Rating the quality of teamwork-a comparison of novice and expert ratings using the Team Emergency Assessment Measure (TEAM) in simulated emergencies

Background: Training in teamwork behaviour improves technical resuscitation performance. However, its effect on patient outcome is less clear, partly because teamwork behaviour is difficult to measure. Furthermore, it is unknown who should evaluate it. In clinical practice, experts are obliged to participate in resuscitation efforts and are thus unavailable to assess teamwork quality. Consequently, we sought to determine if raters with little clinical experience and experts provide comparable evaluations of teamwork behaviour.

Methods: Novice and expert raters judged teamwork behaviour during 6 emergency medicine simulations using the Teamwork Emergency Assessment Measure (TEAM). Ratings of both groups were analysed descriptively and compared with U and t tests. We used a mixed effects model to identify the proportion of variance in TEAM scores attributable to rater status and other sources.

Results: Twelve raters evaluated 7 teams rotating through 6 cases, for a total of 84 observations. We found no significant difference between expert and novice ratings for 7 of the 11 items of the TEAM or in the sums of all item scores. Novices rated teamwork behaviour higher on 4 items and overall. Rater status accounted for 11.1% of the total variance in scores.

Conclusions: Experts' and novices' ratings were similarly distributed, implying that raters with limited experience can provide reliable data on teamwork behaviour. Novices show a consistent, but slightly more lenient rating behaviour. Clinical studies and real-life teams may thus employ novices using a structured observational tool such as TEAM to inform their performance review and improvement.