A systematic review of teamwork training interventions in medical student and resident education

Abstract

Background: Teamwork is important for improving care across transitions between providers and for increasing patient safety.

Objective: This review's objective was to assess the characteristics and efficacy of published curricula designed to teach teamwork to medical students and house staff.

Design: 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.

Measurements: Two reviewers independently abstracted information about curricular content (using Baker's framework of teamwork competencies), educational methods, evaluation design, outcomes measured, and results.

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%) >6 weeks 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.

Conclusions: 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.

Figure 1

Flowchart of search strategy. ERIC = Educational Resources Information Center; EMBASE = Excerpta Medica Database; CINAHL = Cumulative Index of Nursing and Allied Health Literature.

Figure 2

Scatter plot of median overall effect size (Cohen’s d)* versus the number of teamwork principles described in each article. The trend line represents the Spearman’s correlation. The data point numbers correspond to the article reference number. *For each outcome result, the mean pre/post difference was divided by the pooled standard deviation yielding an effect size. The median of all calculated effect sizes within a given article is the median overall effect size.