Multiple Patient Casualty Scenarios

IntroductionEffective teamwork plays a critical role in achieving high-performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach.MethodsA total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question.ResultsThe findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures.DiscussionThe study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research.

Team cognition is more than the aggregate cognition of team members. It is an emerging feature, worthy of study in its own right. In this paper we investigate potential metrics of team knowledge in the context of a broader exploratory study on measures of team knowledge, performance, and situation awareness. Team members assumed different roles in a three-person synthetic task in which they were presented with unique role-relevant information. Successful accomplishment of team objectives required team members to share information. The focus of this paper is on one of several measures collected which required judgments of pairwise relatedness ratings for mission-relevant terms. These data were submitted to Pathfinder network scaling and used to derive three metrics of team knowledge: knowledge accuracy, interpositional knowledge, and knowledge similarity. The metrics revealed different perspectives on team knowledge and were generally predictive of team performance and team situation awareness.

Introduction: The quality of team performance during medical crises impacts patient outcomes. Team performance can be enhanced by simulated or case-based education. Survival after pediatric cardiac arrest is excellent when effective CPR is performed. Measuring team performance during CPR events can identify errors, allowing development of focused team training. Multiple personnel are involved in resuscitative events and hence, multidisciplinary feedback of perceived errors must be sought. Hypothesis: There is a high rate of qualitative errors that occur during CPR events in the PICU and discordance in perception of errors by team members. Methods: A survey was created of demographics and 3 broad categories of errors- 1. Systems issues 2. Improper BLS/PALS application 3. Crisis resource management (CRM) deficiencies. Personnel conducting the surveys were educated about error categories and debriefing techniques. For all cardiopulmonary arrests(CPAs) in the PICU, the Critical Care (CCM) Attending, Fellow, PICU nurse and respiratory therapist that participated in the resuscitation were interviewed, using formatted, yet open-ended questions. Results: There were 30 CPA events from February to July 2012. 6 patients had 2 events each. Spontaneous circulation returned in 24 events (80%). 21 of the 24 patients survived to hospital discharge (84%). The team leader did multidisciplinary code debriefing following 10 events (33%). 360 degree surveys were successfully done for all team members in 28 cases(93%). Only 2 events(6%) were perceived as error-free by all primary respondents. Systems issues were identified by at least 1 team member in 18 events(60%), BLS/PALS deficiencies in 18 events(60%) and CRM deficiencies in 25 events(83%). More than 1 category of error was identified in 23 events(76%). In 14 events(46%), there was lack of clarity about team leadership. Conclusions: There is a significant rate of errors in PICU CPR team performance. Ample opportunity exists to improve the quality of CPR through team training. Based on our results, CRM is the commonest category of qualitative deficiencies during CPAs and must be primarily targeted during multidisciplinary simulation training and mock codes to enhance patient care.

As exploration of new frontiers continues, the need for team training in extreme environments grows. Operating in isolated, confined, and extreme environments (ICE) demands novel approaches to team performance measurement, as well as new strategies and methods for ensuring teams members are (1) equipped with the knowledge, skills, and attitudes critical for effective team performance over time, and (2) are supported by just-in-time training or other resources when breakdowns in performance inevitably occur. This panel brings together a range of experts in human performance in extreme environments to provide a comprehensive overview and discussion of the most current approaches and trends regarding team training and performance measurement in ICE environments.

