Leadership and interprofessional team management — branching viva

Opening (candidate)

My first job is to take the role of team leader out loud, before anything else. I would declare "I am taking the role of team leader", stand back far enough to see the whole bed space, and allocate roles by name and task — airway, compressions, drugs, scribe. I would use closed-loop communication for every dose, build a shared mental model in a structured pause each minute, and flatten the authority gradient so the most junior voice can stop a preventable error. After the event I would debrief. Beyond this single arrest, my job as a consultant is to build a team that performs like this even when I am not standing in it — through role clarity, psychological safety, TeamSTEPPS tools, structured I-PASS handover, and simulation-based crew resource management training with reinforcement. [4] [11] [14]

Branch A — Leadership versus management

Examiner: You were told you lead well but need to develop management. What is the difference? [14]

Candidate: Leadership sets direction and aligns and enables people; management plans, organises, budgets and controls. They are related but distinct skills — a brilliant clinician can be a poor leader, and a strong leader does not have to be the most senior person. In this arrest I am leading: setting direction, allocating roles, enabling the team. The management work — staffing the rota, the resuscitation trolley checks, the audit of arrest outcomes — is what I build around the team so that the next arrest runs as well. [14] [15]

Branch B — Closed-loop communication and the shared mental model

Examiner: Show me closed-loop communication and tell me why it matters. [2]

Candidate: When I want adrenaline I call the dose clearly, the nurse drawing it up reads it back, and I confirm before it is given. That three-step loop — message, read-back, confirm — guarantees the dose and the recipient were heard correctly, which is exactly what an open-loop order into the air cannot do. Alongside it, every minute or two I run a structured pause to share the mental model: who the child is, the working diagnosis, the plan, who is doing what, and the next contingency. Reader's work shows that team situation awareness predicts whether a team correctly anticipates a patient's progress; the shared mental model is what keeps five people coordinated as the picture changes. [2] [4]

Branch C — Psychological safety and the authority gradient

Examiner: The resident noticed the rhythm looked different but said nothing. Why, and what do you do about it? [4]

Candidate: That is a steep authority gradient suppressing voice, and voice is what catches the error before it reaches the child. Psychological safety is the shared belief that the team is safe for interpersonal risk-taking — the condition that lets a junior say "I think that rhythm is different" or "I am uncomfortable". I flatten the gradient deliberately: I invite speak-up by name, I name uncertainty out loud, and critically I respond well the first time someone speaks up, because a poor response silences the team permanently. If a concern is voiced and dismissed once, the TeamSTEPPS two-challenge rule requires voicing it again to force a hearing. [4] [11]

Branch D — Handover and sustaining the team

Examiner: The arrest hands over to PICU. How do you make sure nothing is lost, and how do you sustain this once the arrest is over? [13]

Candidate: The handover uses I-PASS — Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by the receiver — and the receiver's read-back of the plan is the closed loop. Starmer showed a standardised handoff programme reduced medical errors across nine paediatric training programmes. To sustain the team beyond this event I embed TeamSTEPPS in daily work, standardise handover with I-PASS and audit it, and reinforce the skills with simulation-based crew resource management and structured debrief — because without reinforcement the skills decay. I would also run a short debrief after this arrest so the team learns, and I would check on any team member who is struggling, since a clinician harmed by an adverse event is a second victim who needs support, not blame. [3] [13] [14]

Branch E — Evidence and interprofessional care

Examiner: You keep citing teamwork. What is the actual evidence, and how does interprofessional collaboration fit? [3]

Candidate: 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. The mechanism reviews — Manser on teamwork in dynamic domains, Cheng on simulation-based CRM in paediatric critical care — explain why. The Cochrane reviews are more cautious: Zwarenstein on interprofessional collaboration and the Reeves interprofessional education review both conclude these interventions can improve practice and outcomes, but the studies are heterogeneous and often weak. So the honest position is that the direction of effect is reliable and the effect size is context-dependent. For a medically complex child with many teams, genuine interprofessional care — learning and deciding together around shared goals — is better than a multidisciplinary team working in parallel. [3] [5] [11]

Close

I would name myself team leader, allocate roles by name, build a shared mental model in a structured pause, use closed-loop communication for every dose, and flatten the authority gradient so a junior can stop a preventable error. I match an authoritative style in the crisis to a facilitative, inclusive style when I build the longitudinal team. To sustain it I embed TeamSTEPPS and I-PASS handover in daily work, reinforce with simulation-based crew resource management and debrief, and support the second victim. The evidence supports the direction — team training improves performance, interprofessional collaboration can improve outcomes — and I read it honestly, because the effect size is context-dependent and the skills decay without reinforcement. [2] [4] [14]