Teaching team membership to family medicine residents: What does it take?

Abstract

Primary care reform proponents advocate for patient-centered medical homes built on interdisciplinary teamwork. Recent efforts document the difficulty achieving reform, which requires personal transformation by doctors. Currently no widely accepted curriculum to teach team membership in Family Medicine residencies exists. Organizational Development (OD) has 40 years of experience assessing and teaching the skills underlying teamwork. We present a curriculum that adapts OD insights to articulate a framework describing effective teamwork; define and teach specific team membership skills; reframe residents' perception of medicine to make relationships relevant; and transform training experiences to provide practice in interdisciplinary teamwork. Curriculum details include a rotation to introduce the new framework, six workshops, experiential learning in the practice, and coaching as a teaching method. We review program evaluations. We discuss challenges, including institutional resources and support, incorporation of a new language and culture into residency training, recruitment "for fit," and faculty/staff development. We conclude that teaching the relationship skills of effective team membership is feasible, but hard. Succeeding has transformative implications for patient relationships, residency training and the practice of family medicine.

Transformative Learning in Graduate Medical Education: A Scoping Review

“…Twenty-eight citations met inclusion criteria and were published between 2000 and 2018. Twenty (71%) described empirical research [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] or were formal literature reviews. 34 Two articles (7%) used entirely quantitative methodology, 15,27 10 (36%) used qualitative methodology, [16][17][18]20,22,23,26,28,29,34 and 8 (29%) utilized mixed methods.…”

“…Twenty (71%) described empirical research [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] or were formal literature reviews. 34 Two articles (7%) used entirely quantitative methodology, 15,27 10 (36%) used qualitative methodology, [16][17][18]20,22,23,26,28,29,34 and 8 (29%) utilized mixed methods. 19,21,24,25,[30][31][32][33] The remaining articles were either first person accounts of experiences or curricula [35][36][37] or were entirely conceptual.…”

“…7, [38][39][40][41] Nineteen articles (69%) explicitly mentioned ''transformative learning'' or ''transformational learning.'' 7, [16][17][18][19][21][22][23]26,27,29,31,33,34,36,[38][39][40][41] In the case of empirical work and first person accounts, the educational venues were in the United States, [15][16][17][18][19][20][21][23][24][25]27,30,32,33,36,37 Kenya, 29,35 the Netherlands, 26 Norway, 28 Mexico, 31 or described international health electives across multiple countries. 22 The majority of articles described traditional GME (ie, internship, residency, fellowship), with the primary care fields (internal medicine, family medicine, pediatrics, general practice, or unspecified primary care) being most represented (TABLE 1).…”

How to Talk about Gender Inequity in the Workplace: Using WAGES as an Experiential Learning Tool to Reduce Reactance and Promote Self-Efficacy

“…Experiential learning is an effective learning tool in diverse domains. It appears to be particularly effective in contexts in which complex information must be processed (e.g., Burke et al 2011) and contexts in which deeply ingrained behavioral attitudes are challenged (e.g., Eubank et al 2011). Thus an experiential learning-based activity is well suited for teaching about gender inequity.…”

Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system

“…[1][2][3][4][5][6] While new models of care delivery may be associated with changes in quality of care as well as patient and provider experience, 7,8 the transition to team-based care is complicated. [9][10][11][12][13][14][15][16][17] Understanding local contextual factors influencing application of team-based models in primary care is likely to be important to their implementation. The ability to successfully respond to practice change, or capacity for change, measured as practice adaptive reserve, is often based upon relationships-both among team members and between team members and patients.…”