Project Overview Team Situation Awareness (TSA), which is a part of team cognition, is a critical factor that influences team effectiveness. It can be defined as getting the right information from the right person within the right amount of time, in order to overcome an unexpected event (Gorman, Cooke, Pederson, Connor, & DeJoode, 2005). TSA is developed and maintained through team interactions, allowing for the measurement of TSA based on team interaction (Cooke & Gorman, 2009). In the current study, a specific measure, Coordinated Awareness of Situation by Teams (CAST) is used (Cooke & Gorman, 2009). CAST evaluates the effectiveness and efficiency of team interaction under “roadblock” scenarios (Gorman, Cooke, & Winner, 2006). These roadblocks represent novel situations in the task and require effective team communication and coordination. Team members must assess the situation according to their own specialized role and/or resources and coordinate with other team members to overcome each separate roadblock. In this task, effective communication refers to team anticipation. That is, each team member needs to anticipate each other’s needs by pushing information rather than pulling information during the task (Demir, McNeese, & Cooke, 2017). In this study, we examined how pushing and pulling information, and CAST were associated with Team Situation Awareness (TSA) in both Human-Autonomy (HAT) and all-human teams in simulated Remotely Piloted Aircraft System (RPAS) task environment. In this research, we integrated the synthetic agent to the Cognitive Engineering Research on Team Tasks Remotely Piloted Aircraft Systems - Synthetic Task Environment (CERTT-RPAS-STE) which was designed to be both a flexible research platform and a realistic task environment with a view to researching team performance and interaction-based measures of team cognition. In the simulated CERTT testbed, there are three heterogeneous teammates who need to take good photos of each target waypoint by communicating via text-chat: (1) the navigator who creates a dynamic flight plan and provides information about the waypoints, the RPA’s airspeed, and altitude restrictions to the pilot; (2) the pilot, who controls the RPA’s heading, altitude, and airspeed, and negotiates with the photographer in order to take a good photo; and (3) the photographer, who monitors sensor equipment in order to take photographs of target waypoints and sends feedback to the other team members about the quality of the photo. This project aimed to understand how team behaviors and team performance differed between HATs and all-human teams in RPAS operations: (1) the synthetic condition—the pilot role was given to the synthetic teammate, which was an ACT-R based cognitive model (which had a limited interaction ability, see Ball et al., 2010; Demir et al., 2015); (2) the control condition—the pilot was a randomly selected human participant, just like the other two participants; and (3) the experimenter condition—one of the experimenters served as an expert pilot. Experimenter condition utilized a Wizard of Oz paradigm in which a trained experimenter (located in a separate room) used a script to imitate a synthetic teammate and communicated with participants in limited communication behaviors but pushing and pulling information in a timely manner (robust coordination). Method There were 30 teams (10 for each condition): control teams consisted of three participants randomly assigned to each role; synthetic and experimenter teams included two participants randomly assigned to the navigator and photographer roles. The experiment took place over five 40-minute missions, and the goal was to take as many “good” photos of ground targets as possible while avoiding alarms and rule violations. During each mission, teams were presented with “roadblocks” by the introduction of a new, ad hoc target waypoint. We collected several measures, but we focused on: the proportion of roadblocks overcome per mission as an outcome measure of TSA; the CAST which is a coordination sequence of team interaction across the team members (i.e. which team members share with team members their experience during the roadblock); and verbal behaviors such as pushing and pulling information. Results and discussion In this team task, effective teamwork involves anticipating the needs of teammates, which in turn means pushing information before it is requested. However, in addition to anticipation, effective coordination is also needed during roadblocks. HATs demonstrated significantly lower levels of CAST than all-human teams. These results indicate that HATs’ lack of anticipation and coordination resulted in poorer TSA performance. These findings help HATs to grow its coordination and communication methodologies. Finally, future studies might examine the relationships highlighted in this study via nonlinear measures in terms of team stability and flexibility based on their communication and coordination patterns during the novel events. HAT is here to stay but improvements to human-machine interactions must continue if we are to improve team effectiveness.

:The results of a field study of technology-based projects identify specific barriers and drivers to effective team performance. The article provides insight into the organizational environment and managerial leadership conducive to high project performance in technology-oriented team environments. The results suggest that many of the performance criteria have their locus outside of the project organization; yet managerial leadership, at both the project level and senior management level, has significant impact on the team environment that ultimately affects team and project performance. In addition to managing the technical aspects of the project, team leaders must pay particular attention to the people side, managing relations across the entire work process, including support functions, suppliers, sponsors, and partners. An engineering manager can use this article to gain additional perspective into the processes of teamwork, and to glean ideas for enhancing project team performance in technology-based organizations.

There are many unknowns regarding the characteristics and dynamics of human-AI teams, including a lack of understanding of how certain human-human teaming concepts may or may not apply to human-AI teams and how this composition affects team performance. This article outlines an experimental research study that investigates essential aspects of human-AI teaming such as team performance, team situation awareness, and perceived team cognition in various mixed composition teams (human-only, human-human-AI, human-AI-AI, and AI-only) through a simulated emergency response management scenario. Results indicate dichotomous outcomes regarding perceived team cognition and performance metrics, as perceived team cognition was not predictive of performance. Performance metrics like team situational awareness and team score showed that teams composed of all human participants performed at a lower level than mixed human-AI teams, with the AI-only teams attaining the highest performance. Perceived team cognition was highest in human-only teams, with mixed composition teams reporting perceived team cognition 58% below the all-human teams. These results inform future mixed teams of the potential performance gains in utilizing mixed teams' over human-only teams in certain applications, while also highlighting mixed teams' adverse effects on perceived team cognition.

