Teamwork Assessment Tools Research Articles

Assessing Team Performance in a Longitudinal Neonatal Resuscitation Simulation Training Program: Comparing Validity Evidence to Select the Best Tool.

Introduction Neonatal resuscitation is a high-acuity, low-occurrence event that requires ongoing practice by interprofessional teams to maintain proficiency.Simulation provides an ideal platform for team training and evaluation of team performance. Our simulation center supports a longitudinal in situ simulation training program for delivery room teams. In addition to adherence to the Neonatal Resuscitation Program standards, team performance assessment is an essential component of program evaluation and participant feedback. Multiple published teamwork assessment tools exist. Our objective was to select the tool with the best validity evidence for our program's needs. Methods We used Messick's framework to assess the validity of evidence for potential teamwork assessment tools. Four possible tools were identified from the literature: the Mayo High Performance Teamwork Scale (Mayo), Team Performance Observation Tool (TPOT), Clinical Teamwork Scale (CTS), and Team Emergency Assessment Measure (TEAM). Relevant context included team versus individual focus, external evaluator versus self-evaluation, and ease of use (which included efficiency, clarity of interpretation, and overall assessment). Three simulation experts identified consensus anchors for each tool and independently reviewed and scored 10 pre-recorded neonatal resuscitation simulations. Raters assigned each tool a rating according to efficiency, ease of interpretation, and completeness of teamwork assessment. Interrater reliability (IRR) was calculated using intraclass correlation for each tool across the three raters. Average team performance scores for each tool were correlated with neonatal resuscitation adherence scores for each video using Spearman's rank coefficient. Results There was a range of IRR between the tools, with Mayo having the best (single 0.55 and multi 0.78). Each of the three raters ranked Mayo optimally in terms of efficiency (mean 4.66 + 0.577) and ease of use (4+1). However, TPOT and CTS scored highest (mean 4.66 ± 0.577) for overall completeness of teamwork assessment. There was no significant correlation to NRP adherence scores for any teamwork tool. Conclusion Of the four tools assessed, Mayo demonstrated moderate IRR and scored highest for its ease of use and efficiency, though not completeness of assessment. The remaining three tools had poor IRR, which is not an uncommon problem with teamwork assessment tools. Our process emphasizes the fact that assessment tool validity is contextual. Factors such as a relatively narrow (and high) performance distribution and clinical context may have contributed to reliability challenges for tools that offered a more complete teamwork assessment.

Nursing Teamwork: An in-Depth Concept Analysis with Walker & Avant’s Framework

Background: Nursing teamwork is fundamental for delivering high-quality patient care. Successful teamwork includes communication, collaboration, trust, respect, shared decision-making, accountability, and flexibility among healthcare professionals. Objective: The purpose of this concept analysis is to clarify and define the concept of teamwork in nursing, providing nurses with a comprehensive understanding to enhance healthcare delivery. Methods: This study employed a concept analysis using Walker and Avant’s model (1986) to elucidate the significance, characteristics, antecedents, consequences, and empirical referents of teamwork in nursing. Data collection involved a comprehensive literature review of peer-reviewed journals, books, and authoritative online resources. Data were synthesized to identify core themes and patterns related to defining attributes, antecedents, and consequences of teamwork. The ethical considerations were aligned with the Declaration of Helsinki. Data analysis was conducted using SPSS version 25.0, with descriptive statistics summarizing the defining attributes, antecedents, and consequences. Frequencies and percentages were calculated for categorical variables, while means and standard deviations were used for continuous variables. Results: The analysis identified seven key attributes of effective nursing teamwork: communication, collaboration, trust, respect, shared decision-making, accountability, and flexibility. Antecedents included clear roles and responsibilities, open communication, mutual trust and respect, shared goals, cultural competence, and adequate resources. Positive consequences included improved patient outcomes (e.g., 20% reduction in hospital stays), enhanced patient satisfaction (increased by 30%), increased efficiency (20% faster service delivery), and improved staff satisfaction (25% decrease in burnout rates). Negative consequences of poor teamwork included poor patient outcomes, reduced patient satisfaction, increased healthcare costs (by 15%), and staff burnout. Empirical referents included teamwork assessment tools, patient outcomes, reduced healthcare costs, reduced medical errors (by 10%), and improved quality of care. Conclusion: Effective teamwork is integral to nursing practice and significantly impacts patient outcomes, staff satisfaction, and healthcare delivery. Fostering communication, collaboration, and mutual respect among healthcare professionals is essential. Education and training, supportive work environments, patient-centered care, and inter-professional collaboration are critical for enhancing teamwork. Healthcare policies should emphasize quality improvement, patient safety, and workforce development to promote effective teamwork in nursing.

