Table 1.

Study characteristics.

Study	Objective	Content of intervention	Outcome/Conclusions	Teaching
Training practising leadership and assessment
MANTHA, A. et al. 2016	NTS curriculum for Indian paramedic trainees focused on strengthening on-scene leadership, teamwork, and public speaking skills	40 paramedic trainees. Six-day course. Trainees completed self-assessments and delivered two brief video-recorded presentations before and after completion of the curriculum. Independent blinded observers scored 10 randomly selected trainees.	Outcomes of this leadership curriculum demonstrate a significant increase in paramedic trainees' self-perceived confidence, communication, and leadership skills	6 - day seminar. Presentation of a non-professional topic to classmates. Developed new taxonomy
Clinical simulation and leadership assessment
YULE, S. et al. 2015	Demonstrate the effect of non-technical skills coaching on intraoperative behaviours and clinically significant decisions during simulated operations.	16 surgeons, two groups. Five operations each surgeon. Case group received coaching on NTS after each operation - control not. Operation one and five was video recorded. Blinded assessors	Coaching improved residents' non-technical skills in the simulated OR compared with those in the control group	Non-technical skills coaching. NOTECHS inspired (NOTSS)
NICKSA, G.A. et al. 2015	To educate surgical residents in leadership, teamwork, effective communication, and infrequently performed emergency surgical procedures with the use of inter-professional simulations.	43 surgical residents PGYs 1 and 2. Interdisciplinary high-risk clinical scenarios. Pre (control) and 6 Mo after Post (case) 37 responded to a survey. Author assessor	The PGY 2 residents improved their skills, but the PGY 1 residents did not. A total of 89% of the residents felt the sessions were of great benefit.	Feedback, facilitated discussion, instructed on areas of knowledge as needed. Modified Oxford NOTECHS
CARLSON, J. et al. 2009	Develop a measurement tool reliable at capturing team behaviour during a high-fidelity simulation. Explore the relationship between the team behaviours measured and the standard of technical medical care delivered specific to the needs of the case.	Study participants (n = 113), 44 teams (2 or 3 team members) During the workshop, every team participated in the same scripted case scenario facilitated by the same training instructor. Raters using the team behaviour measurement tool	The methods used provide a possible method for training and assessing team performance during simulation. The instrument presented in this study offers a possible template for future work	Simulation - facilitator – debriefing. ANTS adapted from NOTECHS
FERNANDEZ CASTELAO et al. 2015	This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization	Forty-five teams of four members received ALS training. Team leaders in group one attended 90 min. CRM training. All others 90 min. ALS training. Video recorded. Check-list based tool developed by experts. Assessors blinded to the experimental allocation	Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behaviour. (Emphasis on training of team leader behaviour appears to be beneficial in resuscitation and emergency medical course performance.)	CRM team leader training and additional ALS-training.
GILFOYLE, E. et al. 2007	Educational intervention. evaluate immediate and long term learning outcomes in order to determine whether residents could acquire and retain team leadership skills in pediatric advanced resuscitation.	Case 15 paediatric residents 2 leader skills training, simulated resuscitation scenarios. Evaluated again 6 months later. Control N = 7 no training. Rating by checklist and self-reported questionnaire	Residents acquired resuscitation team leadership skills following an educational intervention. Six-month follow-up demonstrated skill retention beyond the initial intervention. Control group suggested that this was because participants had attended the first workshop.	Based on the needs assessment learning objectives were developed. Modified CRM checklist
HUNZIKER, S. et al.2010	The aim of this study was to compare leadership instruction with a general technical instruction in simulated CPR scenario	237 (280) medical stud. in teams of three. CPR simulation, pre-video. Basic instruction 20 min. Two groups. Case: Leadership training. Control: Technical training. CPR simulation, 2 post-video, n = 96 and n = 93. Follow up after 4 Mo. Videotapes coded by two independent blinded researchers	Causal relationship between leadership and performance was proven: Leadership instructions were superior to technical instructions, with more leadership utterances and better overall cardiopulmonary resuscitation performance.	Leadership instruction with pre-specified checklists - LBDQ inspired
