Abstract
BackgroundEffective 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.MethodsForty-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).ResultsCRM-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).ConclusionTraining 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0389-z) contains supplementary material, which is available to authorized users.
Highlights
Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance
We found that teams composed of one crisis resource management (CRM)-trained team leader and three advanced life support (ALS)-trained team members showed higher ADH scores during simulated CPR scenarios as compared to teams with a non-CRM-trained team leader
Our results demonstrate that CRM training only for team leaders can enhance overall CPR performance by increasing the adherence to the ALS guidelines, improving the quality of team leadership, and relieving the cognitive burden of all team members—leaders and followers alike
Summary
Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. The inclusion of team leadership behavior as a main topic in CPR training has been positively evaluated by many studies, showing short- and long-term positive effects on CPR performance [8, 16,17,18,19,20] Such training approaches have been designed to impart specific knowledge on how leaders can contribute systematically to team effectiveness in CPR. Depending on the experience and skills of leader(s) and team members and on the context factors of the task at hand, the complexity of such a multifactorial structure increases, creating the potential for an incomplete understanding of the whole process This incomplete understanding is even more likely during CPR training of inexperienced trainees (e.g., graduates, junior physicians) required to function in the typical CPR setting characterized by time pressure and imminent danger to the patient’s life. Reducing the cognitive workload beforehand by separating role instructions can have a positive impact on the CPR performance and on the trainees’ individual learning process [22, 23]
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