2. 260 BAKER ETAL.
undermine patients' and health professionals' con- training. Finally, we offer a set of conclusions
fidence in the health care system itself. recommendations for future research.
Key to this chapter's orientation toward team-
work-related research, the IOM noted that the
majority of mehcal errors result from health care
system failures, rather than from individual
providers' substandard performance. Thus, in con- i
junction with its drive to implement organizational
crisis was to commission a review of the existing
of a team, we reviewed several often-cited d
tions (Dyer, 1984;Guzzo & Shea, 1992;M
STRUCTURE OF THIS CHAPTER Cohen, & Mohrman, 1995; Salas, Di
dence concerning the extent to which training med- includes the following four characteristic
ical personnel as teams is likely to improve patient teams consist of a minimum of two or
industries and presents a compelling argument for often work under conditions of high workload,
teamwork's relation to patient safety. In the next (d) teams embody the coordmation that re
section, we define the key characteristics of a team from task interdependency, which distingul
and discuss the principles that underlie successful teams from small groups.

3. 17. RELATION BETWEEN TEAMWORK AND PATIENT SAFETY a 261

4. :;ej
;&$ ' Teammate CharacteristicsFamiliarity Knowing the Task-relatedcompetencies,preferences, C
c.9;
>.&.,
f
k
@!$. (
EF;-
?.:%..
6
I
1 Mutual Performance Monitoring Tracking fellow team members' performance to ensure 1
that the work is running as expected and that proper r
procedures are followed
Team Leadership 1 Ability to direct / coordinate team members,assess
team performance,allocate tasks, motivate subordinates.
>*:?>:?
vcv:>
'3:.
.,?.
-: I Closed-LoopCommun~cat~on/ ) The ln~t~atlonof a message by the sender,the recelpt 13 ,
Information Exchange and acknowledgement of the message by the receiver,and ' *
.2
the ver~flcatlonof the message by the inlt~alsender
I
,.
c ATTITUDE COMPETENCIES
-4-
*. . 4
I Team Cohesion
I
g2.r I
:Y
. . I ..'1
' ' t t
ii$
. . L1*
I
'':a , 1
aura, mood, climate of the team's ~nternalenv~ronment ,
Collect~veOrlentation The bellef that a team approach 1sbetter than an
~ndlvrdualone
I Importance of Teamwork
L
Exhlblt 17-1 Essential Team Knowledge, Skiil, and Attltude (KSA)Cornpetenaer-adapted horn (Salar '4et al., 2001a)
Salas, & Baker, 1996), cross-training (Volpe, presented in Exhibit 17-1 provide an exce
Cannon-Bowers, Salas, & Spector, 1996), stress resource for designing team trai
management training (Driskell & Johnston, 1998), Cannon-Bowers and colleagues con
and team self-correction (Smith-Jentsch, Zeisig, I(SA competencies should serve as the
hcton, & McPherson, 1998). for conducting training needs analyses.
In ad&tion to the avadable team training research lishing a team's specific competency requrenl
and practical guidance, the team competencies trainers must specitj appropriate training strate

5. 17. RELATION BETWE
To meet this requirement, Cannon-Bowers and
offered detailed information on the
nature Of training required for developingparticular
ream
and the strategies that are likely
to be
(Cannon-Bowers et al., 1995).
~ i ~ d ~a successful team training program con-
Sdtute~more than developing team members'
AS. For example, because organizational factors
outsidethe training program itself affect the pro-
gram's success, conducting a needs analysis before
designing a training intervention is essential to
,
determiningthe best delivery method or instruc-
donal strategy. In addition, training developers
should take advantage of the increased practice
opportunities provided by certain training tools,
suchas advance organizers (e.g.,outlines, diagrams,
graphic organizers), preparatory information,
prepractice briefs, attentional advice, goal orienta-
don, and meta-cognitive strategies (Cannon-
Bowers & Salas, 1998).
lvate subord~nates
SUMMARY
jer, the receipt fie preceding section discussed the elements that
by the receiver,and . typify effective teamwork and effective team train-
nitial sender ing. High-performing teams exhibit a sense of col-
lective efficacs are dependent on each other, and
qembers to remaln
a means of task
ernal env~ronment
r than an
ed from [Salas 2
.owde an excellent;
trainil
:onten
as the
ialyses
'8
~dec
sta
;. A
believe that they can solve complex problems.