PEM Pandemic Pivot: A Hybrid Approach to Pediatric Emergency Medicine Training in Thailand Allows for COVID-era Flexibility.

Introduction:The COVID-19 pandemic poses challenges in maintaining global medical education partnerships, with travel restrictions and infection control concerns forcing program adaptation. The Pediatric Emergency Medicine Specialty Training and Accelerated Review (PEM-STAR) program is one such international collaboration which addresses education and training gaps in emergency care for children within Thailand. As an assessment of PEM-STAR’s ability to deliver consistent outcomes despite COVID-19 constraints, we compared program results for Cohort #1 (2018-2019, pre-pandemic) and Cohort #2 (2019-2021, spanning pandemic).Method:Oregon Health & Science University and Bangkok Dusit Medical Services implemented the PEM-STAR tandem physician-nurse curriculum in 2018. The cornerstone of the year-long course is a set of 22 PEM-specific topic modules, incorporating remote-accessible voiceover slide lectures, quizzes, and scholarly references to teach pediatric emergency medicine essentials. Content is reviewed via monthly teleconferences. Baseline and final assessments include written knowledge tests and high-fidelity simulation cases led by physician-nurse teams. Cohort #1 simulations were performed with evaluators in-situ using critical action checklists and validated teamwork assessment tools. Due to COVID-19 restrictions, Cohort #2 final assessments were hybrid; students completed Thailand-based simulations while Oregon leaders assessed and debriefed teams via videoconference.Results:Written exam scores for pre-pandemic Cohort#1 improved from 48.6% (95%CI 40.30-56.9) to 92.0% (95%CI 88.1-95.9) (p< 0.001). Cohort #2, during the pandemic, had scores improve similarly from 48.5% (95%CI 40.1-56.9) to 96.4% (95%CI 94.8-98.0) (p< 0.001). One-hundred percent of physician-nurse teams from both Cohort #1 and Cohort #2 achieved the program’s established passing score on final simulation testing: performing >85% of critical action items and scoring > 85% on the teamwork tool.Conclusion:The PEM-STAR design, with its emphasis on videoconferencing, web-based content, and asynchronous learning, required minimal modifications to maintain satisfactory knowledge and skill acquisition during the pandemic. Educational partnerships emphasizing these features have distinct sustainability advantages in times of global disorder.

Unexpected findings of gender bias after a correlation of operating room teamwork assessment tools

Unexpected findings of gender bias after a correlation of operating room teamwork assessment tools

The Association of Teamwork and Adverse Tracheal Intubation–Associated Events in Advanced Airway Management in the PICU

AbstractTracheal intubation (TI) in critically ill children is a life-saving but high-risk procedure that involves multiple team members with diverse clinical skills. We aim to examine the association between the provider-reported teamwork rating and the occurrence of adverse TI-associated events (TIAEs). A retrospective analysis of prospectively collected data from 45 pediatric intensive care units in the National Emergency Airway Registry for Children (NEAR4KIDS) database from January 2013 to March 2018 was performed. A composite teamwork score was generated using the average of each of five (7-point Likert scale) domains in the teamwork assessment tool. Poor teamwork was defined as an average score of 4 or lower. Team provider stress data were also recorded with each intubation. A total of 12,536 TIs were reported from 2013 to 2018. Approximately 4.1% (n = 520) rated a poor teamwork score. TIs indicated for shock were more commonly associated with a poor teamwork score, while those indicated for procedures and those utilizing neuromuscular blockade were less commonly associated with a poor teamwork score. TIs with poor teamwork were associated with a higher occurrence of adverse TIAE (24.4% vs 14.4%, p < 0.001), severe TIAE (13.7% vs 5.9%, p < 0.001), and peri-intubation hypoxemia < 80% (26.4% vs 17.9%, p < 0.001). After adjusting for indication, provider type, and neuromuscular blockade use, poor teamwork was associated with higher odds of adverse TIAEs (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.35–2.34), severe TIAEs (OR, 2.23; 95% CI, 1.47–3.37), and hypoxemia (OR, 1.63; 95% CI, 1.25–2.03). TIs with poor teamwork were independently associated with a higher occurrence of TIAEs, severe TIAEs, and hypoxemia.

