Surgeons do not typically receive training in the areas of leadership, communication and teamwork. A recent study finds standardized training in these areas could be a valuable tool to improve teamwork among surgical teams.

November 16, 2009

Senior surgical residents at Christiana Care, an ACS-verified Level 1 trauma center in Newark, DE, are responsible for leading the trauma activations at the facility. According to physicians at the facility, the residents do not receive any formal training in the way of leadership, teamwork or communication. These skills are extremely important in terms of the residents’ abilities to work with their colleagues to maintain the highest level of patient safety. Communication skills are also crucial when dealing with patients and their families.

As a result of the lack of formal education in these areas, physicians at the facility observed varying levels of competency in terms of leadership, communication and teamwork during a trauma response. Using the TeamSTEPPS curriculum developed by the Agency for Healthcare Research and Quality (AHRQ)/Department of Defense to train residents in teamwork and communication skills, the researchers trained surgical residents at the hospital in these areas. They surveyed the residents on their perceptions of leadership, communication and teamwork before and after training, and hypothesized that if residents received formal training, team functioning and communication during a trauma response will improve.

According to the AHRQ website, TeamSTEPPS is a teamwork system designed for healthcare to improve patient safety, communication and teamwork. It is rooted scientifically in more than 20 years of research and lessons from application teamwork principles. The system is a three-phased process to create and sustain safety. The three steps of the system include:

Phase 1 - Assess the Need
Phase 1 determines an organization’s readiness for undertaking TeamSTEPPS and acts as a training needs analysis.

Phase 2 - Planning, Training and Implementation
Phase 2 involves the planning and execution segment of the system. TeamSTEPPS is designed to be tailored to the organization, so this phase includes options like implementation of all the tools and strategies in the organization, a phased-in approach that targets specific units/departments, or selection of individual tools at specific intervals.

Phase 3 - Sustainment
Phase 3 works to sustain and spread improvements in teamwork performance, clinical processes and outcome resulting from TeamSTEPPS. According to the website, the key is to ensure opportunities exist to implement the tools and strategies taught, practice and receive feedback on skills, and provide continual reinforcement of the principles on the unit or within the department.

In the study, conducted by Nicole Fox, MD, et al, the researchers surveyed 26 surgical residents at the facility to assess their perception prior to team training. A 4-hour training session was held in July 2007, and one trauma conference/month and 2 surgical grand rounds were dedicated to reinforcing team training skills. The initial survey was repeated in May 2008.

Based on the survey results, residents perceived an improvement in the team’s ability to measure performance. They indicated they felt their team roles were better defined, that the team worked well together, communicated more effectively and perceived an improvement in the team’s ability to resolve conflict.

From these findings, the researches concluded that teaching leadership, teamwork and communications skills through a standardized curriculum, like TeamSTEPPS, these skills can improve among residents. As the researchers state, surgeons typically do not receive formal training in these areas, yet are expected to perform these skills everyday in the OR and trauma bay. While further research is necessary, it seems a standardized curriculum could be facilities’ solution to enhancing leadership, communication and teamwork among its team to provide the highest standard of care for patients.


"Team Training: A tool to improve resident teamwork and communication." Nicole Fox MD, MPH, Steven Johnson MD, Nicholas Gagliano MD, Brent Passarello, MD, Carol Moore RN, Debra Resurrecion RN, James Reed MPH. Christiana Care, Newark, DE