Journal of General Internal Medicine

, Volume 23, Issue 12, pp 2053–2057 | Cite as

A Multidisciplinary Teamwork Training Program: The Triad for Optimal Patient Safety (TOPS) Experience

  • Niraj L. Sehgal
  • Michael Fox
  • Arpana R. Vidyarthi
  • Bradley A. Sharpe
  • Susan Gearhart
  • Thomas Bookwalter
  • Jack Barker
  • Brian K. Alldredge
  • Mary A. Blegen
  • Robert M. Wachter
  • The Triad for Optimal Patient Safety (TOPS) Project
Innovations in Education



Communication and teamwork failures are a common cause of adverse events. Residency programs, with a mandate to teach systems-based practice, are particularly challenged to address these important skills.


To develop a multidisciplinary teamwork training program focused on teaching teamwork behaviors and communication skills.


Internal medicine residents, hospitalists, nurses, pharmacists, and all other staff on a designated inpatient medical unit at an academic medical center.


We developed a 4-h teamwork training program as part of the Triad for Optimal Patient Safety (TOPS) project. Teaching strategies combined didactic presentation, facilitated discussion using a safety trigger video, and small-group scenario-based exercises to practice effective communication skills and team behaviors. Development, planning, implementation, delivery, and evaluation of TOPS Training was conducted by a multidisciplinary team.


We received 203 evaluations with a mean overall rating for the training of 4.49 ± 0.79 on a 1–5 scale. Participants rated the multidisciplinary educational setting highly at 4.59 ± 0.68.


We developed a multidisciplinary teamwork training program that was highly rated by all participating disciplines. The key was creating a shared forum to learn about and discuss interdisciplinary communication and teamwork.


teamwork communication patient safety multidisciplinary hospital 



We thank the Gordon and Betty Moore Foundation for their active support and funding of the TOPS project. We also thank our wonderful collaborators at El Camino Hospital in Mountain View, CA (including Suann Schutt, Michael Podlone, Phil Strong, and Sara Mills) and Kaiser Permanente in San Francisco, CA (including Rachel Mueller, Clarissa Johnson, Paul Preston, and Lynn Paulsen) for their contributions to the TOPS Training Program and implementing local versions on their respective medical units. We’re grateful for the support we received to conduct TOPS Training from UCSF Medical Center and the UCSF Internal Medicine Residency Program leadership. Finally, we thank Terrie Evans for her role as TOPS Project Coordinator in orchestrating the successful delivery of the TOPS Training Program sessions. The TOPS Training program was presented as a poster presentation (2006) and workshop (2007) at the Society of General Internal Medicine Annual Meeting.

Conflict of Interest

Jack Barker was employed as a consultant from Mach One Leadership, Inc., to contribute experience and expertise in developing and teaching teamwork training. There are no other conflicts of interest to report for the remaining authors.

Supplementary material

11606_2008_793_MOESM1_ESM.pdf (3.1 mb)
ESM 1 Training guide (PDF 3.12 MB)
11606_2008_793_MOESM2_ESM.doc (144 kb)
ESM 2 Training scenario (DOC 144 KB)
11606_2008_793_MOESM3_ESM.doc (60 kb)
ESM 3 Course evaluation (DOC 60 KB)


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Niraj L. Sehgal
    • 1
  • Michael Fox
    • 2
  • Arpana R. Vidyarthi
    • 1
  • Bradley A. Sharpe
    • 1
  • Susan Gearhart
    • 2
  • Thomas Bookwalter
    • 3
  • Jack Barker
    • 4
  • Brian K. Alldredge
    • 3
  • Mary A. Blegen
    • 2
  • Robert M. Wachter
    • 1
  • The Triad for Optimal Patient Safety (TOPS) Project
  1. 1.Division of Hospital MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.School of NursingUniversity of CaliforniaSan FranciscoUSA
  3. 3.School of PharmacyUniversity of CaliforniaSan FranciscoUSA
  4. 4.Mach One Leadership, Inc.MiamiUSA

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