Teamwork evaluation during emergency medicine residents' high-fidelity simulation

Teamwork training has been included in several emergency medicine (EM) curricula; the aim of this study was to compare different scales' performance in teamwork evaluation during simulation for EM residents.

In the period October 2013-June 2014, we performed bimonthly high-fidelity simulation sessions, with novice (I-III year, group 1 (G1)) and senior (IV-V year, group 2 (G2)) EM residents; scenarios were designed to simulate management of critical patients. Videos were assessed by three independent raters with the following scales: Emergency Team Dynamics (ETD), Clinical Teamwork Scale (CTS) and Team Emergency Assessment Measure (TEAM). In the period March-June, after each scenario, participants completed the CTS and ETD.

The analysis based on 18 sessions showed good internal consistency and good to fair inter-rater reliability for the three scales (TEAM, CTS, ETD: Cronbach's α 0.954, 0.954, 0.921; Intraclass Correlation Coefficients (ICC), 0.921, 0.917, 0.608). Single CTS items achieved highly significant ICC results, with 12 of the total 13 comparisons achieving ICC results ≥0.70; a similar result was confirmed for 4 of the total 11 TEAM items and 1 of the 8 total ETD items. Spearman's r was 0.585 between ETD and CTS, 0.694 between ETD and TEAM, and 0.634 between TEAM and CTS (scales converted to percentages, all p<0.0001). Participants gave themselves a better evaluation compared with external raters (CTS: 101±9 vs 90±9; ETD: 25±3 vs 20±5, all p<0.0001).

All examined scales demonstrated good internal consistency, with a slightly better inter-rater reliability for CTS compared with the other tools.