Reply from the author.

and reliability mandates extra capacity, fail-safes, and standard operating procedures, but especially attention to the team. Engineering also embraces ‘cognitive ergonomics’ to maximize mental processes (awareness, perception, reasoning) and expedite individualized responses. ‘Teamwork’ provides a useful prism through which to examine cognitive workload, decision making, reliability (vs safety vs efficiency), human–human interactions, human–computer interactions, and whether graduates are ‘fit for the task’. For example, if we were engineers then we would design checklists, simulations, rapid responses and service rotas based largely on whether they improve (or worsen) the team’s cognitive ability and problem solving. Hunningher nicely summarized this as the difference between ‘pseudo-teams’ and real teams. Ford wisely pointed out that we need high-functioning teams everyday, not just when excrement hits fans. Traditionally, success has relied on the cult of the individual (Sir Lancelott Spratt comes to mind!). While more prosaic, modern heroes are those that create and direct highperforming teams (make way for Sully Sullenberger). While many critical care drug trials have recently been equivocal or negative, teams that could reliably implement those interventions still often had better outcomes. Perhaps, therefore, the effect of a functioning team matters more than a fortuitous drug. We also have drug trials with different results if the first few patients are excluded or included. This reminds us that teamwork takes time, and mastering teamwork probably improves outcome. If so, then we should measure teamwork’s dose–response effect. There is danger that ‘teamwork’ is misinterpreted to mean nobody disagrees, nobody criticizes, or we strengthen our team by denigrating another. CCM and anaesthesia have a history of lambasting other teams (‘you call us too early’, ‘you always wait too late’). These negative interactions can impact interspecialty teamwork for years. We love debating which team is best and which is worse. For example, anaesthesia, CCM, and surgery can all manage difficult airways . . . but which is the airway expert? This question is likely too simplistic. Teams are sometimes defined by subspecialty, but often by task or location. Provocatively, error rates appear higher when familiar procedures are performed in unfamiliar environments. For anaesthesia, ectopic intubation (done outside the operating room) may be more perilous because we are without our teams, and working with unfamiliar communication styles and subcultures. Regardless, if good teamwork were a drug we would study it rigorously and promote it widely.