B. Statz2, I. H. Osman2, A. A. Rosser2, S. Sullivan2, R. Thompson1, H. Jung2 1University Of Wisconsin,Department Of Emergency Medicine,Madison, WI, USA 2University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: We sought to understand if role or gender affected the way team members spoke during trauma resuscitations and if those differences impacted trauma team performance.
Methods: Communication in 27 interdisciplinary trauma simulations was transcribed. Three physicians (trauma chief resident, trauma junior resident, emergency medicine resident) and two nurses (emergency medicine) participated in each simulation. Team performance was assessed using the Team Emergency Assessment Measure (TEAM) scale.
Speech was coded with Verbal Response Modes (VRM). VRM is a taxonomy that describes the relationship dynamics present in conversation by how the speech acts relate to the speaker or the person whom the speech targets. VRM codes can be classified into three dimensions: Attentive vs. Informative, Presumptuous vs. Unassuming, and Directive vs. Acquiescent. All utterances concerning another’s experience are considered Attentive, whereas utterances concerning the speaker’s experience are considered Informative. When an utterance presumes knowledge about the other person, it is considered Presumptuous. If no such presumption is made, the utterance is Unassuming. Finally, Directive utterances use the speaker’s frame of reference in order to guide conversation, while Acquiescent utterances allow the other’s viewpoint to determine the course of the conversation.
Ratios of speech acts in the three VRM dimensions for each team member were examined. We aggregated these proportions to compute mean VRM dimension ratios for each role and gender within the trauma team. Multiple regression and cluster analysis were performed to investigate relationships between VRM, team role (all physicians, trauma chief, nurses), gender, and TEAM score.
Results: T-tests of VRM dimension ratios demonstrated significant differences between physicians and nurses in how they spoke within simulated trauma resuscitations. Nurse speech was more attentive and unassuming than that of physicians. However, both physicians and nurses used equally directive speech. Trauma teams whose leaders used unassuming speech acts more than presumptuous speech acts had higher TEAM scores (p=0.039). Team member gender did not correlate with differences in speech acts or team performance.
Conclusion: Physicians and nurses speak differently within trauma resuscitations. Teams with leaders who communicate in an unassuming manner perform better. Based on VRM, the relationships between team members and the ways they spoke to one another did not correlate with gender.