Demonstrating the impact of incivility in an obstetric emergency: An interventional simulation study.

Objective: To understand the effect of an uncivil environment on the performance of an obstetric team with a focus on non-technical skills, and to ascertain whether simulation training can be used to demonstrate the impact of incivility. Design: An interventional, simulation study. Setting: Wessex Deanery School of Obstetrics and Gynaecology (O&G), UK. Population or Sample: O&G trainees. Methods: Ethical approval was received from the University of Southampton Research Ethics Committee (81008). Following informed consent, twenty three trainees observed two simulated scenarios of the management of a postpartum haemorrhage (PPH) and completed a Team Emergency Assessment Measure (TEAM) questionnaire for each simulation. In the first scenario the anaesthetist was civil and in the second uncivil. ANOVA was used for statistical analysis, p values of <0.05 were considered statistically significant. Main Outcome Measures: TEAM observation questionnaire domains of leadership, teamwork and team management. Results: There was a significant reduction in the overall team performance in an uncivil environment compared to a civil one (p=0.006). The biggest differences in scores were observed in team morale (4.00/4.00 in the civil versus 2.22/4.00 in the uncivil simulation, p<0.001) and effective communication (4.00/4.00 in the civil versus 2.22/4.00 in the uncivil simulation, p<0.001). Conclusions: Incivility affects the ability of the multi-disciplinary team to effectively manage an obstetric emergency and simulation is an effective tool to demonstrate the impact of poor workplace behaviours.