Team cognition in healthcare simulation: a framework for deliberate measurement

Abstract

Introduction: Team mental models and team situational awareness are key components of healthcare team simulation. Human factors and organizational psychology researchers have developed clear definitions and theories about these concepts that are at times 'lost in translation' within the prevailing forms of measurement and training utilized in healthcare. Simulation research to date has often relied upon indirect and imprecise measures and a conceptualization of team cognition that ill equips simulation educators as they endeavour to optimize healthcare team performance.

Methods: We present a narrative review that examines how team cognition is assessed in healthcare team simulation, critically consider assessment strategies described in key studies, and contrast them to advances in human factors and organizational psychology.

Results: This study presents a framework that reconceptualizes how we measure team cognition in healthcare simulation along the matrices of directness and timing of evaluation. We pair this framework with a table that exemplifies extant measurement techniques and highlight how simulation educators may decide between different 'types' of assessment based upon their needs.

Discussion: We offer recommendations for educators to consider capturing team cognition before, during, and after simulation. We also offer recommendations for researchers to develop tools that may be more readily applied across key settings.

Conclusion: Here, we present a framework of team cognition for healthcare action teams that advances healthcare simulation to better align with human factors and organizational psychology literature. This work will guide healthcare simulation educators and researchers on their quest to optimize team performance through improved team cognition.

Trial registration: None.

Keywords: Action teams; Crisis resource management; Healthcare simulation; Healthcare teams; Mental model; Nontechnical skills; Observation; Situational awareness; Team cognition; Team training.

Fig. 1

A framework for team cognition measure types. Six categories of team cognition measures as defined by timing and directness of measures. Indirect, post-task measures are highlighted with a darkened box because this is the measurement type dominated by the prevailing team cognition measure evidenced by tools such as NO-TECHS [18] and ANTS [25]. Remaining measure types are all reflected in the healthcare literature, with the exception of pre-task indirect measures (i.e. marked in a checkered box); despite being a plausible measure type, this was not identified in our review of cognition measures