Moreover, effective teams are dynamic: they opti-
mize their resources, engage in self-correction,
compensate for each other by providing back-up
behaviors, and adapt as necessary. Because they can
often coordinate without communicating overtly,
effective teams can respond efficiently in high-
stress,time-restricted environments.
Designing training that will improve teamwork
skills on the job is a challenge. In virtually any field,
team training requires a comprehensive, sustained
strategy that targets many aspects of teamwork.
Teams operate in complex environments. Yet team
training is charged with improving trainee I<SAs
and fachtating desirable performance outcomes
(e.g., safety,timely and accurate responding, patient
welfare) under these conditions. Therefore, effec-
tive uaining programs must (a) systematically rep-
resent sound theory and a thorough needs analysis;
(p) provide trainees with information, demonstra-
hens, guided practice and timely diagnostic feed-
back and (c) reflect organizational cultures that
encouragethe transfer of the trained competencies
'O the task environment.
E N TEAMWORK AND PATIENT SAFETY 263
TEAMWORK IN HIGH-RISK CONTEXTS
Commercial Aviation
Because aviation constitutes a Field in whch mis-
takes can cause an unacce~tableloss of life and
property, the flight industry has been on the fore-
front of developing teamwork training to reduce
risk. Among the team training that have
evolved w i h n aviation, the best known is crew
resource management (CRM) training.
Recent research suggests that cRM training
results in heightened safety-related attitudes;
improved communication, coordination, and
decision-making behaviors; and enhanced error-
management skills (Helmreich & Merritt, 1998;
Wiener et al., 1993). CRM training also has demon-
strated consistentlv positive results across a wideL
range of team structures, including pilot crews,
maintenance crews, dispatch crews, and air traffic
control teams (Helmreich & Foushee, 1993; Oser,
Salas, Merket, & Bowers, 2001; Smith-Jentsch,
Baker, Salas, & Cannon-Bowers, 2001).
CRM has grown from focusing solely on aware-
ness and attitude change, to incorporating behav-
ioral skills training, to integrating training in
teamwork with training in technical flying skills, as
is the case with the U.S. Federal Aviation
Administration's new Advanced Qualification
Program (AQP). Recent reviews suggest that CRM
training results in positive reactions to teamwork
concepts, increased knowledge of teamwork prin-
ciples, and improved teamwork performance in the
simulator (Salas, Burke, Bowers, & Wilson, 2001b).
CRMS effect on the ultimate criterion-a reduc-
tion in the number of accidents-has yet to be
empirically established (Salas et al., 2001b).
However, accidents represent a poor criterion
methodologically,because they exhibit an extremely
low base rate (Helmreich & Foushee, 1993). Thus,
researchers have relied on surrogate measures-
like improvements in teamwork-related knowledge
and skills,behavioral demonstrations of CRM skills
on simulated fights, instructor evaluations of
trained versus untrained crews, and changes in an
organization's safety culture-to demonstrate the
effectiveness of CRM training.
Viewed in isolation, each piece of evidence con-
cerning the effectiveness of CRM training can be
dsputed; nevertheless, the pattern of results sug-
gests that CRM training does improve the margin of
aviation safety. In short, the reasonable inference is

6. 264 BAKER ETAL.
(Smith-Jentsch et al., 1998).
The other high-risk industry in which team training summaryhas grown to prominence is the military. The water-
shed for this reseatch was USS Vincennes' acciden- This secdon bneny the empmcal
crew CRM (Spiker, Silverman, Tourville, &
Nullmeyer, 1998). Current military aviation team

7. 17. RELATION BETWEEN TEAMWORK AND PATJENT SAFETY 265
to discussing,learning about, and preventing them. professionals (Gaba, 1998; Gaba, Howard, Fish,
CRM training-which falls under the domain of Smith, & Sowb, 2001a; Howard et al., 1992). To
<'teamtraining"-is one means for helping to bring facilitate this goal, ACRM training provides trainees
. &out this cultural shft. with critical incident case studies to review (Davies,
Moreover,AHRQ is not alone in recognizing the 2001). In addition, ACRM provides training in
importance of teamwork for improving the perfor- technical skill and in team KSAs. Training in the
mance of medical professionals. In concert with selected teamwork skills is intended to enable
AHRQ's goals, the Accreditation Council for trainees to learn from adverse c h c a l occurrences
Graduate hfedical Education (ACGLME) recently and to work more effectively with different leader-
identified several teamwork-related competencies ship, followership, and communication styles
that residents must master. These competencies (Gaba, Howard, Fish, Smith, & Sowb, 2001b).