ROBERTS, N.K. et al. 2014	To investigate if brief training would have a sustained effect on individual acquisition and retention of knowledge and team practice behaviours and on team behaviours of health care professionals in medical emergency situations…	57 medical staff members. Pre-test simulated CPR sessions. Then training concluding with a post simulation. Debriefing. Three weeks later third simulation. Video recordings. Two blinded raters. Questionnaire	Participants changed teamwork and communication behaviour on the post-test, and changes were sustained after a 3-week interval, though there was some loss of retention. Brief training exercises can change teamwork and communication behaviours on ad hoc trauma teams.	Simulation - video analysis - simulation - debriefing. 3 weeks later: simulation and questionnaire. LBDQ inspired
COOPER, S. et al. 2001	Develop a course training leaders with the aim of changing behaviour and performance	Three day ALS course. N = 68. Three courses. Day one: ALS training. Day two and three all acted as team leader in a CPR simulation. After day two case group attended a leadership seminar. Control not. Five independent assessors, blinded	The leadership training programme significantly improved candidates leadership performance in the training situation	The experimental group attended a 75-min leadership development seminar. LBDQ inspired
Assessing the quality of leadership
BRIGGS, A. et al. 2015	Does team's and team leader's NTSs correlate with technical performance of clinical tasks?	20 teams. Two separate, high-fidelity, simulated trauma scenarios. Video, divided into 4 consecutive sections. Team leader assessment using NOTSS. Entire team 2 additional raters used T-NOTECHS	The NTSs of trauma teams and team leaders deteriorate as clinical scenarios progress, and the performance of team leaders and teams is highly correlated. Cognitive NTS scores correlate with critical task performance.	Simulations - brief CRM training. Focus on Measuring. T-NOTECHS
COOPER, S. et al. 1999	Determine the relationship between leadership behaviour, team dynamics and task performance	20 resuscitation attempts were observed. All teams more than five members. A total of 18 leaders. Observers: an ALS instructor and a video rater	Leaders who initiated a structure, distributed tasks, and remained “hands off” improved team performance. An emergency leadership training programme is essential to enhance the performance of leaders and their teams.	Not teaching. LBDQ inspired
MARSCH, S.C. et al. 2004	How human factors affect the team performance during a simulated cardiac arrest. And show correlation between leadership behaviour and outcome	16 teams, each three health-care workers. Simulator. Video. Data analysis was performed independently by two of the authors using a checklist.	Two thirds of teams composed of qualified health-care workers failed to provide basic life support and/or defibrillation within an appropriate time window.	Simulation - video - debriefing LBDQ inspired
HARGESTAM, M. et al. 2016	Investigate how trauma team members are positioned in the emergency room. How leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training.	108 participants. Eighteen trauma teams were audio and video recorded during trauma team training. Focus is on team leaders' communication, analysis is performed in relation to both verbal and non-verbal communication.	Non-verbal communication reinforced the team-leaders’ communication. Team-members who are aware of their non-verbal communication can improve their performance. Vague non-verbal communication reinforces ambiguity and can lead to errors	Team training, CRM
JACOBSSON, M. et al. 2012	Analyse how formal leaders communicate knowledge, create consensus, and position themselves in relation to others in the team	Sixteen trauma teams, six members on each team. High fidelity training in an emergency department. Video.	Communication in trauma teams is complex and consists of more than just transferring messages quickly. It also concerns what the leaders express, and even more importantly, how they speak to and involve other team members	High fidelity training –Qualitative content analysis
KRAGE, R. et al. 2014	To invest whether external distractors influence performance during a standardized simulated CPR scenario in general and whether level of experience has an impact	30 physicians, two simulated CPR. Cross-over study: 1: distractors (radio noise 70 dB, scripted family member, talking at crucial moments) 2: not. Video recorded. Two assessors rated independently	No interaction was observed between additional distractors and experience level. External distractors markedly reduce the quality of cardiopulmonary resuscitation.	Not teaching. Scoring protocol developed.
MCCUE, J.D. et al.1986	To assess the residents' leadership style and the nurses' perceptions of the effectiveness of those styles.	17 residents. A self-administered, self-rating leadership style indicator, LSI. Self reports and Nurses Reports. Questionnaire. Computerised scale. Not blinded assessors	The present study suggests that female residents may be more likely to use high relationship leadership styles in their interaction with nurses … analysis of leadership style is a potentially useful way of helping residents assume leadership more effectively.	Two-hour discussion about leadership. Not teaching. Leadership style indicator, LSI.
