The Anatomy of Health Care Team Training and the State of Practice: A Critical Review

Weaver, Sallie J.; Lyons, Rebecca; DiazGranados, Deborah; Rosen, Michael A.; Salas, Eduardo; Oglesby, James M.; Augenstein, Jeffrey S.; Birnbach, David J.; Robinson, Donald W.; King, Heidi B.

doi:10.1097/acm.0b013e3181f2e907

Cited by 150 publications

(120 citation statements)

References 31 publications

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“…15 Prior reviews have examined teamwork training and interventions, as well as the outcomes of effective teams. 1,[16][17][18][19][20][21][22][23][24] These reviews have advanced the understanding of 'what works' to improve teamwork (i.e. curricula and interventions), but they do not fully answer the critical question of how teamwork is best measured in healthcare.…”

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confidence: 99%

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

et al. 2013

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OBJECTIVE: Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. DATA SOURCES: We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. STUDY ELIGIBILITY: Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. STUDY APPRAISAL AND SYNTHESIS METHODS:Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. RESULTS: Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. LIMITATIONS: Review is limited to quantitative assessments of teamwork in internal medicine. CONCLUSIONS:There is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes. 3,4 Recognizing this, the Institute of Medicine, the Joint Commission, the Agency for Healthcare Research and Quality (AHRQ), and others have made teamwork a top priority in their recommendations for improving healthcare. [5][6][7][8][9] Teamwork is also prominently positioned within the American Board of Internal Medicine (ABIM) requirements for maintenance of certification for internists, 10 as well as the Accreditation Council for Graduate Medical Education's core competencies, 11 milestones, 12 and medical student competencies. 13 As such, every physician at the undergraduate, graduate, and continuing professional level must demonstrate competency in teamwork.While there is broad agreement on the imperative to improve teamwork, there is littl...

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confidence: 99%

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

et al. 2013

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“…[15][16][17] The changes described by our study participants in how they interacted differently following this multidisciplinary team training course would be amenable to measurement by direct observation or through analysis of video recordings.…”

Section: Discussionmentioning

confidence: 99%

“…Email: j.weller@auckland.ac.nz shortcomings in training, but current evidence on the advantages to participants, and ultimately patients, remains unclear. 15,16 Two key gaps in our knowledge in this area of medical education currently exist: first, evidence for the transfer of team learning from the simulated environment to clinical practice is very limited; and second, tools to reliably measure the degree of such learning do not exist. The research designs necessary to detect efficacy of medical education initiatives using simulation are currently difficult and expensive.…”

Section: Introductionmentioning

confidence: 99%

Change in attitudes and performance of critical care teams after a multi-disciplinary simulation-based intervention

et al. 2012

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Objectives: To conduct an in-depth exploration of the selfreported long-term change in attitudes and performance after a full-day multidisciplinary simulation-based course focussed on team management of emergency events in the Critical Care Unit. To address the current lack of knowledge of factors which can lead to improved teamwork performance and their measurement through identification of measurable markers of behaviour and attitude change. Methods: A purposive sample of course participants underwent semi-structured interviews one to five months after course completion. Responses were coded using grounded theory to identify instances of learning, changes in attitudes or clinical performance, and measurable behavioural and attitudinal markers for such change. Interviews continued until data saturation was achieved. Results: Twenty nine participants (15 doctors and 14 nurses) were interviewed. Doctors became more confident in delegating and including nurses in decision making, and nurses became more confident and aware of the need for effective communication. Doctors reported that their ability to assign team roles improved over the day and that they made more frequent use of closed-loop communication. Both professional groups reported improvement in communication in the clinical setting after participation, including better vocalising of thoughts and use of colleagues' names. Attitudes to communication also improved and persisted in the clinical setting. Conclusions: Addressing gaps in current medical education knowledge, self-reported improvements in behaviour and attitudes translated to clinical performance after a simulation course. Measurable behavioural and attitudinal markers were identified that may assist with the development of evidence-based measurement tools in future team training work.

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“…[1][2][3][4][5] As a result, multiple initiatives have targeted teamwork, communication, and other nontechnical skills of multiprofessional teams in acute-care settings of health care. [6][7][8][9] In this setting, one of the most commonly used instructional strategies is Crew Resource Management (CRM) training, a strategy that originated from the aviation industry and aims at enhancing team coordination and performance. 6,10,11 Previous interventions based on the principles of CRM training include large-scale initiatives such as the TeamSTEPPS s12 program of the Department of Defense and the Agency for Healthcare Research and Quality, and the Veteran Health Administration's Medical Team Training 13 program.…”

Section: Introductionmentioning

confidence: 99%

Current Concepts of Team Training in Surgical Residency: A Survey of North American Program Directors

Dedy

Zevin

Bonrath

et al. 2013

Journal of Surgical Education

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The Anatomy of Health Care Team Training and the State of Practice: A Critical Review

Cited by 150 publications

References 31 publications

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

Change in attitudes and performance of critical care teams after a multi-disciplinary simulation-based intervention

Current Concepts of Team Training in Surgical Residency: A Survey of North American Program Directors

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