What is the effect of a shared leadership system for maternity emergency teams on team performance ?

The developed system of shared leadership (dual leadership) will be compared to traditional vertical leadership in a simulated maternity emergency using a comparative trial with a counterbalanced, crossover design. Participants will be attendees (midwives, midwifery students, obstetric doctors and anaesthetic doctors) at the simulation training course “Maternity Emergency Management” (MEM). The course is delivered by an interprofessional team of clinician educators (midwifery/obstetrics and anaesthetics) with training in simulation delivery and debriefing. The setting is a simulation centre which is co-located with a tertiary maternity hospital. Up to 14 participants per course will be divided into two teams who will participate in 2 research scenarios each during the MEM course day. ( research scenarios will be 2&5 (one team) and 3&6 (second team)). The research scenarios are a fully immersive simulation scenario with a high-fidelity human mannequin. Each intact team of 6-7 participants will be called to an emergency and be expected to assess and manage the "patient" as they would in real life. These scenarios will be similar in the diagnostic approach and management required by the team. Teams will be trained in the use of a cognitive aid during non-research scenarios (scenarios 1&4) to enable singular or shared leadership to be practiced prior to participation in the scenario ustilising the respective leadership structure. Non-research scenarios are immersive scenarios in the "rapid cycle deliberate practice style". Teams will "tag in" and "tag out" of caring for the patient. All scenarios will happen in the course of one day with each team participating in the non-research scenarios and 2 research scenarios each. Non-research scenarios last 30-45 minutes, Research scenarios last 5-10 minutes and are followed by a 20-40 minute debriefing. Teamwork scores (primary outcome) for shared and singular leadership will be compared within groups. Teamwork scores will be assessed during the emergency phase (that is the time after the emergency alarm is activated). The leadership type and scenario order will be counterbalanced to reduce the impact of the learning curve through the day. A latin Square will be used to ensure counterbalancing and the order of the implementation of the course each day will be determined by a randomisation.