Learning Objective: To assess leader and team performance during interprofessional in situ simulation and identify characteristics of effective teams.

Background: Patient care in the emergency department (ED) is dependent on highly effective interprofessional teams.

Objectives: To assess leader and team performance during interprofessional in situ simulation and identify characteristics of effective teams.

Methods: This mixed-methods study employed case study methodology. Eligible nurses, technicians, pharmacists, and PGY 2-4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated team performance using the Team Performance Observation Tool (TPOT) 2.0. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, Team Emergency Assessment Measure (TEAM), and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Following the simulations we conducted semi-structured interviews. Transcripts were coded by two coders and underwent thematic analysis.

Results: 23 simulations took place between January-April 2021. Two raters’ scores were on the high end of the scales for the TPOT 2.0 (R1 4.90,SD=0.17;R2 4.53,SD=0.27), TEAM (R1 3.89,SD=0.19;R2 3.58,SD=0.39), and Ottawa GRS (R1 6.6,SD=.56;R2 6.2,SD=.54). Team leader attributes including year in residency, age, and gender did not correlate with performance scores. We identified 6 themes: leadership tone, interdependent energy, strategic staffing, optimal communication, simulation empowering team performance, and team entrustment. Participants acknowledged the effectiveness of in situ simulation in promoting entrustment in the clinical setting.

Conclusions: The TPOT and TEAM were not discriminatory for high-performing ED teams. Our qualitative analysis revealed features such as entrustability, energy, and team size are important for effective team dynamics but are not completely captured on current tools. ED-specific assessments of interprofessional entrustment may be useful in optimizing readiness for the clinical setting.

Learning Objective: The goal of this study was to gain a deeper understanding of the personal and professional impact inter-physician conflict has on physicians’ well-being.

Background: Despite the recognized importance of collaboration and communication, interpersonal conflict amongst healthcare providers in different specialties remains a pervasive issue. Recent work elucidated some of the social conditions and processes that contribute to conflict between EM and IM physicians at the time of admission. However, little is known about the consequences that inter-physician conflict has on providers’ well-being.

Objective: The goal of this study was to gain a deeper understanding of the personal and professional impact inter-physician conflict has on physicians’ well-being.

Methods: In this study, the authors used constructivist grounded theory to explore themes related to the impact of conflict on individual providers. A purposive sampling approach was used to recruit participants (n=18), which included EM residents and attending physicians as well as IM attending physicians. Two authors conducted hour-long, semi-structured interviews and then coded the transcripts following Charmaz’s three stages of coding. The authors used constant comparative analysis until thematic sufficiency was reached.

Results: Participants described personal impacts of inter-physician conflict including emotional and moral distress which occurs in the context of feeling demoralized by colleagues. Conflict further impacted participants professionally by promoting cynicism, job dissatisfaction, and a negative view of their professional identity and professional accomplishments. Finally, participants described the ‘emotional residue’ that remained after conflict, which tended to perpetuate future conflict.

Conclusions: Physicians attributed emotional exhaustion, cynicism, and reduced sense of personal accomplishment to conflicts arising during conversations around admission. In this way, inter-physician conflict is an under-recognized contributor to physician burnout that should be explored to support the well-being of trainees and attending physicians.

Introduction: Optimizing the performance of emergency department (ED) teams impacts patient care, but the utility of current, team-based performance assessment tools to comprehensively measure this impact is underexplored. In this study we aimed to 1) evaluate ED team performance using current team-based assessment tools during an interprofessional in situ simulation and 2) identify characteristics of effective ED teams.

Methods: This mixed-methods study employed case study methodology based on a constructivist paradigm. Sixty-three eligible nurses, technicians, pharmacists, and postgraduate year 2–4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated performance using the Team Performance Observation Tool (TPOT) 2.0 and completed a brief demographic form. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, Team Emergency Assessment Measure (TEAM), and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Following simulations, we conducted semi-structured interviews and focus groups with in situ participants. Transcripts were analyzed using thematic analysis.

Results: Eighteen team-based simulations took place between January–April 2021. Raters’ scores were on the upper end of the tools for the TPOT 2.0 (R1 4.90, SD 0.17; R2 4.53, SD 0.27, IRR [inter-rater reliability] 0.47), TEAM (R1 3.89, SD 0.19; R2 3.58, SD 0.39, IRR 0.73), and Ottawa GRS (R1 6.6, SD 0.56; R2 6.2, SD 0.54, IRR 0.68). We identified six themes from our interview data: team member entrustment; interdependent energy; leadership tone; optimal communication; strategic staffing; and simulation empowering team performance.

Conclusion: Current team performance assessment tools insufficiently discriminate among high performing teams in the ED. Emergency department-specific assessments that capture features of entrustability, interdependent energy, and leadership tone may offer a more comprehensive way to assess an individual’s contribution to a team’s performance.