In the past, team coordination dynamics have been explored using nonlinear dynamical systems (NDS) methods, but the relationship between team coordination dynamics and team performance for all-human teams was assumed to be linear. The current study examines team coordination dynamics with an extended version of the NDS methods and assumes that its relationship with team performance for human-autonomy teams (HAT) is nonlinear. In this study, three team conditions are compared with the goals of better understanding how team coordination dynamics differ between all-human teams and HAT and how these dynamics relate to team performance and team situation awareness. Each condition was determined based on manipulation of the .pilot role: in the first condition (synthetic) the pilot role was played by a synthetic agent, in the second condition (control) it was a randomly assigned participant, and in the third condition (experimenter) it was an expert who used a role specific coordination script. NDS indices revealed that synthetic teams were rigid, followed by experimenter teams, who were metastable, and control teams, who were unstable. Experimenter teams demonstrated better team effectiveness (i.e., better team performance and team situation awareness) than control and synthetic teams. Team coordination stability is related to team performance and team situation awareness in anonlinear manner with optimal performance and situation awareness associated with metastability coupled with flexibility. This result means that future development of synthetic teams should address these coordination dynamics, specifically, rigidity in coordination.

In complex operational environments, such as found in the military, it is necessary to consider not only the situation awareness (SA) of individual team members, but also the SA of the team as a whole. Given their important role in military combat operations, we hypothesized that the SA of team leaders (e.g., unit commanders) may have a significant influence on the SA and subsequent performance of those under their command. Accordingly, the overall objective of this research was to evaluate how much of the variance in a team's SA can be accounted for by the individual SA of the team's leader. To test our hypothesis, we performed an analysis of data collected at three experiments involving complex military operations. Results highlight the significant role of leaders' SA on their team's SA.

Teamwork in emergency medical services

I adopt a leadership as a networks approach to propose ethical leadership can emerge and be shared among team members. Therefore, I introduce the construct of shared ethical leadership and I begin to build the construct's nomological network by first examining ethical leadership training and shared leadership training as factors which, when additively combined, promote the density of shared ethical leadership in teams. Further, I examine these antecedents by predicting their effects will be optimized when power differentials between team members and their nominal leader are minimized. Moving to the consequences of shared ethical leadership, I propose a four-path model of social learning and social-exchange effects on proximal and distal team outcomes. First, I suggest that shared ethical leadership promotes the emergence of the team moral potency needed to make ethical choices when confronted with opportunities to ethically transgress. I then predict that the team's moral potency mediates the positive relationship between shared ethical leadership and team ethical behavior. Additionally, I argue that shared ethical leadership promotes goal concessions among team members and those goal concessions mediate the positive relationship between shared ethical leadership and team performance. I then suggest that shared ethical leadership promotes team information elaboration, which in turn mediates positive relationships with the team's ethical behavior and performance. I examine the hypotheses in a 2x2x2, between-subjects experiment using a simulated team activity with a sample of 56, 5-person teams (n=280). While the findings indicate a lack of support for most of my hypothesized relationships, the density of team's shared ethical leadership network was found to be positively related to team ethical behaviors. In addition, team information elaboration was positively related to team performance. Based on my findings, the theoretical and practical implications of this research are discussed.