Improvement in student-led debriefing analysis after simulation-based team training using a revised teamwork assessment tool

BackgroundTeam debriefing is an important teamwork development intervention for improving team outputs in healthcare. Debriefing is a key component of experiential team training teamwork development interventions such as simulation-based training. Improving the quality of debriefing of healthcare teams, therefore, has multiple benefits. We investigated whether the quality of student-led debriefing improved using a shortened guide. MethodsSenior medical students, nurse anesthesia students, and senior undergraduate nursing students participated in student operating room team training at a health sciences center in the southeastern United States. Student teams participated in a dual-scenario simulation-based training session with immediate after-action debriefings after each scenario. In 2018, student teams conducted the second debriefing using as a guide the teamwork assessment scale, an 11-item, 3-subscale, 6-point Likert-type instrument. In 2019, they used a shortened, revised, 5-item version of the teamwork assessment scale, the quick teamwork assessment scale. Trained observers rated the quality of the student-led debriefings using the Objective Structured Assessment of Debriefing, an 8-item, 5-point instrument. The Wilcoxon-Mann-Whitney test was used to compare the teamwork assessment scale-guided and the quick teamwork assessment scale-guided mean item debriefing scores. ResultsTwo observers rated 3 student-led team debriefings using the teamwork assessment scales as a guide in 2018, and 6 such debriefings happened using the quick teamwork assessment scale as a guide in 2019. For each debriefing, observer scores were averaged for each Objective Structured Assessment of Debriefing item; these mean scores were then averaged with other mean scores for each year. The use of the quick teamwork assessment scale resulted in a statistically significant higher mean score for the Analysis Objective Structured Assessment of Debriefing item compared with the use of the teamwork assessment scale (4.92 [standard deviation 0.20] versus 3.83 [standard deviation 0.76], P = .023). ConclusionThe use of a shortened teamwork assessment instrument as a debriefing guide for student teams in student operating room team training was more effective in analysis of actions than the original, longer tool. Next steps include determining the efficacy of the quick teamwork assessment scale in an actual clinical setting.

P0676 / #912: RAPID CYCLE DELIBERATE PRACTICE FOR INTER PROFESSIONAL EDUCATION IN A NON TRAINEE STAFFED PEDIATRIC INTENSIVE CARE UNIT

Aims & Objectives: Rapid Cycle Deliberate Practice (RCDP) is a simulation debriefing methodology that has been compared to post simulation debriefing (PsD) in simulation based medical education (SBME) studies, mostly focused on resuscitations and procedure skills. The aim of this study is to compare the RCDP versus PsD training as methods for experiential learning in the pediatric intensive care unit (PICU) interprofessional SBME sessions. We also measure PICU team workload perception during the simulation scenario using the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire. We hypothesize the RCDP will be more effective than PsD in improving team performance and minimizing cognitive load of learners and facilitators. Methods: Pediatric Critical Care attending physicians, Nurses, Pharmacists and Respiratory Therapists will participate in a 3-hour simulation workshop. Workshops are being conducted from October 2019 - March 2020, and include 5 workshops covering two medical sepsis scenarios. Each session will schedule 1 physician, 2-3 nurses, 1 pharmacist and 1 RT. The first part of the SBME workshop will be PsD and the second half will be RCDP with hard stops and soft stops. The learners complete pre and post-test crew resource knowledge assessments and cognitive load assessments (NASA Task Load Index). Facilitators complete the validated teamwork assessment tool (TEAM Assessment) andNASA Task Index. Results: Raw scores of crew resource knowledge test, TEAM Assessment and NASA Task Load Index between the two studies will be examined. Conclusions: RCDP during interporfessional SBME is feasible and needs to be designed differently in a trainee versus non trainee environment.

Application of a Simulation-Based Interprofessional Teamwork Assessment Tool (SITAT) to Individual Student Performance in a Team-Based Simulation.

There are a very limited number of instruments to assess individual performance in simulation-based interprofessional education (IPE). The purpose of this study was to apply the Simulation-Based Interprofessional Teamwork Assessment Tool (SITAT) to the individualized assessment of medicine, pharmacy, and nursing students (N = 94) in a team-based IPE simulation, as well as to explore potential differences between disciplines, and calculate reliability estimates for utilization of the tool. Results of an analysis of variance provided evidence that there was no statistically significant difference among professions on overall competency (F(2, 91) = 0.756, P = .472). The competency reports for nursing (M = 3.06, SD = 0.45), medicine (M = 3.19, SD = 0.42), and pharmacy (M = 3.08, SD = 0.49) students were comparable across professions. Cronbach's alpha provided a reliability estimate of the tool, with evidence of high internal consistency (α = .92). The interrater reliability of the SITAT was also investigated. There was moderate absolute agreement across the 3 faculty raters using the 2-way mixed model design and “average” unit (kappa = 0.536, P = .000, 95% CI [0.34, 0.68]). The novel SITAT demonstrates internal consistency and interrater reliability when used for evaluation of individual performance during IPE simulation. The SITAT provides value in the education and evaluation of individual students engaged in IPE curriculum.

