title: Effect of CRM team leader training on team performance and leadership behavior in simulated cardiac arrest scenarios: a prospective, randomized, controlled study.
abstract: BACKGROUND
  Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization.
  
  
  METHODS
  Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV).
  
  
  RESULTS
  CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95% CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95% CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95% CI -2.4, -1.2), p < 0.001); undirected orders (difference -1.82 (95% CI -2.8, -0.9), p < 0.001); planning (difference -0.27 (95% CI -0.5, -0.05) p = 0.018) and task assignments (difference -0.09 (95% CI -0.2, -0.01), p = 0.023).
  
  
  CONCLUSIONS
  Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.
authors.affiliation: Department of Social and Communication Psychology, Georg-Elias-Müller Institute of Psychology, Georg-August-University Göttingen, Gosslerstraße 14, 37073, Göttingen, Germany. e.fernandezcastelao@uni-goettingen.de.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Fernandez Castelao
authors.affiliation: Department of Social and Communication Psychology, Georg-Elias-Müller Institute of Psychology, Georg-August-University Göttingen, Gosslerstraße 14, 37073, Göttingen, Germany. mboos@uni-goettingen.de.
authors.forename: Margarete
authors.initials: M
authors.lastname: Boos
authors.affiliation: Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. chr.ringer@gmail.com.
authors.forename: Christiane
authors.initials: C
authors.lastname: Ringer
authors.affiliation: Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Janusz-Korczak-Allee 12, 30173, Hannover, Germany. eich@hka.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Eich
authors.affiliation: Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. s.russo@medizin.uni-goettingen.de.
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: Russo
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods / Q000592:standards; D003142:Communication; D000067498:Crew Resource Management, Healthcare / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007857:Leadership; D008297:Male; D010348:Patient Care Team / Q000592:standards; D000066908:Simulation Training / Q000379:methods*