Differences in talking-to-the-room behaviour between novice and expert teams during simulated paediatric resuscitation: a quasi-experimental study

Abstract

Background: Team coordination represents an important factor for clinical performance. Research in this area suggests that not only behaviour frequencies but also patterns of team coordination constitute a central aspect of teamwork. However, little is known about potential differences in coordination patterns between novice teams (ie, teams of inexperienced members) and expert teams (ie, teams of experienced members). The current study addresses this gap by investigating the use of talking-to-the-room-an important implicit coordination behaviour-in novice teams versus expert teams.

Aim: To illustrate differences in coordination behaviour between novice and expert teams. This will provide important knowledge for simulation-based training.

Methods: The study was conducted in the context of two resuscitation training courses (introductory course and refresher course) for staff members at a children's hospital. Volunteers from both courses participated in the study. They were randomly assigned to 16 teams each consisting of one physician and two nurses. The study used a quasi-experimental design with two conditions (novice vs expert). Participants of the introductory course were assigned to the novice condition (eight teams), and participants of the refresher course were assigned to the expert condition (eight teams). All teams completed the same standardised paediatric resuscitation scenario. They were videotaped during the simulation, and team coordination behaviour was coded using Co-ACT.

Results: Lag-sequential analysis of 1902 distinct coordination acts revealed that novice teams and expert teams differed significantly in their coordination behaviour. Expert teams were characterised by patterns in which implicit coordination behaviour (ie, talking to the room) was followed by further implicit coordination behaviour and not followed by explicit coordination behaviour (ie, instructions), whereas the reverse was found for novice teams.

Conclusion: The current study highlights role of coordination patterns for understanding teamwork in healthcare and provides important insights for team training.

Keywords: behavioural observation; coordination; talking-to-the-room; team training; teamwork.

Figure 1

Difference in talking-to-the-room patterns between expert and novice teams. Solid lines indicate coordination patterns that occurred significantly above chance, and dotted lines indicate patterns that did not. Action TTTR = action-related talking-to-the-room; Info TTTR = information-related talking-to-the-room; Instruction = giving instructions.