Demonstrating the impact of incivility in an obstetric emergency: An
interventional simulation study.
Objective: To understand the effect of an uncivil environment on the
performance of an obstetric team with a focus on non-technical skills,
and to ascertain whether simulation training can be used to demonstrate
the impact of incivility. Design: An interventional, simulation study.
Setting: Wessex Deanery School of Obstetrics and Gynaecology (O&G), UK.
Population or Sample: O&G trainees. Methods: Ethical approval was
received from the University of Southampton Research Ethics Committee
(81008). Following informed consent, twenty three trainees observed two
simulated scenarios of the management of a postpartum haemorrhage (PPH)
and completed a Team Emergency Assessment Measure (TEAM) questionnaire
for each simulation. In the first scenario the anaesthetist was civil
and in the second uncivil. ANOVA was used for statistical analysis, p
values of <0.05 were considered statistically significant.
Main Outcome Measures: TEAM observation questionnaire domains of
leadership, teamwork and team management. Results: There was a
significant reduction in the overall team performance in an uncivil
environment compared to a civil one (p=0.006). The biggest differences
in scores were observed in team morale (4.00/4.00 in the civil versus
2.22/4.00 in the uncivil simulation, p<0.001) and effective
communication (4.00/4.00 in the civil versus 2.22/4.00 in the uncivil
simulation, p<0.001). Conclusions: Incivility affects the
ability of the multi-disciplinary team to effectively manage an
obstetric emergency and simulation is an effective tool to demonstrate
the impact of poor workplace behaviours.