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Development of a framework for assessing individual physicians' competency in teamwork.

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Chesluk B, Bernabeo E, Hess BJ, Holmboe ES, Lynn LA, Reddy S. — American Board of Internal Medicine

Presented: Jefferson Center for Interprofessional Education, March 2010

Background: All health care is delivered by teams, though these teams are rarely formally recognized or supported. As part of ABIM's increasing focus on certifying physicians' competency in practice, we began a multi-phase project to explore whether, and how, to assess individual physicians' ability to work as part of a team.

Methods: An interdisciplinary research group first reviewed the literature on teamwork in health care and in related fields (i.e., aviation, management, etc.), convened a panel of experts in the field of teamwork improvement, and conducted ethnographic fieldwork to observe health care teams in action and define the role of individual physician. Based on our findings, we developed a draft tool for formative assessment, including self-assessment and feedback from non-physician collaborators. We then conducted a series of "cognitive lab" sessions with non-physician professionals (nurses, social workers, therapists, pharmacists) and others who have recently undergone similar assessments, to review our conceptual model and the draft tool.

Results: Our iterative R&D process led us to modify a framework on physician teamwork developed by Baker et al. (2005), de-emphasizing “leadership” and incorporating new concepts related to “boundary spanning” (i.e., mitigating medicine's hierarchical culture) and “assessing the team environment” (i.e., awareness of context). Field research showed that physicians vary widely in the amount and quality of their collaborations, and that the practice environment greatly influences individual physicians' teamwork. Cognitive lab sessions refined our understanding of what non-physician professionals expect from physicians (reducing the number of survey items from 52 to 32).

Conclusions: Physicians need frameworks and methods for identifying their teams, understanding their own strengths, and working on improvement with their larger team. Assessing physicians' competency in teamwork can help to address an important systemic issue in health care, and may be especially useful for providers working in organizations that do not identify and support teams.

For more information about this presentation, please contact Research@abim.org.