Teamwork has become a major focus in healthcare. In part, this is the result of the Institute of Medicine report entitled To Err Is Human: Building a Safer Health System, which details the high rate of preventable medical errors, many of which are the result of dysfunctional or nonexistent teamwork. It has been proposed that a healthcare system that supports effective teamwork can improve the quality of patient care and reduce workload issues that cause burnout among healthcare professionals. Few clear guidelines exist to help guide the implementation of all these recommendations in healthcare settings. In general, training programs designed to improve team skills are a new concept for medicine, particularly for physicians who are trained largely to be self-sufficient and individually responsible for their actions. Outside of healthcare, research has shown that teams working together in high-risk and high-intensity work environments make fewer mistakes than individuals. This evidence originates from commercial aviation, the military, firefighting, and rapid-response police activities. Commercial aviation, an industry in which mistakes can result in unacceptable loss, has been at the forefront of risk reduction through teamwork training. The importance of teamwork has been recognized by some in the healthcare industry who have begun to develop their own specialty-driven programs. The purpose of this review is to discuss the current literature on teaching about teamwork in undergraduate medical education. We describe the science of teams, analyze the work in team training that has been done in other fields, and assess what work has been done in other fields about the importance of team training (ie, aviation, nonmedical education, and business). Additionally, it is vital to assess what work has already been done in medicine to advance the skills required for effective teamwork. Much of this work has been done in fields in which medical professionals deal with crisis situations (ie, anesthesia, trauma, and labor and delivery). We describe the current programs for teaching medical students these essential skills and what recommendations have been made about the best ways to introduce teaching this skill set into the curriculum. Finally, we include a review on assessing teamwork because one cannot teach team training without implementing an assessment to ensure that the skills are being learned.
Background: For more than two decades, national career development programs (CDPs) have addressed underrepresentation of women faculty in academic medicine through career and leadership curricula. We evaluated CDP participation impact on retention. Methods: We used Association of American Medical Colleges data to compare 3268 women attending CDPs from 1988 to 2008 with 17,834 women and 40,319 men nonparticipant faculty similar to CDP participants in degree, academic rank, first year of appointment in rank, and home institution. Measuring from first year in rank to departure from last position held or December 2009 (study end date), we used Kaplan-Meier curves; Cox survival analysis adjusted for age, degree, tenure, and department; and 10-year rates to compare retention. Results: CDP participants were significantly less likely to leave academic medicine than their peers for up to 8 years after appointment as Assistant and Associate Professors. Full Professor participants were significantly less likely to leave than non-CDP women. Men left less often than non-CDP women at every rank. Participants attending more than one CDP left less often than those attending one, but results varied by rank. Patterns of switching institutions after 10 years varied by rank; CDP participants switched significantly less often than men at Assistant and Associate Professor levels and significantly less often than non-CDP women among Assistant Professors. Full Professors switched at equal rates. Conclusion: National CDPs appear to offer retention advantage to women faculty, with implications for faculty performance and capacity building within academic medicine. Intervals of retention advantage for CDP participants suggest vulnerable periods for intervention.
Background: Surprisingly little research is available to explain the well-documented organizational and societal influences on persistent inequities in advancement of women faculty. Methods: The Systems of Career Influences Model is a framework for exploring factors influencing women's progression to advanced academic rank, executive positions, and informal leadership roles in academic medicine. The model situates faculty as agents within a complex adaptive system consisting of a trajectory of career advancement with opportunities for formal professional development programming; a dynamic system of influences of organizational policies, practices, and culture; and a dynamic system of individual choices and decisions. These systems of influence may promote or inhibit career advancement. Within this system, women weigh competing influences to make career advancement decisions, and leaders of academic health centers prioritize limited resources to support the school's mission. Results and Conclusions: The Systems of Career Influences Model proved useful to identify key research questions. We used the model to probe how research in academic career development might be applied to content and methods of formal professional development programs. We generated a series of questions and hypotheses about how professional development programs might influence professional development of health science faculty members. Using the model as a guide, we developed a study using a quantitative and qualitative design. These analyses should provide insight into what works in recruiting and supporting productive men and women faculty in academic medical centers.
The findings contribute to the growing evidence that career development programs, concurrent with strategic, intentional support of institutional leaders, are necessary to achieve gender equity and diversity inclusion.
Students who receive simulation training participate more actively in the clinical environment during the course of the clerkship. Student simulation training is beneficial to learn obstetric skills in a minimal risk environment, demonstrate competency with maneuvers, and translate this competence into increased clinical participation and confidence.
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