Evaluation of teamwork assessment tools for interprofessional simulation: a systematic literature review

ABSTRACTThere is growing evidence supporting the use of simulation-based education to improve teamwork in the clinical environment, which results in improved patient outcomes. Interprofessional simulation improves awareness of professional roles and responsibilities, promotes teamwork and provides training in non-technical skills. Tools have been developed to assess the quality of teamwork during simulation, but the use of these tools should be supported by validity evidence in appropriate contexts. This study aims to assess the validity of teamwork tools used in simulation-based interprofessional training for healthcare workers and students, and to compare the design and reporting of these studies. Medline, EMBASE, ERIC, and CINAHL were searched using terms synonymous with simulation, crew resource management, training, assessment, interprofessional, and teamwork, from 2007–2017. Interprofessional healthcare simulation studies involving objectively rated teamwork training were included. The initial search provided 356 records for review, of which 24 were ultimately included. Three tools demonstrated good validity evidence underpinning their use. However, three studies did not explore tool psychometrics at all, and the quality of reporting amongst these studies on design and participant demographics was variable. Further research to generate reporting guidelines and validate existing tools for new populations would be beneficial.

L’éducation interprofessionnelle des équipes de soins critiques par la simulation : concept, mise en œuvre et évaluation

Interprofessional simulation-based education is effective for learning non-technical critical care skills and strengthening interprofessional team collaboration to optimize quality of care and patient outcome. Implementation of interprofessional simulation sessions in initial and continuing education is facilitated by a team of "champions" from each discipline/profession to ensure educational quality and logistics. Interprofessional simulation training must be integrated into a broader interprofessional curriculum supported by managers, administrators and clinical colleagues from different professional programs. When conducting interprofessional simulation training, it is essential to account for sociological factors (hierarchy, power, authority, interprofessional conflicts, gender, access to information, professional identity) both in scenario design and debriefing. Teamwork assessment tools in interprofessional simulation training may be used to guide debriefing. The interprofessional simulation setting (in-situ or simulation centre) will be chosen according to the learning objectives and the logistics.

Why wasn't sport included? Comment on the special issue on the science of teamwork (2018).

The special issue of the American Psychologist (May-June 2018) is devoted to the science of teamwork, with 20 articles addressing the history and foundation of teamwork research and highlighting the importance of teamwork in aviation, military, business, space exploration, academic, and health care settings. Articles that address factors influencing team performance and evaluation of interventions with teams are also included. The editors of the special issue direct attention to key areas in teamwork research that would benefit from further inquiry. That is, a call is made for research that focuses on teamwork measurement and assessment tools, explores multi-team systems, and bridges the gap between theory and practice. The special issue is a gem, likely to advance teamwork research in the years to come. Missing, however, is discussion of research related to sport teams and the sport psychology literature, although a sport team is featured on the cover of the science of teamwork special issue. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Measuring the teamwork performance of teams in crisis situations: a systematic review of assessment tools and their measurement properties

BackgroundEducational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement...

Teamwork Assessment Tools in Obstetric Emergencies: A Systematic Review

(Simul Healthc. 2017;12(3):165–176) Interdisciplinary collaboration is essential in cases of obstetric emergencies, but breakdowns in team communication can have adverse effects on maternal and fetal outcomes. Although many teamwork assessment tools exist, it remains unclear whether a specific tool is better adapted for assessment in obstetric emergency scenarios than another. In this qualitative systematic review, the authors searched the medical literature for prospective studies in order to find and evaluate the tools available for obstetric emergency team assessment.

Teamwork Assessment Tools in Obstetric Emergencies: A Systematic Review.

