Simulation, Team Training, Debriefing

Hendrik Eismann, Jörn Halser, Mathias Robert, Markus Flentje

Hintergrund: Das Arbeitsumfeld der prähospitalen Notfallmedizin stellt die Rahmenbedingungen einer Hochrisikoorganisation dar. Nicht-technische Kompetenzen sind eine wichtige Grundlage für erfolgreiche Teamleistungen. In Deutschland wurde 2014 ein neues Berufsbild – Notfallsanitäter:in – eingeführt, für das erstmals auch nicht-technische Kompetenzen in den Lehrplan aufgenommen wurden. Erstmals wurde geregelt, wie Rettungsfachpersonal bei ausgewählten erweiterten Maßnahmen, wie beispielsweise der Verabreichung ausgewählter Medikamente, vorgehen. Notfallsanitäter:innen müssen jährlich 30 Stunden Fortbildung absolvieren. Da es keine inhaltlichen Vorgaben gibt, haben wir untersucht, ob die Ausbildung nicht-technischer oder technischer Kompetenzen die Versorgung eines simulierten Patienten verbessert. Die Ergebnisse sollen Aufschluss darüber geben, welche Schwerpunkte in der Fortbildung gesetzt werden sollten.
Methode: Die Teams wurden während der Fortbildung randomisiert und die Nachbesprechungen fanden je nach Studienarm mit Schwerpunkt auf nicht-technischen Fähigkeiten oder Algorithmen basierten technischen Fertigkeiten statt. Sechs Monate später bewerteten wir die Leistung der Teams in einem Simulationsszenario anhand des „Time-Key-Item-Product“ Scores und der Anwendung von Methoden des Incident Managements.
Ergebnisse: Beim Vergleich der Leistung mit Crisis Resource Management (CRM)/ nicht-technischen Fähigkeiten und technischer Ausbildung fanden wir keinen signifikanten Unterschied im Time-Key-Item-Product score (TKIP). Auch bei der Anwendung von Methoden des Incident Managements gab es keine Unterschiede. Checklisten wurden nur in geringer Anzahl verwendet. Über die Hälfte der Teams schaffte es nicht, 75 % der geforderten Maßnahmen im Szenario durchzuführen.
Schlussfolgerung: Es fällt auf, dass nur wenige Gruppen alle geforderten Maßnahmen durchgeführt haben. Die unvollständige Behandlung lässt darauf schließen, dass die Verwendung von Checklisten Notfallteams helfen kann. Der Umgang mit nicht-technischen Fähigkeiten sollte intensiv trainiert werden, da deren Einsatz noch nicht routinemäßig zu erfolgen scheint.

Anna Pałyga, Heide Lukosch

Purpose: This article provides insights into the methodology of research that can serve to gain a deep understanding of team functional communication patterns. The study aimed to show how disciplined observation and speech-act theory can be a useful tool for measuring behavior and uncovering insights that might not be apparent through other research methods. As a result of this methodological approach, the article presents selected cases of team communication patterns with an in-depth analysis. Design/methodology/approach: We employed a disciplined observation method for functional communication coding, well established in psycholinguistics and adapted for the purpose of research in gameplay. The approach involved trained behavioral coders systematically recording and analyzing functional communication observations. We recorded teams in decision-making processes during business simulation games and analyzed them using quantitative and qualitative methods. Findings: The analysis revealed that winning teams used significantly more References to Present Objects (RPO) and References to Self (RTS), while losing teams employed more Registering Disapproval (DAP). These results might indicate that team success depended less on communication quantity and more on the pragmatic alignment of speech acts. Moreover, we observed other specific communication patterns in both team types, such as asking Questions (QST) or Responses (RES). The findings suggest that speech-act theory and disciplined observation can provide valuable insights into team communicative patterns of game play. Practical implications: The findings from this study have practical implications for team leaders and managers. By recognizing communication patterns linked to team effectiveness, leaders can foster cohesion and performance. Practically, training should promote grounding strategies (RPO), encourage explicit commitment (RTS), and reframe disapproval (DAP) into constructive feedback. Ultimately, team success does not depend on communication volume but speech acts that translate language into coordinated action. More importantly, using speech-act theory and disciplined observation, leaders can design targeted interventions to enhance team performance. Originality/value: This research provides a unique perspective on measuring team communication in gameplay. It adds to the growing body of literature on team communication by showing how this approach can serve to gain insights into communication patterns that are useful to analyze game play and its effects. Furthermore, this research provides valuable insights for practitioners and researchers interested in team communication and gameplay performance.

