How do maternity teams perform in and perceive a role-based approach to teamwork in maternity emergencies? A qualitative study in simulation

Effective teamwork in interprofessional healthcare teams requires expert performance by individuals in clearly defined roles. This focus on role clarity and role performance provides the basis of the ‘pit crew’ approach, now commonly utilized in resuscitation teams with demonstrated benefits in patient care. Maternity teams responding to emergencies may benefit from a similar approach to teamwork; however, little attention has been paid to team member roles within the maternity emergency context. In this qualitative case study of maternity teams responding to two simulated maternity emergencies in the context of a teamwork training course, we aimed to describe team member performance in roles and explore clinician perceptions of role allocation and performance within the team. Video analysis of role performance demonstrated team members performed actively and passively in multiple roles throughout the scenario, with some improvement in role consistency between Case 1 and Case 2. Workload distribution was uneven, with some clinicians performing tasks across several roles concurrently, while others did not appear to take on any role. Thematic analysis of debriefing conversations and post-scenario interviews and focus groups revealed four themes. Three themes related to the process of team member allocation to roles with participants describing the need to firstly gain an understanding of the situation, have knowledge of clinical requirements and priorities and consider their suitability for role in the clinical case. The fourth theme related to participants shift in conceptual understanding of how to work in roles facilitated by the simulations and debriefings. This study provides a preliminary understanding of how team members allocate roles in ad hoc maternity teams and supports the use of simulation-based training to improve role-based teamwork. Further research is recommended to enhance our understanding of the impact of role-based teamwork in maternity emergencies, and how simulation and debriefing can most effectively improve this important domain of teamwork.Full Tex

Hermeneutics of complexity and the limits of learning pre-specification

Contemporary work confronts researchers and educators with a range of challenges, including those posed by complex environments in which workers grapple with uncertainty in high-stakes situations. A different challenge lies in the assumptions brought to learning design and facilitation, assumptions which together constitute a ‘paradigm’ concerning how to approach these tasks. Without a paradigm, designers and practitioners may exercise an incoherent practice; but if the paradigm is in some way problematic, then the practice may be compromised. In this article, we focus on work in complex environments, problematizing a particular paradigm—the ‘pre-specification’ approach—that is often brought to bear on it. The key to this paradigm is that work can be analysed and represented such that it can be specified in advance as a reference point for educational endeavours. We problematize key epistemological and ontological assumptions of this paradigm. Hermeneutics draws attention to the limits of these assumptions regarding what we can understand and represent about work, while complexity theory allows us to recognize ontological features of work that make pre-specification difficult or untenable. We conclude that in complex work, representation-making needs to be a distributed activity rather than a specialty, and it occurs at multiple points on the learning continuum rather that solely at the beginning.Full Tex

Cross-sector investigation into simulator-based training for maternity emergency management: competence-based issues

This paper reports a cross-sector reflection on a current, simulation-based program for maternity emergency management in an Australian healthcare site. It aims to develop our understandings of how learning can be enhanced through simulation and debriefing practices. It discovers how the healthcare and aviation sectors, which have seen increasing collaboration in areas of human factors and non-technical skills in the last decade, can continue to evolve beyond these areas and considers what each sector can learn from the other. A cross-sector research team observed a one-day course on maternity emergencies. The observers took reflective notes progressively throughout the day and held a post-course discussion about their observations and reflections. Thematic analyses of their cross-sector reflections – observation notes and a transcribed team discussion – identified vague understandings of occupational competence embedded in current simulation-based practices. Possible avenues to improve practices were identified, taking into consideration the differing views among researchers from different sectors

Developing a learning tool for advanced life support and resuscitation: Performance Reflection Model for Resuscitation (PRM-Resus)

BACKGROUND: Acquiring proficiency in advanced life support (ALS) can pose challenges for novice learners. Simulation-based training (SBT) is widely used to address this, offering learners opportunities to practise and receive feedback during debriefing. However, existing performance tools often lack the clarity, behavioural specificity, and educational scaffolding required to support deep reflective learning. This study aimed to develop and evaluate the Performance Reflection Model for Resuscitation (PRM-Resus) and to integrate it with the ALS Team Model and structured video exemplars as a comprehensive learning package to enhance ALS training. METHODS: The study involved four phases. Phase 1 created the ALS Team Model to clarify individual roles. Phase 2 focused on co-designing PRM-Resus, using team expertise and the Team Model to create behaviourally anchored performance descriptors. In Phase 3, video scenarios were produced to represent ALS team performance at varying proficiency levels. Phase 4 evaluated the PRM-Resus through expert think-aloud studies. Qualitative content analysis was used alongside Cronbach's alpha to assess internal consistency and its use for SBT. RESULTS: The PRM-Resus comprises four domains-clinical skills, clinical knowledge, team management, and leadership-each defined by behavioural descriptors across three performance levels. The participating experts endorsed the tool's clarity, structure, and educational value for novice learners. Internal consistency was high (α > 0.95). When used alongside the ALS Team Model and video exemplars, PRM-Resus facilitated deeper performance analysis, which had potential for enhancing post-simulation reflection and supporting faculty development. CONCLUSIONS: This study presents a novel, interdisciplinary framework that integrates PRM-Resus, the ALS Team Model, and video exemplars to support reflective learning in ALS simulation. Together, these tools help novice learners build a concrete understanding of effective team performance and enable educators to deliver more structured feedback. Further research should explore its impact on learner development and potential translation into improved clinical outcomes.Full Tex