Team-based training and simulation can improve patient safety, by improving communication, decision making, and performance of team members. Currently, there is no general consensus on whether or not a specific assessment tool is better adapted to evaluate teamwork in obstetric emergencies. The purpose of this qualitative systematic review was to find the tools available to assess team effectiveness in obstetric emergencies. We searched Embase, Medline, PubMed, Web of Science, PsycINFO, CINAHL, and Google Scholar for prospective studies that evaluated nontechnical skills in multidisciplinary teams involving obstetric emergencies. The search included studies from 1944 until January 11, 2016. Data on reliability and validity measures were collected and used for interpretation. A descriptive analysis was performed on the data. Thirteen studies were included in the final qualitative synthesis. All the studies assessed teams in the context of obstetric simulation scenarios, but only six included anesthetists in the simulations. One study evaluated their teamwork tool using just validity measures, five using just reliability measures, and one used both. The most reliable tools identified were the Clinical Teamwork Scale, the Global Assessment of Obstetric Team Performance, and the Global Rating Scale of performance. However, they were still lacking in terms of quality and validity. More work needs to be conducted to establish the validity of teamwork tools for nontechnical skills, and the development of an ideal tool is warranted. Further studies are required to assess how outcomes, such as performance and patient safety, are influenced when using these tools.

Tradução e retrotradução do instrumento de avaliação do trabalho em equipe TeamSTEPPS® para uso no ensino por simulação no Brasil

Aims: To describe the results of translation and back-translation of the TeamSTEPPS® questionnaire to Brazilian Portuguese. This North American questionnaire has been used globally as an useful tool in simulation environment with evaluation intent, aiming at improving patient safety inside health settings, based on effective communication and teamwork.Methods: The adopted methodology consisted in translation and back-translation, with subsequent semantic analysis by experienced professors in health practice evaluations.Results: The translated tool showed a simple format and easy interpretation and understanding when analyzed by authors, professors and translators, and does not generate any kind of discrepancy in their items. In the subsequent analysis by the professors, it was shown that the items were relevant and clear to the Brazilian reality.Conclusions: All the steps of the translation and back-translation process were carried out successfully, finalizing the TeamSTEPPS® teamwork assessment tool in Brazilian Portuguese. The translation process of any tool is complex, and does not end in the linguistic equivalence. Therefore, a second step of this work will be the application of this scale in simulated scenarios focused in teamwork training, to retrace data on psychometric analyses in the educational context and semantic equivalence analyses.

Addressing the Interprofessional Collaboration Competencies of the Association of American Medical Colleges: A Systematic Review of Assessment Instruments in Undergraduate Medical Education.

To summarize characteristics and validity evidence of tools that assess teamwork in undergraduate medical education (UME), and provide recommendations for addressing the interprofessional collaboration competencies of the Association of American Medical Colleges (AAMC). The authors conducted a systematic review, searching MEDLINE, MEDLINE In-process, CINAHL, and PsycINFO from January 1, 1979, through April 1, 2014; they searched reference lists and national meeting abstracts. They included original research reports that described a quantitative tool used to assess teamwork in UME. They abstracted characteristics and validity evidence for the tools, plus study quality, according to established frameworks. Two authors independently abstracted 25% of articles and calculated agreement. Authors then applied predefined criteria to identify tools best suited to address the AAMC's teamwork competencies. Of 13,549 citations, 70 articles describing 64 teamwork assessment tools were included. Of these 64 tools, 27 (42%) assessed teamwork in classroom, 31 (48%) in simulation, and only 7 (11%) in actual clinical settings. The majority (47; 73%) of tools assessed medical students' teamwork in interprofessional teams. On the basis of content concordance, strength of validity evidence, generalizability of scores, and level of outcomes, four published tools were recommended to assess the AAMC's teamwork competencies: the Collaborative Healthcare Interdisciplinary Relationship Planning Scale, Readiness for Interprofessional Learning Scale, Communication and Teamwork Skills assessment, and Teamwork Mini-Clinical Evaluation Exercise. Substantial validity evidence supports the use of several UME teamwork assessments. Four tools have been appropriately designed and sufficiently studied to constitute appropriate assessments of the AAMC's teamwork competencies.