include communication with patients and significant ACRM training takes place in a simulated operat-
others, patient counseling and education, working ing room (OR), after completing the reading assign-
with othcr health care professionals, and facilitating ments that precede each module. The simulated OR
, medcal school and residency. The results ulate a patient's breathing, pulses, heart and lung
revealed the importance of a number of teamwork- sounds, exhaled CO,, thumb twitches, and other
model, citing it as hlgh in impact but low in evi- module consists of a similar smucture: preassigned
dence supporting its effecuveness (Pizzi et al., readings, course introduction and review of materials,

8. 266 BAKER ETAL.
debriefing and a postcourse data collection. Each ACRM training on actual performance ou
scripted training scenario is approximately 45 min With respect to individd (i.e., technical)
long; each debriefing session lasts approximately mance, this lack of outcome-related
40 rnin (Gaba et al., 2001a).
training, is currently used at several major teaching constructive focus for future research. F
institutions in the United States and around the more, given the current state of simulation,
practitioners as well as for trainees. Moreover, teamwork skills might be worthwhile.
some malpractice insurers (i.e., Harvard Risk
Management Foundation) have lowered their rate
structure for hCRhf-trained anesthesiologists Med~eams'Purpose and Strategy
manEe on each dmension (Gaba et al.,-1998). ED team as a group of 3-10 (average = 6)
Measures of interrater agreement exhibited rq personnel who work interdependently d
values flames, Demaree, & Wolf, 1984) ranging shift and who have been trained to use

9. 17. RELATION BETWEEN TEAMWORK AND PATIENT SAFETY 267
and refined during three 5-day expert
CONCLUSIONS AND
RECOMMENDATIONS
Lacks a Theoretical Model of Team
Performance.
TO date, research has not developed a comprehen-
this gap in knowledge, the fust research effort we
advocate is to develop a theoretical medical team
performance model that hypothesizes (a) the rela-
tions among predictors of performance and (b) the
mance model that focuses on medical teams per se,
previous research has provided considerablerelevant
knowledge;the availability of this knowledge under-
lies several of the remaining conclusions.
m assertive ro
curriculum was
. .
analysis of these data indicated a positive effect of
training on orrtcome nitetia (e.g.,medical errors, patient
satisfaction;Morey et al., 2002). I-lowever, th~sstudy
suffered two significant limtations; participating
hospitals self-selectedinto either the experimental or
control groups, and observers were not blind to the
experimental conditions. To address this limitation, a
subsequent evaluation of MedTeams in labor and
delivery units is in progress, using a randomized clin-
ical trial design (Goldman, Shapiro, Mann, Risser, &
Greenberg,2002).
Summary
This chapter has summarized the general state of
medical team training. We concentrated our discus-
sion on ,%CRI and MedTeams, because these are
the most thoroughly documented medical team
training programs. These programs have made
progress in improving patient safety; nevertheless,
despite the encouraging nature of the extant data,
the degree to whch medical, CIirvI-inspired train-
ing LVIIIenhance patient safety remains in question.
nus, to provide a strategy for further investiga-
Qon,the final section of ths chapter integrates our
fhdngs into conclusions and recommendations
telexrantto medical team training.
Performance and Training can Help
the Medical Community Improve
Patient Safety.
As discussed in this chapter, a more general science
of team performance and training has evolved and
matured over the last 20 years. This science has
produced a number of principles, lessons learned,
tools, and guidelines that will serve the patient
safetymovement. Our recommendations are as fol-
lows: (a) that the medical community continue to
inform itself of the progress of this science
through a variety of venues (e.g., specialized work-
shops, books) and (b) that the medical community
enlist the help of team training experts to apply to
patient safety the principles, guidelines, and learn-
ing afforded by previous research.
Conclusion 3: Research Has Already
Identified Many of the Competencies
Necessary for Effective Teamwork
in Medical Environments.
Previous investigations have identified the compe-
tencies required for effective team functioning in
a number of complex settings. Many of these

10. 268 BAKER ETAL
competencies apply to the medical community.
