HomeProfessionalsCareer DevelopmentFellowsInnovations in Fellowship Education2017 ▶ Leadership Education for Critical Care Fellows Using Simulation
Leadership Education for Critical Care Fellows Using Simulation

University of Washington

Seattle, WA

Abstract Authors: Trevor C. Steinbach MD; Rosemary Adamson MB BS; David Carlbom MD; Nicholas J. Johnson, MD; Patricia A. Kritek MD, EdM; and Başak Çoruh, MD

Program Director: Mark Tonelli, MD

Type of Program: Pulmonary/Critical Care



Leadership skills are essential for critical care physicians. Most fellowship programs do not include focused education about leadership. Furthermore, there is no commonly employed framework for leadership training within pulmonary and critical care medicine. In order to address this gap in current training, a formal curriculum aimed at teaching leadership skills to critical care medicine fellows was developed using a novel framework. High-fidelity simulation was employed as a means to practice and solidify newly learned leadership techniques and behaviors.


Commonly identified leadership skills and behaviors were extracted from a review of the literature and used to develop a Crisis Leadership Framework (Fig. 1). This framework was used to teach leadership skills to first-year critical care fellows at a single institution. These skills were then assessed using high-fidelity simulation of low-frequency, high risk critical care scenarios, with fellows leading multidisciplinary teams consisting of physicians, nurses, and respiratory therapists. Each scenario concluded with a clinical debrief led by the fellow. Immediate feedback on leadership behaviors was provided by the non-participating fellows, facilitated by a faculty member, using the Crisis Leadership Framework. Leadership skills were formally assessed by course faculty using the Non-Technical Skills for Surgeons (NOTSS) assessment tool (Fig. 2). Participants were also surveyed regarding their perceptions of the utility of the training and their leadership skills.


After the first simulation session, all participating fellows (N = 11) agreed that they better understood key concepts of leadership (45% strongly agree, 55% somewhat agree) and all reported feeling better prepared to lead a team during crisis (45% strongly agree, 55% somewhat agree). Ninety-one percent of fellows felt comfortable leading a clinical debrief following the session (36% strongly agree, 55% somewhat agree). NOTSS ratings improved in all domains (scale 1-4) between the first and second simulation session: the situational awareness mean score increased from 2.5 to 3.3, communication and teamwork from 2.0 to 3.3, leadership from 2.0 to 3.0, and decision-making from 2 to 2.3.


Implementation of a leadership curriculum within critical care fellowship training is both feasible and well-received by trainees. Focused development of leadership skills using simulation enhanced fellows’ perceived leadership knowledge and preparation as well as their adoption of leadership behaviors. Further studies are needed to see if exposure to this curriculum translates to improved leadership skills and team performance during real-life emergencies.

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