Team Emergency Assessment Measure (TEAM)

Abstract

The Team Emergency Assessment Measure (TEAM) is a specialized observational rating scale developed to provide a valid, reliable, and feasible method for assessing team performance during high-stakes medical emergencies, particularly resuscitation events. Developed to address a gap in existing assessment tools which were often generic or specific only to fields like anaesthetics, TEAM focuses specifically on the non-technical skills crucial for effective emergency response. The final instrument comprises 12 items—11 specific behavioral ratings and 1 global rating—categorized across three core domains: Leadership, Teamwork, and Task Management. Initial studies confirmed TEAM as a psychometrically sound tool for clinicians measuring team dynamics during critical incidents.

Keywords

Team Emergency Assessment Measure, TEAM, Teamwork, resuscitation, emergency medicine, non-technical skills, crew resource management, leadership, task management, medical simulation, observational assessment.

Authors

Cooper S, Cant R, Porter J, Sellick K, Somers G, Kinsman L, Nestel D.

Purpose

The primary purpose of the TEAM instrument is the evaluation of teamwork performance and non-technical skills in the context of acute medical emergencies. This includes assessment of teams involved in critical events such as cardiac arrest or other intensive resuscitation scenarios.

The scale is designed as an observational rating tool, intended to be completed by expert clinicians. This methodology ensures accurate performance rating and facilitates constructive feedback regarding specific dimensions of team function, including leadership, situation awareness, communication, and task execution, thereby serving as both a research instrument and a training feedback tool.

Construct

The TEAM measure evaluates the overarching construct of effective teamwork in emergency settings, conceptualized primarily as a measure of non-technical skills. This primary construct is operationalized through three distinct, yet interrelated, sub-constructs, which are measured using a total of 11 specific items and one global rating item.

• Leadership: Focuses on the ability of the designated or emergent team leader to provide clear direction, command, and maintain a global perspective of the evolving clinical situation, including appropriate delegation.
• Teamwork: Assesses collective team behavior, including effective communication (verbal, non-verbal), timely task completion, composure, positive morale, and adaptation to changing clinical circumstances.
• Task Management: Evaluates the team’s efficiency and adherence to protocols, specifically focusing on the prioritization of clinical tasks and the consistent application of approved medical standards and guidelines.

Validity

The development process for the TEAM instrument incorporated rigorous steps to establish its validity, beginning with an extensive literature review and review by an expert clinical team. Seven international experts provided review for face and content validity during the development phase.

Empirical testing demonstrated strong evidence of validity. The total content validity index (CVI), following expert review, was reported as high (0.96). Furthermore, concurrent validity was established through a strong correlation between the total item score (the sum of the 11 specific items) and the single global rating item (rho = 0.95; p < 0.01). This high correlation suggests that the specific items effectively capture the overall performance perceived by the observer.

Reliability

The reliability of the TEAM instrument was assessed using multiple measures during testing involving 56 video-recorded events. The internal consistency of the instrument was found to be strong, with a Cronbach’s alpha of 0.89, supporting the homogeneity of the items in measuring the underlying construct.

Measures of interrater and retest reliability were also calculated. Interrater reliability (kappa, k= 0.55) and retest reliability (kappa, k= 0.53) were classified as ‘fair’. Although moderate, these findings suggest sufficient stability and agreement for an observational instrument designed to capture complex, dynamic behavioral performance in high-stress environments. Positive feasibility ratings were also obtained following ‘real time’ testing on 15 simulated events.

Factor Analysis

During the instrument testing phase, which involved analysis of data from 56 video-recorded hospital and simulated resuscitation events, psychometric analysis identified a single unifying construct, labeled ‘teamwork‘. This suggests that while the instrument is structured into three categories (Leadership, Teamwork, Task Management), the items load together to measure a general domain of emergency team performance and non-technical skills.

Instrument

Test Type: Observational Rating Score / Non-Technical Skills Assessment

Format: 12 items, consisting of 11 specific behavioral items and 1 global rating item. The specific items use a 5-point Likert-type scale (0 to 4), while the global rating uses a 10-point scale (1 to 10).

Language Available: English (Original development language).

Population Group: Emergency medical teams (e.g., resuscitation and trauma teams) and trainees (e.g., senior nursing and medical students).

Age Group: Adult (Applicable to professional medical staff and students).

Population Details: The initial development and testing involved senior nursing and medical students, as well as expert clinicians who served as raters. The instrument is designed for use in real-world or simulated clinical settings where emergency medical teams operate.

Test Methodology: The instrument is completed by expert clinical observers who rate the team’s performance based on observable behaviors during an emergency event. Rating prompts are included for specific items to guide the observer’s judgment regarding situation awareness, communication, and delegation.

Keywords

Emergency medical team, non-technical skills, simulation, assessment tool, cardiac arrest, psychometric properties, interrater reliability, concurrent validity, content validity index.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content.

Permissions & Fee and Test Year

Test Year: 2010 (Year of primary publication).

Permissions/Fee: The original instrument is generally used for academic and clinical training purposes. Permissions for commercial or modified use should be sought from the primary authors or the journal publisher (Resuscitation).

Feasibility: The instrument demonstrated positive feasibility ratings following ‘real time’ testing on simulated events, suggesting it is practical for use in clinical observation and training.

Reference’s

Cooper S, Cant R, Porter J, Sellick K, Somers G, Kinsman L, Nestel D. Rating medical emergency team performance: development of the Team Emergency Assessment Measure (TEAM). Resuscitation 2010: 81(4): 446-452.

Items of the Team Emergency Assessment Measure (TEAM)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

This non- technical skills questionnaire has been designed as an observational rating score for valid, reliable and feasible ratings of emergency medical teams (e.g. resuscitation and trauma teams). The questionnaire should be completed by expert clinicians to enable accurate performance rating and feedback of leadership, team work, situation awareness and task management. Rating prompts are included where applicable. The following scale should be used for each rating: