Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

ABSTRACTOBJECTIVEValid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties.DATA SOURCESWe searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies.STUDY ELIGIBILITYIncluded studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams.STUDY APPRAISAL AND SYNTHESIS METHODSInstrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated.RESULTSOf 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63–0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes.LIMITATIONSReview is limited to quantitative assessments of teamwork in internal medicine.CONCLUSIONSThere is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes.

[1]  J Bryan Sexton,et al.  Discrepant attitudes about teamwork among critical care nurses and physicians* , 2003, Critical care medicine.

[2]  B. Primack,et al.  Exploring successful community pharmacist-physician collaborative working relationships using mixed methods. , 2010, Research in social & administrative pharmacy : RSAP.

[3]  William R Doucette,et al.  Influential Characteristics of Physician/Pharmacist Collaborative Relationships , 2004, The Annals of pharmacotherapy.

[4]  M. Burmester,et al.  Impact of an embedded simulation team training programme in a paediatric intensive care unit: a prospective, single-centre, longitudinal study , 2011, Intensive Care Medicine.

[5]  Halim Issever,et al.  Turkish version of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration: A preliminary study , 2006, Contemporary nurse.

[6]  Transdisciplinary teamwork simulation in obstetrics-gynecology health care education. , 2012, The Journal of nursing education.

[7]  D. Roblin,et al.  An Evaluation of the Influence of Primary Care Team Functioning on the Health of Medicare Beneficiaries , 2011, Medical care research and review : MCRR.

[8]  R. Kane,et al.  Using Scripted Video to Assess Interdisciplinary Team Effectiveness Training Outcomes , 2004, Gerontology & geriatrics education.

[9]  K. O’Leary,et al.  Teamwork on inpatient medical units: assessing attitudes and barriers , 2010, Quality and Safety in Health Care.

[10]  Vicki R LeBlanc,et al.  Personalized Oral Debriefing Versus Standardized Multimedia Instruction After Patient Crisis Simulation , 2009, Anesthesia and analgesia.

[11]  Boaz Shulruf,et al.  Evaluation of an instrument to measure teamwork in multidisciplinary critical care teams , 2011, Quality and Safety in Health Care.

[12]  W. Doucette,et al.  Examining the development of pharmacist-physician collaboration over 3 months. , 2010, Research in social & administrative pharmacy : RSAP.

[13]  Diane K Boyle,et al.  Enhancing Collaborative Communication of Nurse and Physician Leadership in Two Intensive Care Units , 2004, The Journal of nursing administration.

[14]  C. Vincent,et al.  Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool , 2011, Quality and Safety in Health Care.

[15]  J. Proudfoot,et al.  Team climate for innovation: what difference does it make in general practice? , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[16]  S. Lurie,et al.  Assessing teamwork: a reliable five-question survey. , 2011, Family medicine.

[17]  B. Shulruf,et al.  The effect of a simulation-based training intervention on the performance of established critical care unit teams* , 2011, Critical care medicine.

[18]  S. Wheelan,et al.  The link between teamwork and patients' outcomes in intensive care units. , 2003, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[19]  Nick Sevdalis,et al.  Observational teamwork assessment for surgery: content validation and tool refinement. , 2011, Journal of the American College of Surgeons.

[20]  C. Bekes,et al.  Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate , 2008 .

[21]  W. Berry,et al.  Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention , 2011, Quality and Safety in Health Care.

[22]  S. Hamstra,et al.  Nontechnical Skills in Anesthesia Crisis Management with Repeated Exposure to Simulation-based Education , 2005, Anesthesiology.

[23]  T. Shimbo,et al.  Universal problems during residency: abuse and harassment , 2009, Medical education.

[24]  K. Dodd,et al.  Australian Health Review , 2007 .

[25]  C. Lockwood,et al.  A Comprehensive Obstetrics Patient Safety Program Improves Safety Climate and Culture , 2012 .

[26]  V. Schneider,et al.  Preliminary evaluation of an educational model for promoting positive team attitudes and functioning among pain medicine fellows. , 2010, Pain medicine.

[27]  M. Berner,et al.  Effect of crew resource management training in a multidisciplinary obstetrical setting. , 2008, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[28]  S. Reeves,et al.  A best evidence systematic review of interprofessional education: BEME Guide no. 9 , 2007, Medical teacher.

[29]  D. Tibboel,et al.  Patient safety culture in a Dutch pediatric surgical intensive care unit: An evaluation using the Safety Attitudes Questionnaire , 2011, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[30]  J. Fitzpatrick,et al.  Nurse-physician collaboration in an acute care community hospital , 2010, Journal of interprofessional care.

[31]  S. Weiss,et al.  Validity and Reliability of the Collaborative Practice Scales , 1985, Nursing research.

[32]  C. Clancy.  Ten Years After To Err Is Human , 2009, American journal of medical quality : the official journal of the American College of Medical Quality.

[33]  L. Lowry,et al.  An interprofessional course in bioethics: Training for real-world dilemmas , 2009, Journal of interprofessional care.

[34]  A I Mushlin,et al.  Nurse-physician collaboration and satisfaction with the decision-making process in three critical care units. , 1997, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[35]  D. P. Baker,et al.  The role of teamwork in the professional education of physicians: current status and assessment recommendations. , 2005, Joint Commission journal on quality and patient safety.

[36]  John Kim,et al.  A Comparison of Global Rating Scale and Checklist Scores in the Validation of an Evaluation Tool to Assess Performance in the Resuscitation of Critically Ill Patients During Simulated Emergencies (Abbreviated as “CRM Simulator Study IB”) , 2009, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[37]  P. Hjortdahl,et al.  Doctor and nurse perception of inter-professional co-operation in hospitals. , 2004, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[38]  Kevin J O'Leary,et al.  Improving teamwork: impact of structured interdisciplinary rounds on a hospitalist unit. , 2011, Journal of hospital medicine.

[39]  Thomas J. Nasca,et al.  The new recommendations on duty hours from the ACGME Task Force. , 2010, The New England journal of medicine.

[40]  J. Schneider,et al.  Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care , 2003 .

[41]  Julia Adler-Milstein,et al.  Residents' and nurses' perceptions of team function in the medical intensive care unit. , 2011, Journal of critical care.

[42]  J. Beard,et al.  Prospective observational study to evaluate NOTSS (Non‐Technical Skills for Surgeons) for assessing trainees' non‐technical performance in the operating theatre , 2011, The British journal of surgery.

[43]  Rhona Flin,et al.  Experience matters: comparing novice and expert ratings of non‐technical skills using the NOTSS system , 2009, ANZ journal of surgery.

[44]  Scott Reeves,et al.  The effectiveness of interprofessional education: Key findings from a new systematic review , 2010, Journal of interprofessional care.

[45]  A. Darzi,et al.  Efficient implementation of patient-specific simulated rehearsal for the carotid artery stenting procedure: part-task rehearsal. , 2011, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[46]  M. Paasche-Orlow,et al.  Team Improvement and Patient Safety Conferences: Culture Change and Slowing the Revolving Door Between Skilled Nursing Facility and the Hospital , 2012, Journal of nursing care quality.

[47]  C. Taylor.  Attitudes toward physician-nurse collaboration in anesthesia. , 2009, AANA journal.

[48]  M. Hammick,et al.  Learning in interprofessional teams: AMEE Guide no 38 , 2009, Medical teacher.

[49]  J. Neily,et al.  Improving Perceptions of Teamwork Climate With the Veterans Health Administration Medical Team Training Program , 2011, American journal of medical quality : the official journal of the American College of Medical Quality.

[50]  R. Flin,et al.  Anaesthetists' Non-Technical Skills (ANTS): evaluation of a behavioural marker system. , 2003, British journal of anaesthesia.

[51]  S. Bosnic-Anticevich,et al.  INSTRUCTIONAL DESIGN AND ASSESSMENT An Interprofessional Learning Module on Asthma Health Promotion , 2011 .