The need for leadership training
HJORTDAHL, M. et al.2009	To obtain a deeper understanding of which non-technical skills are important to members of the trauma team during initial examination and treatment of trauma patients.	Twelve semi-structured interviews. 2 authors participated in all 12.	Leadership was perceived as an essential component in trauma management. The ideal leader should be an experienced surgeon, have extensive knowledge of trauma care, communicate clearly and radiate confidence. Lack of leadership was often given as a reason for dysfunctional teamwork.	Not teaching
RINGEN, A.H. et al. 2011	To assess the experience and education of Norwegian trauma team leaders, and allow them to describe their perceived educational needs	Written questionnaires. All 45 hospitals in Norway receiving severely injured trauma victims were contacted, randomly selected weeknight. Team leaders asked to specify what trauma related training programs they had participated in, how much experience they had, and what further training they wished, if any.	Level of experience among team leaders was highly variable and their educational background insufficient according to international and proposed national standards. Team leaders stated that more experience and better training are important to them in order to become better leaders	Not teaching
ROBINSON, P.S. et al. 2016	To assess the perceptions of leadership and team working among members of a cardiac arrest team and to evaluate future training needs	102 members of a cardiac arrest team. Survey. Responses sought from doctors, nurses and healthcare assistants	We recommend that training in and assessment of leadership skills in emergency scenarios should be an integral component of postgraduate medical training	Not teaching
WISBORG, T. et al. 2003	Does the training of multi professional trauma teams and resuscitation teams for newborns vary?	Survey of training practices. The head nurse at each emergency department (n = 50) and neonatal ward (n = 16) was interviewed in a structured fashion. Asked if their emergency team personnel had participated in practical multi professional training during the previous 6 or 12months.	Regular team training represents an underused potential to improve handling of low-frequency emergencies.	Not teaching
HAYES, C.W. et al. 2007	Determine internal medicine residents' perceptions of the adequacy of their training to serve as inhospital cardiac arrest team leaders	654 residents were sent a survey, 289 residents (44.2%) responded. Subjects: adequacy of training, perception of preparedness, adequacy of supervision and feedback, and effectiveness of additional training tools	A significant number of internal medicine residents feel inadequately trained, unprepared, and unsupervised to lead cardiac arrest teams in teaching hospitals.	Not teaching
ITANI, K.M. et al. 2004	Assess the perception of surgical residents in leadership skills.	Questionnaire, 43 residents. 1) Residents ranked 18 leadership skills on a scale of 1–4 in importance for career development. 2) Similar scale with regard to their personal confidence and competence in these same areas. 3) Evaluate themselves with regard to five leadership traits.	Traditionally, development of physician leadership has occurred at random in surgical training. It is our job as surgical educators to provide this opportunity to our residents. Ethics was the only area in which 75% of the residents believed themselves to be more than minimally competent	Not teaching
KOLEH-MAINEN, C. et al. 2014	Investigating code leadership as perceived by residents in four areas: (1) learning to be a code leader (2) leadership defines code success (3) ideal code leadership behaviours (4) leadership and gender	25 residents, semi-structured telephone or in-person interviews. Recorded and transcribed. Three authors analysed three interviews focusing on content areas. Four authors read all transcripts in full	Leadership defines code success. Poor leadership was cited as the major factor to a chaotic code. Participants reported that it was important to be “authoritative”; to have a “strong presence” by being both seen and heard. Female participants described feeling stress from having to violate gender behavioural norms in the role of code leader.	Not teaching
YULE S et al. 2006a Developing	Describe the method used to identify surgeons' non-technical skills, and the development of a skills taxonomy and behavioural rating system to structure observation and feedback in surgical training	27 consultant surgeons. Interview. Identify key non-technical skills and interpersonal skills. Multidisciplinary group developed the interview schedule (psychologists, surgeons and an anaesthetist).	The NOTSS skills taxonomy and marker system presented here has been grounded empirically in surgery, and was developed with domain experts (consultant surgeons) at every stage to ensure that the system is explicit, transparent and has an acceptable degree of construct validity.	Not teaching. Development of a tool - NOTSS
LEENSTRA, N.F. et al. 2016	Need for a taxonomy of leadership skills that specifies the skill components to be learned and the behaviours by which they can be assessed across the five phases of trauma care, the authors developed the Taxonomy of Trauma Leadership Skills, TTLS	28 interviews w. trauma leaders and 14 raters. Skill elements captured by 67 behavioural markers. Categorized using multiple raters	The TTLS provides a framework for teaching, learning, and assessing team leadership skills in trauma care and other complex, acute care situations	Not teaching. Developed the Taxonomy of Trauma Leadership Skills, TTLS
MAKINEN, M. et al. 2007	The purpose of this study was to assess the resuscitation skills of nurses to facilitate construction of an educational programme	From Finland: 110, Sweden: 40 nurses. Case, leadership training (S), control not (F). Subjects tested in pairs. A checklist used to grade. 5 assessors independently, not blinded	Defining and teaching leadership seems to improve resuscitation performance.	Not teaching. Adapted ANTS (NOTECHS inspired)
SADIDEEN, H. et al. 2016	Video analysis of leadership behaviours within The Burns Suite (a simulation tool to deliver inter professional and team work training). Explore whether Simulation-based team training within TBS can elaborate on key leadership theories. Which leadership models appeared predominant within TBS.	N = 12, 3 simulations, each team 4 members. Video. Focus group interviews after debriefing. Objective to identify leadership skills mapping them on to leadership theory. 2 authors and 2 other authors independently assessors	Effective leadership is essential for successful functioning of work teams and accomplishment of task goals. Leadership in a team-based resuscitation scenario can be considered as distributed, rather than continuously being associated with a specific leader.	Simulation - video - debriefing.