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Team and leadership training

Question Type:
Intervention
Full Question:
Among students who are taking advanced life support courses in an educational setting (P), does inclusion of specific leadership or team training (I), compared with no such specific training (C), change improve patient outcomes, bystander CPR performance, skill performance in actual resuscitations, skill performance at 1 year, skill performance at course conclusion, cognitive knowledge (O)?
Consensus on Science:
For the critical outcome of patient survival, we found no randomized clinical trials but found very-low-quality evidence (downgraded for risk of bias and indirectness) from 2 observational studies.(Neily 2010, 1693; Andreatta 2011, 33) One study documented an increase in hospital survival from pediatric cardiac arrest over a 4-year period after implementation of a hospital-wide mock code program, which included team training.(Andreatta 2011, 33) The other study documented reduced severity-adjusted surgical mortality in 74 hospitals in the United States that had implemented a surgical team training program, compared with 34 hospitals that had not introduced such a program.(Neily 2010, 1693)For the critical outcome of skill performance in actual resuscitation, we found very-low-quality evidence (downgraded for risk of bias, indirectness and imprecision) from a single RCT that randomly assigned 32 internal medicine residents to receive simulation training with a focus on the role of the resuscitation team leader versus no additional training; there was no effect on CPR quality during actual resuscitation of patients.(Weidman 2010, 1556) We also found very-low-quality evidence (downgraded for risk of bias, inconsistency, indirectness, and imprecision) from 2 observational studies.(Nadler 2011, 163; Su 2014, 856)For the important outcome of skill performance at 4 months to 1 year (patient tasks), we found very-low-quality evidence (downgraded for risk of bias, inconsistency and imprecision) from 2 randomized trials(Hunziker 2010, 1086; Thomas 2010, 539) that showed that team or leadership training improved CPR hands-on time and time to initiation of various patient tasks at follow-up assessment. For the important outcome of skill performance at 4 months to 1 year (teamwork performance), we found low-quality evidence (downgraded for bias and imprecision) from a single randomized trial(Thomas 2010, 539) and very-low-quality evidence (downgraded for risk of bias) from a single observational study(Garbee 2013, 339) that showed more frequent teamwork behaviors demonstrated in the teamwork-trained learners at follow-up assessment.For the important outcome of skill performance at 4 months to 1 year (leader performance), we found moderate-quality evidence (downgraded for risk of bias) from a single randomized trial(Hunziker 2010, 1086) and very-low-quality evidence (downgraded for risk of bias and imprecision) from a single observational study(Gilfoyle 2007, e276) that showed more frequent leadership behaviors demonstrated in the leadership-trained learners at follow-up assessment. For the important outcome of skill performance at course conclusion (patient tasks) (assessed with time to completion of various patient tasks), we found low-quality evidence (downgraded for risk of bias and imprecision) from 8 randomized trials(Hunziker 2009, 3; Hunziker 2010, 1086; Thomas 2010, 539; Chung 2011, 690; Fernandez Castelao 2011, 1338; Jankouskas 2011, 316; Fernandez 2013, 2551; Blackwood 2014, e168) and very-low-quality evidence (downgraded for risk of bias and indirectness) from 4 observational studies(DeVita 2005, 326; Makinen 2007, 264; Yeung 2012, 2617; Blackwood 2014, e168) that showed that team or leadership training improved CPR hands-on time and time to initiation of various patient tasks at course conclusion. A dose-response gradient was found. For the important outcome of skill performance at course conclusion (teamwork performance) (assessed with teamwork score), we found low-quality evidence (downgraded for risk of bias and imprecision) from 6 randomized studies(Thomas 2007, 409; Thomas 2010, 539; Chung 2011, 690; Fernandez Castelao 2011, 1338; Jankouskas 2011, 316; Fernandez 2013, 2551) and very-low-quality evidence (downgraded for risk of bias, indirectness, inconsistency and imprecision) from 3 observational studies(Makinen 2007, 264; Garbee 2013, 339; Sawyer 2014, 781) that showed that teamwork-trained learners demonstrated more frequent teamwork behaviors at course conclusion. For the important outcome of skill performance at course conclusion (leader performance), we found low-quality evidence (downgraded for risk of bias and imprecision) from 4 randomized studies(Cooper 2001, 33; Hunziker 2009, 3; Hunziker 2010, 1086; Blackwood 2014, e168) and very-low-quality evidence (downgraded for indirectness and imprecision) from 2 observational studies(Gilfoyle 2007, e276; Yeung 2012, 2617) that showed that leadership-trained learners demonstrated more frequent leadership behaviors at course conclusion.For the important outcome of cognitive knowledge, we found no evidence.
Treatment Recommendation:
We suggest that team and leadership training be included as part of ALS training for healthcare providers (weak recommendation, low-quality evidence).Values, Preferences, and Task Force InsightsIn making this recommendation, we have placed emphasis on the potential benefit, lack of harm, and high level of acceptance of team and leadership training and lesser value on associated costs. There are many ways that leadership and team behavior training can be delivered. As such, there was considerable heterogeneity in the studies analyzed. It was recognized that there are multiple variables other than direct instruction on a life support course that contribute to the development of leadership skills. There are numerous studies from outside the medical literature that could have been included, but these were considered not to be directly relevant to the PICO.
CoSTR Attachments:
EIT 631 Slides team leadership 2015-Final.pdf    
EIT 631 Team articles summary bias_n.xlsx    
EIT 631 Team Training GRADE RCT.pdf    
EIT 631Team Training GRADE non-RCT.pdf    

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