Table A1.

ETCC^TM Curriculum Summary

Course Component	Contents
Introduction	The ETCC introduction justifies the need for teams and team-work in the current health care environment. It begins with a discussion of four elements that distinguish work teams from work groups and continues with an overview of teamwork research findings. An explanation of the paradigm shift that occurs when traditional groups move to a team system is presented followed by a discussion of the attitude shifts necessary to build a strong teamwork system. The introduction concludes with a review of the five Team Dimensions, which are introduced as categories of observable behavior used to train and measure team performance.
Module 1. Maintain Team Structure and Climate	This module addresses ED composition and defines the Core Team in the ED context. This module describes the Designated Team Leader, Situational Leader, and Team Member roles. It highlights the characteristics of team climate and includes strategies for managing conflicts that arise within the team. It also provides an opportunity for course instructors to present the locally determined team structure defined for their ED. Examples of behaviors taught are (a) establish the leader, (b) hold each other accountable for team outcomes, and (c) resolve conflicts constructively.
Module 2. Apply Problem-Solving Strategies	This module addresses planning and decision making as central teamwork actions associated with performing clinical tasks. Forms of planning are presented, as are various decision-making models. Instruction includes a discussion of error and the role of the team in supporting the decision maker with information to reduce the occurrence of decision-making errors. Cross-monitoring, assertion, advocacy, and the Two-Challenge Rule are introduced as elements of the Teamwork Monitoring Cycle. A practical exercise is included that demonstrates the relationship between a shared mental model and team communication. Examples of behaviors taught are (a) engage team members in the planning process, (b) reports slips, lapses, and mistakes to the team, and (c) advocate and assert a position or corrective action.
Module 3. Communicate with the Team	This module addresses the quality of information exchange within the team. Situation awareness is presented as a central concept to explain the importance of effective communication. It addresses the practice of offering and requesting information that can improve situation awareness and impact clinical practice and patient outcomes. Standards of effective communication are provided as are a number of techniques for communicating vital information within the team. This module includes a number of practical exercises that raise awareness of the impact of language on shared mental models and reinforce the importance of validating information transfer. Examples of behaviors taught are (a) provide situational awareness updates, (b) call out critical informational during emergent events, and (c) communicate decisions and actions to team members.
Module 4. Execute Plans and Manage Workload	This module addresses the impact of workload on work performance. It describes several strategies for managing workload including delegation, prioritization and secondary triage, resource management, and task assistance. A practical exercise is included that provides an opportunity for participants to practice resource reallocation in a rapidly changing environment. Examples of behaviors taught are (a) prioritize tasks for individual patients, (b) execute the team-established plan, and (c) request assistance for task overload.
Module 5. Improve Team Skills	This module addresses the issue of team skill improvement through coaching, situational learning, and team performance review. Performance goals, performance feedback, and performance improvement strategies are described as key elements of the team improvement process. The Resuscitation Videotape Review is an optional exercise for departments with video capabilities. Examples of behaviors taught are (a) engage in situational learning and teaching with the team, (b) conduct event reviews, and (c) participate in educational forums addressing teamwork.
Integration Unit	Customized by each participating hospital to address issues pertinent to the implementation of the teamwork system into that emergency department.