Approaching the Evidence Basis for Aviation-Derived Teamwork Training in Medicine

Zeltser, Marina; Nash, David B.

doi:10.1177/1062860609345664

Cited by 69 publications

(45 citation statements)

References 23 publications

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“…For example, process measures (eg, introduction of new procedures, use of checklists, assessments of the quality of team briefing) are a useful way to assess the impact of training on unit level processes that may be an intermediary in the path of influence to clinical care outcomes. The situation is summed up succinctly by Zeltser et al 11 who state that “research examining the effectiveness of CRM training will need to operationalise terminology for outcome measures and hone in on specific relationships among variables with explicit plausibility for causation”.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of the effectiveness of crew resource management training in acute care domains

O’Dea

O’Connor

Keogh

2014

Postgraduate Medical Journal

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The healthcare industry has seen an increase in the adoption of team training, such as crew resource management (CRM), to improve teamwork and coordination within acute care medical teams. A meta-analysis was carried out in order to quantify the effects of CRM training on reactions, learning, behaviour and clinical care outcomes. Biases in the research evidence are identified and recommendations for training development and evaluation are presented. PUBMED, EMBASE and PsychInfo were systematically searched for all relevant papers. Peer reviewed papers published in English between January 1985 and September 2013, which present empirically based studies focusing on interventions to improve team effectiveness in acute health care domains, were included. A total of 20 CRM-type team training evaluation studies were found to fulfil the a priori criteria for inclusion in the meta-analysis. Overall, CRM trained participants responded positively to CRM (mean score 4.25 out of a maximum of 5), the training had large effects on participants' knowledge (d=1.05), a small effect on attitudes (d=0.22) and a large effect on behaviours (d=1.25). There was insufficient evidence to support an effect on clinical care outcomes or long term impacts. The findings support the premise that CRM training can positively impact teamwork in healthcare and provide estimates of the expected effects of training. However, there is a need for greater precision in outcome assessment, improved standardisation of methods and measures, and more robust research design. Stronger evidence of effectiveness will require multi-level, multicentre, multispecialty and longitudinal studies.

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Section: Discussionmentioning

confidence: 99%

A meta-analysis of the effectiveness of crew resource management training in acute care domains

O’Dea

O’Connor

Keogh

2014

Postgraduate Medical Journal

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“…The experience of the aviation industry is often referenced in this regard. While healthcare educators stress the increased complexity of working within the more uncertain clinical environment, there is evidence that crew resource management training has a role in healthcare teamwork training under certain conditions (Zeltser & Nash, 2010). In the business world more broadly, there are clear indications of how and why teams dysfunction (Edmondson, 2012;Gittell, 2003;Lencioni, 2002).…”

Section: Learning Together To Work Togethermentioning

confidence: 98%

Interprofessional collaborative practice and relational coordination: Improving healthcare through relationships

Gittell

Godfrey

Thistlethwaite

2012

Journal of Interprofessional Care

229

173

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“…The health sector shares commonalities with industrial sectors including vulnerability to human errors [11, 14]. Therefore, a better understanding of the available evidence on cognitive biases influencing medical decisions is crucial.…”

Section: Introductionmentioning

confidence: 99%

Cognitive biases associated with medical decisions: a systematic review

Saposnik

Redelmeier

Ruff

et al. 2016

BMC Med Inform Decis Mak

702

577

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BackgroundCognitive biases and personality traits (aversion to risk or ambiguity) may lead to diagnostic inaccuracies and medical errors resulting in mismanagement or inadequate utilization of resources. We conducted a systematic review with four objectives: 1) to identify the most common cognitive biases, 2) to evaluate the influence of cognitive biases on diagnostic accuracy or management errors, 3) to determine their impact on patient outcomes, and 4) to identify literature gaps.MethodsWe searched MEDLINE and the Cochrane Library databases for relevant articles on cognitive biases from 1980 to May 2015. We included studies conducted in physicians that evaluated at least one cognitive factor using case-vignettes or real scenarios and reported an associated outcome written in English. Data quality was assessed by the Newcastle-Ottawa scale. Among 114 publications, 20 studies comprising 6810 physicians met the inclusion criteria. Nineteen cognitive biases were identified.ResultsAll studies found at least one cognitive bias or personality trait to affect physicians. Overconfidence, lower tolerance to risk, the anchoring effect, and information and availability biases were associated with diagnostic inaccuracies in 36.5 to 77 % of case-scenarios. Five out of seven (71.4 %) studies showed an association between cognitive biases and therapeutic or management errors. Of two (10 %) studies evaluating the impact of cognitive biases or personality traits on patient outcomes, only one showed that higher tolerance to ambiguity was associated with increased medical complications (9.7 % vs 6.5 %; p = .004). Most studies (60 %) targeted cognitive biases in diagnostic tasks, fewer focused on treatment or management (35 %) and on prognosis (10 %). Literature gaps include potentially relevant biases (e.g. aggregate bias, feedback sanction, hindsight bias) not investigated in the included studies. Moreover, only five (25 %) studies used clinical guidelines as the framework to determine diagnostic or treatment errors. Most studies (n = 12, 60 %) were classified as low quality.ConclusionsOverconfidence, the anchoring effect, information and availability bias, and tolerance to risk may be associated with diagnostic inaccuracies or suboptimal management. More comprehensive studies are needed to determine the prevalence of cognitive biases and personality traits and their potential impact on physicians’ decisions, medical errors, and patient outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0377-1) contains supplementary material, which is available to authorized users.

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Approaching the Evidence Basis for Aviation-Derived Teamwork Training in Medicine

Cited by 69 publications

References 23 publications

A meta-analysis of the effectiveness of crew resource management training in acute care domains

A meta-analysis of the effectiveness of crew resource management training in acute care domains

Interprofessional collaborative practice and relational coordination: Improving healthcare through relationships

Cognitive biases associated with medical decisions: a systematic review

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