Content Validation and Evaluation of an Endovascular Teamwork Assessment Tool

To modify, content validate, and evaluate a teamwork assessment tool for use in endovascular surgery. A multistage, multimethod study was conducted. Stage 1 included expert review and modification of the existing Observational Teamwork Assessment for Surgery (OTAS) tool. Stage 2 included identification of additional exemplar behaviours contributing to effective teamwork and enhanced patient safety in endovascular surgery (using real-time observation, focus groups, and semistructured interviews of multidisciplinary teams). Stage 3 included content validation of exemplar behaviours using expert consensus according to established psychometric recommendations and evaluation of structure, content, feasibility, and usability of the Endovascular Observational Teamwork Assessment Tool (Endo-OTAS) by an expert multidisciplinary panel. Stage 4 included final team expert review of exemplars. OTAS core team behaviours were maintained (communication, coordination, cooperation, leadership team monitoring). Of the 114 OTAS behavioural exemplars, 19 were modified, four removed, and 39 additional endovascular-specific behaviours identified. Content validation of these 153 exemplar behaviours showed that 113/153 (73.9%) reached the predetermined Item-Content Validity Index rating for teamwork and/or patient safety. After expert team review, 140/153 (91.5%) exemplars were deemed to warrant inclusion in the tool. More than 90% of the expert panel agreed that Endo-OTAS is an appropriate teamwork assessment tool with observable behaviours. Some concerns were noted about the time required to conduct observations and provide performance feedback. Endo-OTAS is a novel teamwork assessment tool, with evidence for content validity and relevance to endovascular teams. Endo-OTAS enables systematic objective assessment of the quality of team performance during endovascular procedures.

Commentary on ‘Content Validation and Evaluation of an Endovascular Teamwork Assessment Tool’

Commentary on ‘Content Validation and Evaluation of an Endovascular Teamwork Assessment Tool’

Measuring teamwork performance: Validity testing of the Team Emergency Assessment Measure (TEAM) with clinical resuscitation teams

AimTo test the resuscitation non-technical Team Emergency Assessment Measure (TEAM) for feasibility, validity and reliability, in two Australian Emergency Departments (ED). BackgroundNon-technical (teamwork) skills have been identified as inadequate and as such have a significant impact on patient safety. Valid and reliable teamwork assessment tools are an important element of performance assessment and debriefing processes. MethodsA quasi experimental design based on observational ratings of resuscitation non-technical skills in two metropolitan ED. Senior nursing staff rated 106 adult resuscitation team events over a ten month period where three or more resuscitation team members attended. Resuscitation events, team performance and validity and reliability data was collected for the TEAM. ResultsMost rated events were for full cardiac resuscitation (43%) with 3–15 team members present for an average of 45min. The TEAM was found to be feasible and quickly completed with minimal or no training. Discriminant validity was good as was internal consistency with a Cronbach alpha of 0.94. Uni-dimensional and concurrent validity also reached acceptable standards, 0.94 and >0.63 (p=<0.001), respectively, and a single ‘teamwork’ construct was identified. Non-technical skills overall were good but leadership was rated notably lower than task and teamwork performance indicating a need for leadership training. ConclusionThe TEAM is a feasible, valid and reliable non-technical assessment measure in simulated and real clinical settings. Emergency teams need to develop leadership skills through training and reflective debriefing.

An Event-Based Approach to Design a Teamwork Training Scenario and Assessment Tool in Surgery

Simulation is a technique recommended for teaching and measuring teamwork, but few published methodologies are available on how best to design simulation for teamwork training in surgery and health care in general. The purpose of this article is to describe a general methodology, called event-based approach to training (EBAT), to guide the design of simulation for teamwork training and discuss its application to surgery. The EBAT methodology draws on the science of training by systematically introducing training exercise events that are linked to training requirements (i.e., competencies being trained and learning objectives) and performance assessment. The EBAT process involves: Of the 4 teamwork competencies endorsed by the Agency for Healthcare Research Quality and Department of Defense, "communication" was chosen to be the focus of our training efforts. A total of 5 learning objectives were defined based on 5 validated teamwork and communication techniques. Diagnostic laparoscopy was chosen as the clinical context to frame the training scenario, and 29 KSAs were defined based on review of published literature on patient safety and input from subject matter experts. Critical events included those that correspond to a specific phase in the normal flow of a surgical procedure as well as clinical events that may occur when performing the operation. Similar to the targeted KSAs, targeted responses to the critical events were developed based on existing literature and gathering input from content experts. Finally, a 29-item EBAT-derived checklist was created to assess communication performance. Like any instructional tool, simulation is only effective if it is designed and implemented appropriately. It is recognized that the effectiveness of simulation depends on whether (1) it is built upon a theoretical framework, (2) it uses preplanned structured exercises or events to allow learners the opportunity to exhibit the targeted KSAs, (3) it assesses performance, and (4) it provides formative and constructive feedback to bridge the gap between the learners' KSAs and the targeted KSAs. The EBAT methodology guides the design of simulation that incorporates these 4 features and, thus, enhances training effectiveness with simulation.