tasks were measured independently.
  
  
  RESULTS
  NTSs performance by both teams and team leaders in all NTS categories decreased from the beginning to the end of the scenario (all p < 0.05). There was significant correlation between team's and team leader's cognitive skills and critical task performance, with correlation coefficients between 0.351 and 0.478 (p < 0.05). The NTS performance of the team leader highly correlated with that of the entire team, with correlation coefficients between 0.602 and 0.785 (p < 0.001).
  
  
  CONCLUSIONS
  The NTSs of trauma teams and team leaders deteriorate as clinical scenarios progress, and the performance of team leaders and teams is highly correlated. Cognitive NTS scores correlate with critical task performance. Increased attention to NTSs during trauma team training may lead to sustained performance throughout trauma scenarios. Decision making and situation awareness skills are critical for both team leaders and teams and should be specifically addressed to improve performance.
authors: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Alexandra
authors: A
authors: Briggs
authors: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors: Ali S
authors: AS
authors: Raja
authors: STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Maurice F
authors: MF
authors: Joyce
authors: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Steven J
authors: SJ
authors: Yule
authors: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Wei
authors: W
authors: Jiang
authors: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Stuart R
authors: SR
authors: Lipsitz
authors: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: jhavens@partners.org.
authors: Joaquim M
authors: JM
authors: Havens
mesh_terms: D001364:Awareness; D003142:Communication; D003657:Decision Making; D006801:Humans; D007318:Inservice Training; D007400:Interprofessional Relations; D007857:Leadership; D010348:Patient Care Team / Q000458:organization & administration*; D011361:Professional Competence; D012151:Resuscitation / Q000193:education*; D012189:Retrospective Studies; D000066908:Simulation Training; D014194:Traumatology / Q000193:education*; D014741:Video Recording
keywords: Interpersonal and Communication Skills; Patient Care; Systems-Based Practice; nontechnical skills; trauma simulation; trauma team training