However, as Cannon-Bowers and colleagues (1995)
noted, the team skills literature is confusing, contra-
dctory, and plagued with inconsistent labels and def-
initions. For example, across studies, different labels
are used to refer to the sameteamwork skills, and the
same labels are used to refer to different skills. Thus,
we recommend using a two-step process to develop
a taxonomy with standard nomenclature; thts taxon-
omy would name and define teamwork-related
KSAs that constitute the core cotnpetencies related to
successfulteamwork in the medical domain.
The first step in developingsuch a taxonomyis to
determine an appropriate level of explanation; the
constructs included in the taxonomy must be con-
ceptudzed broadly enough to span the medical field
yet be specific enough to facilitate valid measure-
ment. Further, although this list of core competen-
cies should reflect all relevant aspects of team
performance, it must be concise enough to generate
teamwork and team training research and to facilitate
team training needs analyses in organizations.
The second step, determining relevant core com-
petencies, encompasses two activities. One task is to
establish whtch of the many competencies mani-
I
fested in previous research arerelevantto virtuallyall
medical teams; another task is to identify core med-
4 ical team competencies that have not emerged from
team research in other domains. We believe that
Q using task analpc techniques (e.g., survey question-
3 naires, structured interviews, and unobtrusive obser-
3 vations) will yield the most valid information. We
3
also emphasize the importance of large-scale,strati-
-@
fied data collections, because the goal is to identify
,F .
14ji generic competency requirements with which the
medical community at-large concurs.
Conclusion 4: A Number of Proven
lnstructional Strategies are Available
for Promoting Effective Teamwork.
The science of team performance and training
has developed and validated numerous training
strategies that can provide requisite competencies
to teams who perform in complex environments.
Through a variety of formats and objectives,these
strategies extend beyond CRM training. We recom-
mend (a) that the medical community use these
strategies wherever possible, given that some are
relatively easy to design and deliver and @) that the
community explore strategies other than CRM to
Conclusion 5: Team-Training
Strategies Must Be Further
Adapted to Medical Needs.
We are convinced that no singlemodel of team tr
ing can be applied across all medical practi
contexts. For the purposes of this discuss
define a "practice" as a medical specialty or
cialty, such as emergency medicine, general or
medicine,intensive care, surgicalmedicine, or obs
rics. Medical practices differ dramatically acres
variety of criteria: size, purpose, duration, red
dancy of expertise, decision time, and conseque
of error, to name but a few
Moreover, a particular practice may opera
number of diverse contexts. As an example,
gency medicine providers function in hospital
in emergency-response mobile units, and on ba
fields. Similarly,to mention several obvious dis
tions, urban and rural general providers operate
independent or multipractitioner offices, as well
in community walk-in clinics. Neither the comp
tencies that impel successful teamwork nor an o
mal team-training strategy can be expected
generalize across all these contexts. And, of cour
not all members within the same team will ne
sarily need the same IGAs.
Therefore, in addition to the core-compete
taxonomy, we also recommend develop I
practice-specific taxonomies. These putative
onomies would not be redundant with the genen-
core-competency taxonomy. Rather, a practi
specific taxonomy would denote the specificK
requirements that are central to teamwork
a given practice. The medical content and p
dures that define this practice would drive
identification of relevant team competencies.
Virtually no previous research has addres
manner in which differences within and b
medical practices should be reflected in prac
specific taxonomies. Yet we find this issue su
Gently compelling to warrant further investiga
Because these taxonomies are derived from
medical characteristics of specific practices
contexts within them), subject-matter experts
represent each practice might be invaluablein i
tifying practice-specific team competencies th
not redundant with the generic core-compe
taxonomy. Nevertheless, we also suggest
researchers avail themselves of survey ques
naires, structured interviews, and unobtru
observations.

11. 17. RELATION BETWEEN TEAMWORK AND PATIENT SAFETY .269
analysis to investigate the behaviors that result in
successful and unsuccessful performance during
medical school and residency. Although not origi-
siderable Progress in Designing nally targeted toward team performance, the results
Team Training revealed the importance of a number of teamwork-
,,,,, a i umber of Settings. related competencies.