[52]  Hilde Smith-Strøm,et al.  Improving patient safety by using interprofessional simulation training in health professional education , 2006, Journal of interprofessional care.

[53]  S. Leggat,et al.  Effective healthcare teams require effective team members: defining teamwork competencies , 2007, BMC Health Services Research.

[54]  Mindy E. Flanagan,et al.  Healthcare Team Vitality Instrument (HTVI): developing a tool assessing healthcare team functioning. , 2010, Journal of Advanced Nursing.

[55]  B. Lown,et al.  The Schwartz Center Rounds: Evaluation of an Interdisciplinary Approach to Enhancing Patient-Centered Communication, Teamwork, and Provider Support , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[56]  M. West,et al.  A failure of function : teamwork in primary health care , 1997 .

[57]  P. Bower,et al.  The association between culture, climate and quality of care in primary health care teams. , 2007, Family practice.

[58]  P. Schyve.  Teamwork--the changing nature of professional competence. , 2005, Joint Commission journal on quality and patient safety.

[59]  P. McCulloch,et al.  The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre , 2009, Quality & Safety in Health Care.

[60]  François Desjardins,et al.  Looking in the mirror: Self-debriefing versus instructor debriefing for simulated crises* , 2011, Critical care medicine.

[61]  How much teamwork exists between nurses and junior doctors in the intensive care unit? , 2011, Journal of advanced nursing.

[62]  S. Thomson.  Nurse-physician collaboration: a comparison of the attitudes of nurses and physicians in the medical-surgical patient care setting. , 2007, Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses.

[63]  M. Kivimäki,et al.  A short version of the Team Climate inventory : Development and psychometric properties , 1999 .

[64]  Mark V. Williams,et al.  Interdisciplinary teamwork in hospitals: a review and practical recommendations for improvement. , 2012, Journal of hospital medicine.

[65]  Patricia S. O’Sullivan,et al.  Validation of a self-efficacy instrument and its relationship to performance of crisis resource management skills , 2011, Advances in health sciences education : theory and practice.

[66]  R. Grol,et al.  DOC questionnaire: measuring how GPs and medical specialists rate collaboration. , 2010, International journal of health care quality assurance.

[67]  Nick Sevdalis,et al.  Self vs expert assessment of technical and non-technical skills in high fidelity simulation. , 2011, American journal of surgery.

[68]  M. West,et al.  The determinants of effectiveness in primary health care teams , 1999 .

[69]  R. Fox,et al.  Attitudes Toward Safety and Teamwork in a Maternity Unit With Embedded Team Training , 2011, American journal of medical quality : the official journal of the American College of Medical Quality.

[70]  David A Cook,et al.  Association between funding and quality of published medical education research. , 2007, JAMA.

[71]  Kim A. Noble,et al.  SIMULATION as a Means to Foster Collaborative Interdisciplinary Education , 2009, Nursing education perspectives.

[72]  Marije Bosch,et al.  Organizational culture, team climate, and quality management in an important patient safety issue: nosocomial pressure ulcers. , 2011, Worldviews on evidence-based nursing.

[73]  N. Schaper,et al.  Inefficacy of simulator‐based training on anaesthesiologists' non‐technical skills * , 2009, Acta anaesthesiologica Scandinavica.

[74]  R. Grol,et al.  The Team Climate Inventory: application in hospital teams and methodological considerations , 2008, Quality & Safety in Health Care.

[75]  Theodore Speroff,et al.  The impact of aviation-based teamwork training on the attitudes of health-care professionals. , 2004, Journal of the American College of Surgeons.

[76]  R. Lew,et al.  Development of a Tool to Assess the Team Leadership Skills of Medical Residents , 2006, Medical education online.

[77]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[78]  D. Cook,et al.  Current concepts in validity and reliability for psychometric instruments: theory and application. , 2006, The American journal of medicine.

[79]  Eric S. Holmboe,et al.  Tools for direct observation and assessment of clinical skills of medical trainees: a systematic review. , 2009, JAMA.

