Rosenman Elizabeth D, Grand James A, Fernandez Rosemarie
Department of Emergency Medicine University of Michigan Medical School Seattle Washington USA.
Department of Psychology University of Maryland College Park Maryland USA.
AEM Educ Train. 2025 Apr 7;9(2):e11061. doi: 10.1002/aet2.11061. eCollection 2025 Apr.
Team leadership is a critical skill in trauma resuscitation teams, linked to better teamwork and improved patient care. There are numerous published team leadership assessments, though data regarding the performance of these measures in patient care settings (vs. simulation-based settings) remain limited. There remains a need for a valid, reliable, and efficient measure of resuscitation team leadership in the clinical setting to support medical education and research efforts.
We constructed a 12-item behaviorally anchored rating scale (BARS) to measure trauma team leadership. Multiple raters then used the BARS to measure team leadership in 360 recorded trauma resuscitations across 60 participants. In addition to examining inter-rater reliability, we examined the construct validity of the BARS assessment through both correlational and latent modeling techniques to compare the ratings collected with the BARS to those collected using a previously studied checklist-based assessment using a multitrait-multimethod (MTMM) approach. Lastly, we examined the criterion validity of the BARS measure by examining its relationship with previously obtained patient care scores.
BARS items demonstrated high inter-rater reliability when scores were computed using observations averaged over multiple raters (mean item intraclass correlations ICC1k 0.90, item range 0.85-0.98). The correlation between the aggregate ratings from the team leadership BARS and checklist measure demonstrated a strong positive correlation ( = 0.75), and the MTMM analyses indicated consistent evidence for both convergent (mean monotrait-heteromethod = 0.50) and discriminant (mean heterotrait-heteromethod = 0.27) validity. Hierarchical Bayesian regression analyses revealed that aggregate BARS scores were predictive of patient care scores (β = 7.06, 95% HDI 3.76-10.43).
The team leadership BARS and a previously studied checklist-based team leadership measure produced convergent assessments of team leadership behavior in the present data. Furthermore, higher overall ratings on the BARS correlated with better patient care delivery at the team level.
团队领导力是创伤复苏团队的一项关键技能，与更好的团队协作及改善患者护理相关。虽然有大量已发表的团队领导力评估方法，但关于这些方法在患者护理环境（与基于模拟的环境相比）中的表现的数据仍然有限。在临床环境中，仍然需要一种有效、可靠且高效的复苏团队领导力测量方法，以支持医学教育和研究工作。
我们构建了一个包含12个项目的行为锚定评级量表（BARS）来测量创伤团队领导力。然后，多名评估者使用该BARS对60名参与者的360次记录在案的创伤复苏过程中的团队领导力进行测量。除了检验评估者间的信度外，我们还通过相关分析和潜在建模技术检验了BARS评估的结构效度，以使用多特质多方法（MTMM）方法将用BARS收集的评分与使用先前研究的基于检查表的评估方法收集的评分进行比较。最后，我们通过检验BARS测量方法与先前获得的患者护理评分之间的关系，来检验其效标效度。
当使用多个评估者的平均观察值计算分数时，BARS项目显示出较高的评估者间信度（平均项目组内相关系数ICC1k为0.90，项目范围为0.85 - 0.98）。团队领导力BARS的总体评分与检查表测量方法之间的相关性显示出强正相关（r = 0.75），MTMM分析表明存在收敛效度（平均单特质 - 异方法r = 0.50）和区分效度（平均异特质 - 异方法r = 0.27）的一致证据。分层贝叶斯回归分析表明，BARS总体评分可预测患者护理评分（β = 7.06，95% HDI为3.76 - 10.43）。
在本数据中，团队领导力BARS与先前研究的基于检查表的团队领导力测量方法对团队领导行为产生了收敛性评估。此外，BARS上的总体评分越高，在团队层面与更好的患者护理提供相关。