Simply stated, for medical team training to deliver
ourreviewof team training programs clearly shows the impact that it can potentially exert on patient
that he community is strivingto implement safety, it must be instantiated at every stage of a
mftf&ing across a number of medical domains. provider's workinglife. For example, certain medical
we recommend that this trend be continued. school assignments might require students to pre-
However, the extent to whch these programs are pare team projects. Interns and residents might
being
implemented with the help of what we know observe, participatein, and evaluatepracticingteams
the science of learfig, of team performance, in hospitals. The larger challenge, however, occurs
uld of training is less dear. Thus, we recommend after pro~ldershave completed their formal training.
ening the link between scientific knowledge We believe that the structure of health care, as
al team training. Furthermore, as noted currently conceptualized, does offer appropriate
the medical community should explore junctures where teamwork skills could be evaluated.
that medical team training be developed to it might ultimatelybe usefui to develop a board certi-
nflect the established instructional principles that fication test for teamwork. Such an exam might com-
team-training research. Second, we recom- bine a written test of knowledge and situational
.earnworknor an 0 mendthat the quhty of these programs be evaluated judgment with performance in a simulated scenario.
on the basis of confirmed scientific criteria (e.g., Because the board examinationsare practice specific,
assessing the degree to whch training transfers to theit teamwork component could assess practice-
he actual work environment). specific teamwork competencies. In addition, the
Joint Commission on Accrehtation of Healthcare
Organizationscurrentlyevaluates hospitals on criteriaConclusion 7: The
Institutionalization of Medical- that range from medical practices to manageria' sys-
tems to facilities maintenance. At some point in the
Team Training Across Different future, folding generic competency criteria into .the
Medical Settings Has Not Been Joint Commission evaluation might focus providers'
attention on the importance of teamwork in medical
settings, as well as ylelding valuable research data.
Our h a 1 conclusion focuses on what we consider
ice would drive the imperative need to embed medical team training
in professional development. By "embedding" we ACKNOWLEDGMENTS
mean implementing and regulating medical team
trainingthroughouta health careprovider's career.As This research was supported by a grant from the
noted earlier, the ACGMF. identified several team- AHRQ and the DOD, TriCare Management
find h s issue su work-related competencies that residents must Activity. The views expressed herein are those of
master. Sldarly,AAMC funded a "critical incident" the authors.
re derived from
t-matter experts w
be invaluable in ide
K. h., Goodwn, G. F., Scarcy, C. A,, Norris, D. G., & Agency €01 Health Care Research and Quality (AHRQ ).
C ) ~ ~ l e r ,S. H. (2001). Deueioprnent of a PerfomanceModel of the (2000).Doing What Countsfor Patient Sujeg: FederalActions to
l"fcdicfllEd~icationProcess. Te~bniral&port Comm,isioned 5 the Reduce Medictrl Errors and Their Impnd. Rockvie, MD:
A850[7fltio~of American Medical Colleges. Washington, DC: Author.
American lnsurutes €orKesearch. Boyatzis, R. E. (1982). The Competent Mannger. New York: Wiley.

12. 270 BAKER ETAL.
Brannick, M. T., Salas, E., & Prince, C. (1997). Team Performance
Assessment andilleasurement.Mahwah, NJ: Lawrence Erlbaum
Associates, Inc.
Campion, hf. A,, Medsker, G.J., & Higgs, A. C. (1993). Relations
between work group characteristics and effectiveness: Gully, S. M., Incalcaterra, K. A., Joshi, A,, & Beaubi
Implications for designing effective work groups. Personnel (2002). A meta-analysis of team efficacy, potency,
P~chology,46, 823-850. formance: Interdependence and le~elof analysis a
Cannon-Bowers, J. A,, & Salas, E. (1998). Making Decisions under ators of observed relationships. ]ournu1 of Applied P
S&ess:Implicationsfor Indi~ndualandTeam Training. Washington,
DC: American Psychological Association.
Cannon-Bowers, J. A., Tannenbaum, S. I.,Salas,E., & Volpc, C.
E. (1995). Defmng competencies and establishing team
training requirements. In R. A. Guzzo, E. Salas,& Associates
(Eds.), Team Efectiveness and Decirion-Making in Organarahans
@p. 333-380). San Francisco:Jossey-Bass.
Cohen, S. G.,& Bailey, D. E. (1997). What makes teams work:
Group effecaveness research from the shop floor to the
executive suite.]ournu1 of Management, 23,239-290.