Jan B. Schmutz, Mirko Antino

ABSTRACT Teamwork is vital for patient safety and clinical performance, yet measuring it reliably in healthcare simulation remains challenging. This article offers a practical overview of three common approaches to assess teamwork: survey measures, systematic behavioural observation (SBO) and Behaviourally Anchored Rating Scales (BARS). Surveys capture how team members perceive their teamwork and are best suited for shared psychological states such as trust or cohesion. SBO records what teams actually do in real time, allowing detailed analysis of interaction patterns. BARS combine observation with evaluative judgement, providing structured and feedback-oriented assessments of teamwork quality. The article also highlights key issues in measurement quality, including reliability, validity, rater training and level of analysis. No single method captures teamwork fully; the choice depends on purpose and resources. Combining methods often yields the most complete understanding and supports targeted debriefing, improved training and ultimately, better patient care. Key points:
- Teamwork is essential for clinical performance and patient safety but challenging to measure reliably in simulation.
- Three complementary measurement methods can be used: surveys, systematic behavioural observation (SBO) and Behaviourally Anchored Rating Scales (BARS).
- Surveys assess perceptions and shared psychological states; behavioural observation captures real actions; BARS evaluate the quality of observed behaviours.
- High-quality teamwork measurement requires clear definitions and checks for validity and reliability, including rater training.
- Combining multiple methods provides the most comprehensive picture of teamwork and supports targeted debriefing and improvement.

Kolbe, M., Grande, B., Lehmann-Willenbrock, N., Seelandt. J.-C.

Background
Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants’ reflection in debriefings.
Methods
In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants’ verbalisation of a mental model as a particular form of reflection.
Results
The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers’ observation to debriefers’ opinion (z=9.85, p<0.001), from opinion to debriefers’ open-ended question (z=9.52, p<0.001) and from open-ended question to participants’ mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes.
Conclusion
When debriefers pair their observations and opinions with open-ended questions, paraphrase participants’ statements and ask specific questions, they help participants reflect during debriefings.

Gartmeier, M., Pfurtscheller, T., Hapfelmeier, A., Grünewald, M., Häusler, J., Seidel, T., Berberat, PO.

Background: Case-based learning (CBL) is a highly interactive instructional format widely used in medical education. One goal of CBL is to integrate basic biomedical knowledge and its application to concrete patient cases and their clinical management. In this context, we focus the role of teacher questions as triggers for reproductive vs. elaborative student responses. Specifically, our research questions concern the kinds of questions posed by clinical teachers, the kinds of responses given by students, the prediction of student responses based upon teacher questions, and the differences between the two medical disciplines in focus of our study, internal medicine and surgery.
Methods: We analyse 19 videotaped seminars (nine internal medicine, ten surgery) taught by clinicians and attended by advanced medical students. Multiple raters performed a low-inference rating process using a theorybased categorical scheme with satisfactory interrater-reliability.
Results: We found that medical teachers mostly posed initial (instead of follow-up) questions and that their questions were more often closed (instead of open). Also, more reasoning (than reproductive) questions were posed. A high rate of student non-response was observed while elaborative and reproductive student responses had a similar prevalence. In the prediction context, follow-up reasoning questions were associated with low nonresponse and many elaborative answers. In contrast, the highest student non-response rate followed open reproduction questions and initial reasoning questions. Most reproductive statements by students were made following closed reproduction questions.
Conclusions: These results deepen our understanding of interactive, questions-driven medical teaching and provide an empirical basis for clinical teachers to use questions in didactically fruitful ways.
Keywords: Case-based learning , Teacher questions , Teaching methods , Video study , Student elaboration

Grundgeiger, T., Scharf, M., Grundgeiger, J., Scheuchenpflug, R.

Emergency medical services personnel are involved in more transportation accidents and have higher fatality rates than do other professions, and traveling with light-and-siren is particularly risky. One factor that might contribute to transportation accidents is driver distraction. We investigated what kind of manual secondary tasks - distractions that require the driver to take at least one hand off the steering wheel - ambulance drivers face and compared the relative frequency and proportion of time spent in manual operations not related to driving for light-and-siren travel vs. non-light-and-siren travel. The results indicate that ambulance drivers face more manual distractions when traveling with light-and-siren than non-light-and-siren. In particular, operating the light-and-siren system is causing most of the manual distractions. We discuss the results and potential implication for practice.