title: Teamwork skills in actual, in situ, and in-center pediatric emergencies: performance levels across settings and perceptions of comparative educational impact.
abstract: BACKGROUND
  Pediatric emergencies require effective teamwork. These skills are developed and demonstrated in actual emergencies and in simulated environments, including simulation centers (in center) and the real care environment (in situ). Our aims were to compare teamwork performance across these settings and to identify perceived educational strengths and weaknesses between simulated settings. We hypothesized that teamwork performance in actual emergencies and in situ simulations would be higher than for in-center simulations.
  
  
  METHODS
  A retrospective, video-based assessment of teamwork was performed in an academic, pediatric level 1 trauma center, using the Team Emergency Assessment Measure (TEAM) tool (range, 0-44) among emergency department providers (physicians, nurses, respiratory therapists, paramedics, patient care assistants, and pharmacists). A survey-based, cross-sectional assessment was conducted to determine provider perceptions regarding simulation training.
  
  
  RESULTS
  One hundred thirty-two videos, 44 from each setting, were reviewed. Mean total TEAM scores were similar and high in all settings (31.2 actual, 31.1 in situ, and 32.3 in-center, P = 0.39). Of 236 providers, 154 (65%) responded to the survey. For teamwork training, in situ simulation was considered more realistic (59% vs. 10%) and more effective (45% vs. 15%) than in-center simulation.
  
  
  CONCLUSIONS
  In a video-based study in an academic pediatric institution, ratings of teamwork were relatively high among actual resuscitations and 2 simulation settings, substantiating the influence of simulation-based training on instilling a culture of communication and teamwork. On the basis of survey results, providers favored the in situ setting for teamwork training and suggested an expansion of our existing in situ program.
authors.affiliation: From the Center for Simulation and Research (T.B.C., B.T.K., R.G.T., G.L.G.), and Division of Emergency Medicine (B.T.K., R.G.T., M.F., G.L.G.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; and Hospital Israelita Albert Einstein (T.B.C.), São Paulo, Brazil.
authors.forename: Thomaz Bittencourt
authors.initials: TB
authors.lastname: Couto
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Kerrey
authors.forename: Regina G
authors.initials: RG
authors.lastname: Taylor
authors.forename: Michael
authors.initials: M
authors.lastname: FitzGerald
authors.forename: Gary L
authors.initials: GL
authors.lastname: Geis
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003430:Cross-Sectional Studies; D004501:Education, Medical / Q000379:methods; D004630:Emergencies; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006776:Hospitals, Pediatric; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D010372:Pediatrics / Q000193:education*; D012189:Retrospective Studies; D000066908:Simulation Training / Q000379:methods*; D014193:Trauma Centers