Leadership and interprofessional team management — formative SAQs

SAQ 1 — Leading a paediatric resuscitation team (10 marks)

A four-year-old arrests on the ward. You arrive first as the senior registrar. There are two nurses, a resident and a pharmacist present, and the parents are at the bedside. Describe how you would lead this team in the first minutes. [4] [11]

Questions

1. Describe your immediate actions to establish team leadership and role allocation in the first 60 seconds. (3 marks) [4]
2. Explain how you would use closed-loop communication and a shared mental model during the resuscitation, and why each matters. (4 marks) [2] [11]
3. State two concrete actions you would take to flatten the authority gradient so a junior can speak up, and what you would do after the event to help the team learn. (3 marks) [4] [14]

Model answer

Establishing leadership and roles (3). I would declare myself team leader out loud ("I am taking the role of team leader"), stand back far enough to see the whole bed space and the monitors but close enough to direct, and allocate roles by name and task: one person on airway, one doing compressions, one on drugs drawing up as I call each dose, and one as scribe and time-keeper. A leader who is also doing compressions has stopped leading; my job is to run the team and think ahead, not to perform the tasks. [4] [11]

Closed-loop communication and shared mental model (4). For every dose and critical task I would use closed-loop communication: I state the message, the receiver reads it back, and I confirm — this guarantees the dose and recipient were heard correctly and prevents a dose being missed or doubled. Every minute or two I would run a structured pause to share the mental model: who the child is, the working diagnosis, the current plan, who is doing what, and the next contingency. A shared mental model keeps five people coordinated as the picture changes; without it each works from a different assumption and tasks are duplicated or omitted. [2] [4]

Flattening the gradient and learning (3). To flatten the authority gradient I would invite speak-up by name ("If anyone sees something wrong, please say it — that includes the student") and respond well the first time someone does, because a poor response silences the team permanently. After the event I would run a short structured debrief — what went well, what we learned, what we will change — and I would check on the team members and the parents, because a clinician harmed by an adverse event (a second victim) needs structured support, not blame. [4] [14]

SAQ 2 — Building and sustaining an interprofessional team (10 marks)

You are the new consultant leading the care of a medically complex child with a tracheostomy, home ventilation, a gastrostomy and six specialist teams involved. The ward sister reports that handover omissions and duplicated tasks are common. [5] [13] [17]

Questions

1. Describe how you would build a high-performing interprofessional team for this child, naming the principles and the people you would include. (4 marks) [5] [14]
2. Outline how you would implement a structured handover and which evidence supports it. (3 marks) [13]
3. Appraise the evidence for team training and for interprofessional collaboration interventions, stating the honest caveats. (3 marks) [3] [5] [17]

Model answer

Building the team (4). I would start with role clarity: each person knows their role, who they report to, and which decisions are theirs — including a named care coordinator who holds the single shared plan. I would build a genuine interprofessional team — paediatrician, ward nurse, community nurse, pharmacist, dietitian, speech and language therapist, social worker and the family as core members — that learns and decides together around shared goals, rather than a multidisciplinary team working in parallel. I would make the plan explicit and repeatable (a shared mental model, written down so it survives rotations), and I would protect psychological safety so the plan can be corrected by anyone who sees it is wrong. Leadership style here is facilitative and inclusive, matching the style to the complexity of longitudinal care. [5] [14]

Structured handover (3). I would implement the I-PASS handover — Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by the receiver — with a standard template, brief training, and ongoing audit of handover completeness. The receiver's synthesis is the closed loop of handover. The evidence is the Starmer multicentre study, which showed a standardised handoff programme reduced medical errors across nine paediatric training programmes. [13]

Appraising the evidence (3). The strongest intervention evidence is for team training: the Salas meta-analysis found team training improves team performance and, to a lesser degree, affective outcomes, which supports simulation-based crew resource management. The Cochrane reviews are more cautious — Zwarenstein on interprofessional collaboration and Reeves on interprofessional education both conclude these interventions can improve professional practice and outcomes, but flag heterogeneous studies and weak designs. So the honest position is that the direction of effect is reliable and the effect size is context-dependent; I would implement the interventions and measure their local effect rather than assume a guaranteed gain. [3] [5] [17]