The role of leadership in medical trainee team-regulation dynamics in crisis resource management simulation education

Medical simulation education allows trainees to work together in teams, and to practise assuming the roles of leader and followers, while completing real-world scenarios designed to develop the skills needed to be effective in clinical practice. Despite the importance of residents developing leadership skills to optimize performance and patient outcomes, gaps exist in our understanding of how leadership affects teamwork dynamics, and how leadership skills are observed during crisis resource management (CRM) medical simulation training. Research often frames medical education training from the perspective of self-regulated learning (SRL) and socially shared regulated learning (SSRL) framework, but there is a need to use theory-guided approaches to how SRL and SSRL can be used to teach leadership skills. This study explored how the SRL and SSRL strategies employed by leaders influence teams during CRM medical simulation education scenarios. Eight second-year internal medicine residents were observed as they engaged in two CRM simulations within a high-fidelity medical education simulation environment. The research team observed behaviours, SRL and SSRL strategies, and the leadership and communication skills of the leaders. Behavioural and regulatory coding using the SRL/SSRL group regulation perspective showed that more successful CRM leaders made more frequent use of communication, organizational and group regulation strategies and were thus able to utilize the assets of their team more effectively than leaders who used these skills less frequently. SRL and SSRL are under-examined frameworks in medical and simulation education. Our current case-based analyses illustrate that these frameworks can provide a valuable lens to examine and better understand team behaviours in these contexts. Future work will continue to explore whether the educational applications of SRL/SSRL group regulatory strategies can improve CRM leadership.