Assessing Team Leadership in Emergency Medicine: The Milestones and Beyond

Elizabeth D. Rosenman; Jeremy B. Branzetti; Rosemarie Fernandez

摘要

Background?Team leadership is a critical skill for emergency medicine physicians that directly affects team performance and the quality of patient care. There exists a robust body of team science research supporting team leadership conceptual models and behavioral skill sets. However, to date, this work has not been widely incorporated into health care team leadership education.;Objective?This narrative review has 3 aims: (1) to synthesize the team science literature and to translate important concepts and models to health care team leadership; (2) to describe how team leadership is currently represented in the health care literature and in the Accreditation Council for Graduate Medical Education Milestones for emergency medicine; and (3) to propose a novel, evidence-based framework for the assessment of team leadership in emergency medicine.;Methods?We conducted a narrative review of the team science and health care literature. We summarized our findings and identified a list of team leadership behaviors that were then used to create a framework for team leadership assessment.;Results?Current health care team leadership measurement tools do not incorporate evidence-based models of leadership concepts from other established domains. The emergency medicine milestones include several team leadership behaviors as part of a larger resident evaluation program. However, they do not offer a comprehensive or cohesive representation of the team leadership construct.;Conclusions?Despite the importance of team leadership to patient care, there is no standardized approach to team leadership assessment in emergency medicine. Based on the results of our review, we propose a novel team leadership assessment framework that is supported by the team science literature.;Introduction Team leadership is a critical team skill that directly impacts team performance and patient care.1–3 In a report by The Joint Commission, failures in team leadership were linked to more than 50% of adverse events in acute health care settings.4 Additionally, a study of health care teams identified lack of a proficient team leader as a significant safety risk.5 Team leadership is even more critical under the uncertain and time-pressured conditions faced in the emergency department setting.6 Several widely implemented clinical training programs (eg, Advanced Cardiovascular Life Support, Pediatric Advanced Life Support, and Advanced Trauma Life Support) include a team leadership component, reinforcing the importance that team leadership plays in the provision of advanced resuscitation care.7–9 There has also been increased emphasis on team leadership training and assessment in graduate medical education overall,10,11 and within the specialty of emergency medicine (EM).12 While the number of studies describing efforts in team leadership training and assessment has risen exponentially over the past decade, the best mechanisms for effectively training and assessing team leadership within EM remain elusive.13,14 This knowledge gap leaves EM residency programs to approach this task in isolation, resulting in a wide variation in how team leadership is defined, trained, and assessed. The objective of this review article is to (1) synthesize the team science literature and translate important concepts and models to health care team leadership; (2) describe how team leadership is currently assessed within the health care literature and in the Accreditation Council for Graduate Medical Education (ACGME) milestones for EM; and (3) propose a novel, evidence-based framework for team leadership assessment in EM.;Discussion Effective team leaders elevate the performance of the team, help the team adapt to changes in their environment, and ensure that team performance remains strong despite environmental or patient care challenges.2 Behaviors necessary for effective leadership are largely dependent on the nature of the team, the task, and the environment. Our review focuses on EM teams

机译：背景？团队领导是紧急医学医师的关键技能，直接影响团队表现和患者护理的质量。存在一个强大的团队科学研究支持团队领导概念模型和行为技能。然而，迄今为止，这项工作尚未被广泛纳入医疗保健团队领导教育。目标？这个叙述审查有3个目标：（1）综合团队科学文献，将重要的概念和模型转化为医疗保健团队领导; （2）描述如何在医疗保健文学和急诊医学研究生医学教育里程碑的认可理事会中代表团队领导力; （3）为评估急救医学中的团队领导，提出一部基于循证的框架。;方法？我们对团队科学和医疗保健文学进行了叙述审查。我们总结了我们的调查结果，并确定了一份团队领导行为列表，然后用于为团队领导评估创建一个框架。;结果？当前的医疗团队领导力测量工具不纳入其他既定域的证据领导概念模型。紧急医学里程碑包括若干团队领导行为，作为更大的常驻评估计划的一部分。然而，他们没有提供团队领导力建设的全面或凝聚力代表。;结论？尽管团队领导对患者关怀的重要性，但在紧急医学中没有标准化的领导评估。根据我们的评论结果，我们提出了一部新的团队领导评估框架，这些框架是团队科学文献的支持。;介绍团队领导是一项关键的团队技能，直接影响团队表现和患者护理.1-3联合委员会，团队领导的失败与急性医疗保健设施中超过50％的不良事件相关联.4另外，对医疗团队的研究确定了缺乏熟练的团队领导，作为一个重要的安全风险.5团队领导力是在急诊部门环境中面临的不确定和延时条件下更为关键.6若干广泛实施的临床培训计划（例如，先进的心血管寿命支持，儿科先进的生命支持和先进的创伤生涯支持）包括团队领导成分，加强团队领导力在提供先进的复苏护理中发挥的重要性.7-9也有增加重点eam领导培训和研究生医学教育总体培训和评估总体，11,11和急诊医学（EM）的特产为了有效培训和评估EM中的团队领导仍然难以捉摸.13,14这一知识差距让EM居住计划孤立地接近这项任务，导致团队领导如何定义，培训和评估的广泛变化。本综述文章的目的是（1）综合团队科学文献，将重要的概念和模型转化为医疗保健团队领导; （2）描述如何在医疗保健文学中以及对EM的研究生医学教育（ACGME）里程碑的认可理事会内评估团队领导力; （3）提出了一种新的循证课程，用于EM的团队领导评估。;讨论有效的团队领导者提升了团队的表现，帮助团队适应他们环境的变化，并确保仍然存在环境仍然强劲或患者护理挑战.2有效领导所需的行为在很大程度上取决于团队的性质，任务和环境。我们的评论重点是EM团队

Assessing Team Leadership in Emergency Medicine: The Milestones and Beyond

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