Concepts and Commentary Measuring Team Performance in Simulation-Based Training: Adopting Best Practices for Healthcare Michael A. Rosen, MA; Eduardo Salas, PhD; Katherine A. Wilson, PhD; Heidi B. King, MS; Mary Salisbury, RN, MSN; Jeffrey S. Augenstein, MD, PhD, FACS; Donald W. Robinson, MD; David J. Birnbach, MD Team performance measurement is a critical and frequently overlooked component of an effective simulation-based training system designed to build teamwork competen- cies. Quality team performance measurement is essential for systematically diagnosing team performance and subsequently making decisions concerning feedback and remediation. However, the complexities of team performance pose a challenge to effectively measuring team performance. This article synthesizes the scientific literature on this topic and provides a set of best practices for designing and implementing team performance measurement systems in simulation-based training. (Sim Healthcare 3:33– 41, 2008) Key Words: Team training, Team performance measurement, Simulation-based training Training is one of the most flexible and adaptive means for improving performance in organizations. 1 As such, training has been one of the main thrusts in the drive to increase safety in healthcare systems. 2 Specifically, the use of simulation- based training (SBT) to train teamwork skills holds promise as a powerful method to increase safety and effectiveness in healthcare. 3–7 However, to maximize learning in SBT, a sys- tematic and scientific approach must be taken to the devel- opment of learning experiences. This is true in general, and especially for training the complexities of teamwork. Team performance measurement is central to a scientifi- cally rooted approach to SBT for training teamwork skills. 8,9 When executed correctly, team performance measurement provides a systematic means for determining the causes of effective and ineffective performance, providing feedback to correct deficiencies in the individual and team competencies targeted for training, and making decisions about what fu- ture training is necessary for the team as a whole or for spe- cific individuals. 10 –12 Simulation-based team training with- out team performance measurement results in unguided practice for teams, which limits the effectiveness of time and resources spent training. Feedback and remediation are nec- essary for developing the teamwork skills critical to patient safety and team performance measurement is the foundation upon which these rest. This article provides a set of best practices for develop- ing team performance measures for the purpose of train- ing teamwork skills in healthcare. These best practices are developed from a review of the theoretical, empirical, and practice-based literature concerning team training, SBT, and team performance measurement. 10,13–16 These best practices are not drawn solely from the work done in healthcare; they are drawn from the broader sample of communities and domains applying SBT to train team- work. This broader knowledge base is presented in the form of best practices for healthcare. Furthermore, we hope this article will facilitate the development of stan- dards for team performance measurement in SBT for healthcare. Before presenting these best practices, we first outline the need for team training and SBT in healthcare, show the importance of team performance measurement to achieving the goals of SBT for teams, and highlight some of the challenges to effective team performance measure- ment in SBT. Why is Teamwork, Team Training and SBT Needed in Healthcare? Teamwork is central to safety in healthcare as it is often the interactions of healthcare workers that produces effective or ineffective performance. 17,18 Healthcare is an inherently mul- tidisciplinary task where the effectiveness of patient care re- lies on the interaction of individuals from highly diverse backgrounds in terms of expertise, training, and experi- ence. 19,20 Based on a hospital’s historical census and acuity data, a trauma team may consist of several nurses, allied health professionals, a surgeon, an emergency room doctor, and several specialist physicians. All of these individuals have received extensive training in their respective disciplines, but have generally not received formalized training on how to From the Department of Psychology, and Institute for Simulation and Training, University of Central Florida (M.A.R., E.S., K.A.W.); Miller School of Medicine, University of Miami, William Lehman Injury Research Center (K.A.W., J.S.A, D.J.B.); Office of the Assistant Secretary of Defense (Health Affairs) (H.B.K.); TRICARE Management Activity, Falls Church, VA; The Cedar Institute, Inc., North Kingstown, RI; Army Trauma Training Center, (M.S.): Ryder Trauma Center (D.W.R.); and Department of Anesthesiology, University of Miami, Jackson Memorial Hospital Center for Patient Safety, Miami, Florida (D.J.B.). This work was supported by the Department of Defense under contract W81XWH- 05-1-0372. Reprints: Eduardo Salas, PhD, Department of Psychology, and Institute for Simulation and Training, University of Central Florida, Florida. (e-mail: esalas@ist.ucf.edu). The authors have indicated they have no conflicts of interest to disclose. Copyright © 2008 Society for Simulation in Healthcare DOI: 10.1097/SIH.0b013e3181626276 Vol. 3, No. 1, Spring 2008 33