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Helping physicians assess and improve their ability to work as part of an interprofessional team.

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

Presented: AcademyHealth Annual Research Meeting, June 2011

Research Objective: All health care involves teamwork, and teamwork is widely recognized as a critical element in providing safe, high-quality patient care. Despite this, the interprofessional teams that provide care are often not formally recognized by their members or supported by their organizational contexts. The American Board of Internal Medicine (ABIM) increasingly focuses on work-based assessment—certifying physicians' competency in practice—and regards teamwork as a potential physician competency to assess.

Study Design: An interdisciplinary ABIM research group conducted extensive research on teamwork as a physician competency, including interviews with experts and health care practitioners and ethnographic research with providers in a variety of settings. Based on this research, we developed a conceptual model of inpatient interprofessional teamwork as a physician competency, consisting of the physician's abilities in 1) communicating, 2) collaborating, 3) mitigating the harmful effects of hierarchy and 4) knowing the team's context and resources. We also defined a set of critical tasks/behaviors associated with these teamwork competencies as they arise in the everyday practice of hospital medicine. We then created an assessment “module” for use by hospitalists, which combines 1) identifying their interprofessional team (primarily non-physicians, that is, nurses, nurse practitioners, professional therapists, etc., and at least one nurse manager), 2) assessing themselves and gathering multi-source feedback data from their team on how consistently they perform critical teamwork tasks/behaviors and 3) reflecting on those data with at least one team member or trusted peer and developing an improvement plan.

Population Studied: We conducted a Web-based pilot test of this teamwork assessment tool with an initial, self-selected group of 25 hospitalists.

Principal Findings: Twenty out of 25 of the hospitalists invited completed the teamwork assessment. We solicited extensive written and interview feedback on the multi-source assessment process from physicians and raters. Raters stated they valued the opportunity to provide feedback across professional lines. Hospitalists stated the process produced meaningful, actionable information they could not obtain in other ways. Some hospitalists and raters said that they wanted to use the teamwork assessment more widely in their own practices or with other team members. In addition, we learned that we must improve our methods of helping physicians reflect on their team’s feedback. ABIM’s next step will be to conduct a more extensive test of the tool with a broader sample of hospitalists.

Conclusions: Preliminary findings from a small pilot test suggest a process combining self-assessment, multi-source feedback and a structured review of those data with a peer can provide meaningful and actionable data to help individual physicians improve their teamwork skills and behaviors.

Implications for Policy, Delivery or Practice: Assessing individual physicians' competency in interprofessional teamwork can help to address an important systemic issue in health care, and may be especially useful for professionals who work in organizations that do not explicitly focus on identifying and supporting teams. Assessors need to develop frameworks and methods that guide physicians in 1) mapping their teams, 2) gathering feedback on concrete behaviors from team members across professional boundaries, 3) reflecting on this feedback to understand their own strengths and 4) working on improvement with their larger teams.

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