Dalies, J. M. (2001). hiedical applications of crew resource man- @p. 315-342). Englewood Cliffs, NJ: Prentice Hall.
agement. In E. Salas, C. A. Bowers, & E. Edens (Eds.),
Iqroving Teamwork in Organixations: Apphcations of Resource of top management team heterogeneity on firms' co
~bfanagementTraining @p. 265-281). Mahwah, NJ: Lawrence
Erlbaum Associates, Inc.
Driskell, J. E.,&Johnston, J. H. (1998). Stress exposure training. (1995). Behavioral Markers in Acrident~and Incidents.
InJ. A. Cannon-Bowers & E. Salas Fds.), Making Deririons Commissioned By the F A A (NASA/UT/FAA Tec
UnderStrerclmplications for Indim'dual and Team Training @p.
191-21 7). Washington, DC: American Psychological
Association.
Dnskell, J. E., & Salas, E. (1992). CoUective behavior and team
performance. Human Factors, 34, 277-288.
Dunnington, ti. L., & Williams, R. G. (2003). Addressing the
new competencies for residents' surgical training. Academic Helmeich, R. L., & Merritt, A. C. (1998). Culture at Wo
Medi~ne,78, 14-21. Aviation and Medicine: National, O~ani~ational,and ProjEr
Dyer, J. L. (1984). Team research and ttaining: A state of the Inf/wences.Brookfield, VT: Ashgate.
art review. In F. A. Muckler (Ed.), Human Factors Review
@p. 285-323). Santa Monica, CA: Human Factors and
Ergonomics Society
Fleishman, E. A,, & Zaccaro, S.J. (1992).Toward a taxonomy of
team performance functions. In R. W Swezey, & E. Salas
(Eds.), Teams: Their Training and l'e$omance @p. 31-56).
Nomood, NJ: Ablex. James, L. R., Demaree, R. G., & Wolf, G. (1984). Estima
Foushee, H. C. (1984). Dyads and triads at 35,000 feet: Factors
affecting group processes and aircrew performance. bias. ]ournal of Applied Pyhology, 69, 85-98.
A~nericnnPgchologirt, 39, 885293.
Gaba, D. hI. (1998).Research techniques in human performance
using realistic sirnulacion. In L. C. Henson & A. H. Lee
(Eds.), Simulators in Anesthesiology Education @p. 95101).
New York: Plenum.
Gaba, D. M., Howard, S. K., Fish, K.J., Smith, B. E., & Sowb, Y
A. (2001a). Simulation-based training in anesthesia crisis Behavioral & Social Sciences.
resource management (ACRhQ: A decade of experience.
Simulahon & Gaming,32, 175-1 93.
Gaba, D. M., Howard, S. K., Fish, K.J., Smith, B. E.,& Sowb, Y.
A. (2001b). Simulation-based training in anesthesia crisis
resource management (ACRM): A decade of experience. 16173
Simulation d-Gaming, 32, 175-193. McGrath, J. E. (1984). Growps: Interaction and Pe$ornlcl'lr
Gaba, D. M., Howard, S. K., Fianagan, B., Smith, B. E., Fish, K. Englewood Cliffs, NJ: Prentice Hall.
J., & Botney, R. (1998). Assessment of clinical performance Mohrman, S. A,, Cohen, S. G., & Mohrman, A. hi. (199
during simulared crises using both technical and behavioral Designing Team-Bused Organixations: New Forms for Knoiljle
ratings. Anesthesiolo~,89, 8-1 8. Work San Francisco: Jossey-Bass.
Goldman, M. B., Shaplro, D. E., Mann, S., Risser, D. T., & Morey,J. C., Simon, R., Jay, G. D., &Rice, M.M. (2003).A t~
tireenberg, P. (2002). Stu4 design considerations for the sition from aviation crew resource management to hasp
Melireams Evaltiation (unpubhshed technical reportj. emergency departments: The MedTeams story. In R.
Andover, MA Dynamics Research Corporation. Jensen (Ed.), Proceedings of the 12th InternationalJ~JII,POS~/I~'/

13. 17. RELATION BETWEEN TEAMWORK AND PATIENT SAFETY 271
h,orcf, j. c.,Slmon, R., Jay, G. D., Wears, R., Salisbury, M.,
Dukes,K.A , et al. (2002).Error reduction and performance
improvementm the emergency de~arunentthrough formal
training: Evaluation results of the MedTeams
prole,-t Health SerMces Rejearth, 37, 1553-1 581. Smith, P. C., & Kendall, L. M. (1963). Retranslation of expecta-
hfurns,q B., & Schneider, A. J. L. (1997). Using simulators for bons: An approach to the construction of unambiguous
educlnon and t.rainmg m anesthesiology. Americnn Son'e~of anchors for rating scales. Journal oj Applied Plychology, 47,
149-1 55.
requirements: The case of air traffic control teams. In E.
