A Systematic Review of Teamwork Training Interventions in Medical Student and Resident Education
Teamwork is important for improving care across transitions between providers and for increasing patient safety.
This review’s objective was to assess the characteristics and efficacy of published curricula designed to teach teamwork to medical students and house staff.
The authors searched MEDLINE, Education Resources Information Center, Excerpta Medica Database, PsychInfo, Cumulative Index of Nursing and Allied Health Literature, and Scopus for original data articles published in English between January 1980 and July 2006 that reported descriptions of teamwork training and evaluation results.
Two reviewers independently abstracted information about curricular content (using Baker’s framework of teamwork competencies), educational methods, evaluation design, outcomes measured, and results.
Thirteen studies met inclusion criteria. All curricula employed active learning methods; the majority (77%) included multidisciplinary training. Ten curricula (77%) used an uncontrolled pre/post design and 3 (23%) used controlled pre/post designs. Only 3 curricula (23%) reported outcomes beyond end of program, and only 1 (8%) >6weeks after program completion. One program evaluated a clinical outcome (patient satisfaction), which was unchanged after the intervention. The median effect size was 0.40 (interquartile range (IQR) 0.29, 0.61) for knowledge, 0.38 (IQR 0.32, 0.41) for attitudes, 0.41 (IQR 0.35, 0.49) for skills and behavior. The relationship between the number of teamwork principles taught and effect size achieved a Spearman’s correlation of .74 (p = .01) for overall effect size and .64 (p = .03) for median skills/behaviors effect size.
Reported curricula employ some sound educational principles and appear to be modestly effective in the short term. Curricula may be more effective when they address more teamwork principles.
Key wordsteamwork cooperation medical education curricula medical student house staff resident residency
The authors are indebted to Ms. Cheri Smith from the Harrison Medical Library, Johns Hopkins Bayview Medical Center, for her library assistance and to Ms. Ming An from the Bloomberg School of Public Health for assistance with statistical analysis. Dr. Scott Wright is an Arnold P. Gold Associate Professor of Medicine and a Miller-Coulson Family Scholar. At the time this review was conducted, Dr. Chayan Chakraborti was supported by National Research Service Award Institutional Grant (#5-T-32-HP10025). Dr. Romsai Boonyasai was supported by Behavioral Research in Heart and Vascular Disease Grant (#T32HL07180). Dr. Chakraborti had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Boonyasai was involved in data collection, interpretation, and analysis. Dr. Wright and Dr. Kern provided methodological advice, data interpretation, and edited the manuscript. Material from this manuscript was presented at the 2007 Society of General Internal Medicine National Conference in Toronto, Canada.
Conflict of Interest
- 5.Pizzi L, Goldfarb N, Nash D. Crew resource management and its applications in medicine. In: Making health care safer: a critical analysis of patient safety practices. Evidence Report/Technology Assessment: AHRQ Publication No. 01- E058. 2001;43:501–9.Google Scholar
- 11.Corrigan J. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001.Google Scholar
- 12.Aspden P, Wolcott J, Bootman J, Cronenwett L. Committee on identifying and preventing medication errors: quality chasm series. Washington, D.C.: National Academies Press; 2006.Google Scholar
- 13.Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, D.C.: National Academy Press; 2000.Google Scholar
- 14.ACGME. ACGME outcome project—core competencies. Chicago, IL: ACGMEAvailable at: http://www.acgme.org/outcome/comp/compMin.asp. Accessed February 10, 2008.
- 17.Baker DP, Gustafson S, Beaubien JM, Salas E, Barach P. Advances in patient safety: medical team training programs in health care. Washington, D.C.: Am Institute for Research; 2004.Google Scholar
- 18.Zwarenstein M, Bryant W. Interventions to promote collaboration between nurses and doctors. Cochrane Database Syst Rev. 2000(2):CD000072.Google Scholar
- 19.Zwarenstein M, Reeves S, Barr H, Hammick M, Koppel I, Atkins J. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2001(1):CD002213.Google Scholar
- 23.Cannon-Bowers JA, Salas E, Converse S. Shared mental models in expert team decision making. Hillsdale, New Jersey: Lawrence Erlbaum Assoc Inc.; 1993.Google Scholar
- 26.Cooper HM, Hedges LV. The handbook of research synthesis. New York: Russell Sage Foundation; 1994.Google Scholar
- 27.Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.Google Scholar