Background: In complex human-machine-systems often teams of operators perform the tasks. Therefore, the quality of their teamwork processes is a factor that influences the performance of the overall system. There are theoretical models that predict teamwork processes which are critical for good team performance. The work presented in this paper researches how these generic processes become apparent in the domain of air traffic tower control. A scenario was used where operators control two airports simultaneously, i.e. they have to guarantee a safe flow of traffic. Method: An exploratory study was conducted to identify teamwork processes within a team of two tower controllers. Video data from a high fidelity simulation were analyzed and combined with radio communication data. Cognitive demanding situations were analyzed and compared to identical situations worked by a single operator. Results: Teamwork processes within the tower controller teams did not become apparent in explicit verbal communication but rather within the timing of activities. All teams showed a distinct pattern of activity defined as “flexible task assignment” within this paper. This behavior allowed the teams to respond to new aircraft with less delay, compared to the single controller working the same situation. Outlook: Further examples of “real-world” teamwork behaviors should be collected to understand the influence of the specific domain on the phenotype of teamwork processes. These behaviors should be mapped to underlying cognitive processes, like team situation awareness. This knowledge might not only be of academic interest but also a helpful basis for other research field of human factors, like enabling automation to serve as a team partner.

Organizations increasingly set up multiteam projects for the development of highly complex products. While team research has emphasized the importance of team-internal processes for smaller scale projects, we know little about collaborative processes (especially between teams) in such large-scale projects. This study utilizes a multi-informant longitudinal research design on a product development project (39 teams, 36 months) in the European automotive industry investigating collaboration between and within teams. The results of the study demonstrate that interteam coordination, project commitment, and teamwork quality as rated by the team members at Time 1 (Month 12; end of concept phase) are significantly correlated to project managers’ ratings of overall team performance at Time 3 (Month 36; end of project). The process variables measured at Time 2 (Month 24; end of design phase) display generally weaker correlations with team performance at Time 3. Multiple regression analyses further detail the effects of collaborative processes within and between teams on different measures of team performance (i.e., overall performance, quality, budget, schedule). The results show that collaborative processes during the project have predictive properties in regard to later team performance and can serve as early warning indicators. Furthermore, the results of this study provide support for our hypotheses predicting positive relationships between interteam coordination, project commitment, and teamwork quality. Theoretical and practical implications of this study are discussed.

Military healthcare providers working in military interprofessional healthcare teams (MIHTs) require situational awareness (SA) to ensure safe and efficacious patient care. This study aimed to explore SA in MIHTs to understand how SA can be reinforced and maintained in MIHTs. The research team set out to answer two questions: "What aspects of individual and team SA are particularly important for MIHTs?" and "How can we enable military healthcare providers to be effective MIHTs members with robust SA?". This study used Grounded Theory methodology collecting perspectives from 30 study participants from various backgrounds, including 11 different healthcare professions from the U.S. Army, Air Force, and Navy. Each study participant had experiences participating in, leading one, or leading many MIHTs. Data were collected in three cycles and analyzed within each cycle until saturation was reached. Five themes were robustly represented in the data set regarding SA: (1) contextually informed adaptability, (2) readiness, (3) trust, (4) communication, and (5) mission focus. The urgency often faced by MIHTs brings SA and the principles that underpin SA into sharper focus. The SA themes identified in this research may provide insight into training effectiveness, team strengths and weaknesses, and team performance.

This research assessed how the performance and team skills of three-person teams working with an Intelligent Team Tutoring System (ITTS) on a virtual military surveillance task were affected by feedback privacy, participant role, task experience, prior team experience, and teammate familiarity. Previous work in Intelligent Tutoring Systems (ITSs) has focused on outcomes for task skill training for individual learners. As research extends into intelligent tutoring for teams, both task skills and team skills are necessary for good team performance. This work includes a brief review of previous research on ITTSs, feedback, teams, and teamwork, including the recounting of two categories of a framework of teamwork performance, Communication and Cognition, which are relevant to the present study. This research examines the effects of an intelligent agent, as well as features of the team, its members, and the task being undertaken, on team communication (measured by relevant key-presses) and team situation awareness (as measured by scores on a quiz). Thirty-seven teams of three participants, each at their own computer running a multiplayer surveillance simulation, were given just-in-time private (individually delivered) or public (team-delivered) performance feedback during four 5-min trials. In the fourth trial, two of the three participants switched roles. Feedback type, teamwork experience, and teammate familiarity had no statistically significant effect on communication or team situation awareness. However, higher levels of role experience and task experience showed significant and medium-sized effects on communication performance. Results, based on performance data and structured interview responses, also revealed areas of improvement in future feedback design and a potential benchmark for feedback frequency in an action-oriented serious game-based ITTS. Among the conclusions are six design objectives for future ITTSs, establishing a foundation for future research on designing effective ITTSs that train interpersonal skills to nascent teams.