Salas, C. A. Bowers, & E. Edens Fds.), Improving Teamwork
in Organixahons:Apptications of Resource Management Training
ose&R. L.,Salas, E., Merket, D. C., & Bowers, C. A. (2001). @p. 31-54>. Mahwah, NJ: Lawrence Erlbaum Associates,
Applyingresource management training in naval aviation: A Inc.
,,thodology and lessons learned. In E. Salas, C. A. Bowers, Smith-Jentsch, I<. A., Salas, E., & Baker, D. l? (1996). Training
& E. Edens (Eds.), Iqrozing teamwork in organi~ations: team performance-related assertiveness. Personne/ P~~choiogy,
Applications of resource management !raining @p. 283-301). 49, 909-936.
bfahwah,NJ: Lawrence Erlbaum Associates, Inc. Smith-Jentsch, K. A,, Zeisig, R L., Acton, B., & McPherson, J.
parry, S. B. (1998).Just what is a competency? (And why should A. (1998). Team dimensional training. In J. A. Cannon-
we care?).Training, 35, 558-64. Bowers & E. Salas (Eds.), Making Deciions Under Stre,,:
pizz,,L., Goldfarb, Pu'. I., & Nash, D. B. (2001). Crew resource Inplicationsfor Indiniiual and Team Training Washington, DC:
managemrnt and its applications in medicine. In K. G. American PsychoIogicalAssociation.
Shojana, B. W.Duncan, K. M. McDonald, & R. hl.Wachter Splker, V. A,, Silverman, D. R., Tourville, S. J., & Nullmeyer, R.
(Eds.),Mabng Health Care Sajr: a Critica/Ana~sirgf l'atient T. (1998). Tactical Team Resource Management Elfies on Combat
&fig Prad'cer @p. 501-510). Rockville, MD: AHRQ. Mijsion Training Pe$omance (USAF AMRL Technical Report
Salas,E., Bowers,C. A,, & Cannon-Bowers, J. A. (1995). Military AL-HR-TR-1997-0137). Brooks Air Force Base, San
team research: 10 years of progress. Militay Pychology, 7, Antonio, 'I%U.S. Air Force Systems/Matenel Command.
Stevens, M. J., & Campion, M. A. (1994). The knowledge, skill,
and ability requirements for teamwork: Implications for
human resource management. Journal gf Management, 20,
Team training in the skies:Does crew resource management Sajeely Through Human Factors Training (HCR Reference
(CRn uaining work? Human Factorr, 43, 641-674. Number: 00080). Eglin Air Force Base, FL: Military Health
edinir 63, 765770. System Health Care.
1 in organizanons: Some
4, 129-139. have we learned from the Harvard Medical Practice Study?
If, G. (1984). Esdmatlng In M. M. Rosenthal & I(. M. Sutcliffe (Eds.), MedicaIErroc
What DO We Know? What Do We Do? @p. 533). San
son. At. S. (Eds.). (1999).
ea/tii System. WashLngto~h
adable from Institute of
:.iom.edu/report.asp?id',
171-190). Mahwah, XJ: Lawrence Erlbaum Associates, Inc.
.rartjon and Peghmann.. R., Langford, 5!, Locke, A,, Morey, J. C., Risser, D., & An empirical investigation. Human Factors, 38, 87-100.
Salisbury,hi. (2000).A successful transfer of lessons learned West, M. A,, & Anderson, N. R. (1996). Innovation in top man-
ohman, .%. hi. (1995). in aviation psychology and flight safety co health care: The agement teams. Jouma/o/ Applied P~tcbology,881, 680-693.
Sew Foms for Knowled~ SledTeams system. In Patient Sajg lnihati~~2000-Jpotirghting Wiener, E. L., Icanki, B. G., & Helmreich, R. L. (1 993). Cockpit
Sfrflregies, Sharing Soir~hons@p. 45-49). Chicago: Xational Resource Management.San Diegu: Academic.
:e, X1.31. (2003).A mn- , Patient Safer)-Foundation.
managemenr to hospid :
ITearns sror!. In R.

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