[80]  M. Enriquez,et al.  The Negative Impact of Nurse-Physician Disruptive Behavior on Patient Safety: A Review of the Literature , 2009, Journal of patient safety.

[81]  J. Fitzpatrick,et al.  CRNA-physician collaboration in anesthesia. , 2009, AANA journal.

[82]  C. Holzmueller,et al.  Variation in caregiver perceptions of teamwork climate in labor and delivery units , 2006, Journal of Perinatology.

[83]  Lawrence W. Way,et al.  The Efficacy of Medical Team Training: Improved Team Performance and Decreased Operating Room Delays: A Detailed Analysis of 4863 Cases , 2010, Annals of surgery.

[84]  J. Fitzpatrick,et al.  Attitudes towards collaboration and servant leadership among nurses, physicians and residents , 2009, Journal of interprofessional care.

[85]  Paul Barach,et al.  Errors and the burden of errors: attitudes, perceptions, and the culture of safety in pediatric cardiac surgical teams. , 2008, The Annals of thoracic surgery.

[86]  A. Stahelski,et al.  Predictors of Cooperation in Health Care Teams , 1990 .

[87]  Tami L. Remington,et al.  Evaluation of evidence for interprofessional education. , 2006, American journal of pharmaceutical education.

[88]  N. Sevdalis,et al.  Observational Skill-based Clinical Assessment tool for Resuscitation (OSCAR): Development and validation☆ , 2011, Resuscitation.

[89]  M. Makary,et al.  Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. , 2006, Journal of the American College of Surgeons.

[90]  Seshadri C. Mudumbai,et al.  External Validation of Simulation-Based Assessments With Other Performance Measures of Third-Year Anesthesiology Residents , 2012, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[91]  J. Beaubien,et al.  Understanding Interdisciplinary Health Care Teams: Using Simulation Design Processes From the Air Carrier Advanced Qualification Program to Identify and Train Critical Teamwork Skills , 2010, Journal of patient safety.

[92]  B. Kalisch,et al.  The impact of nurse/physician collaboration on patient length of stay. , 2009, Journal of nursing management.

[93]  E. Thomas,et al.  The impact of a tele-ICU on provider attitudes about teamwork and safety climate , 2010, Quality and Safety in Health Care.

[94]  E. Ream,et al.  Teamwork: a concept analysis. , 2008, Journal of advanced nursing.

[95]  J. Dawson,et al.  Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness , 2003, British Journal of Cancer.

[96]  J. Verhoef,et al.  The impact of introducing an ICF-based rehabilitation tool on staff satisfaction with multidisciplinary team care in rheumatology: an exploratory study , 2008, Clinical rehabilitation.

[97]  William R Doucette,et al.  Utility of a questionnaire to measure physician-pharmacist collaborative relationships. , 2006, Journal of the American Pharmacists Association : JAPhA.

[98]  Jody Hoffer Gittell,et al.  Is the doctor in? A relational approach to job design and the coordination of work , 2008 .

[99]  Effects of a multicentre teamwork and communication programme on patient outcomes: results from the Triad for Optimal Patient Safety (TOPS) project , 2011, BMJ quality & safety.

[100]  Rhona Flin,et al.  Debriefing surgeons on non-technical skills (NOTSS) , 2008, Cognition, Technology & Work.

[101]  Ken R Catchpole,et al.  A Multicenter Trial of Aviation-Style Training for Surgical Teams , 2010, Journal of patient safety.

[102]  Rosanne M. Leipzig,et al.  Integrating Housestaff into a Geriatric Inpatient Interdisciplinary Team , 2001 .

[103]  J. Fitzpatrick,et al.  Collaboration and autonomy: Perceptions among nurse practitioners , 2011, Journal of the American Academy of Nurse Practitioners.

[104]  N. Anderson,et al.  Measuring climate for work group innovation: development and validation of the team climate inventory , 1998 .

[105]  G. Brattebø,et al.  Teamwork skills, shared mental models, and performance in simulated trauma teams: an independent group design , 2010, Scandinavian journal of trauma, resuscitation and emergency medicine.

[106]  L. Sjodahl.  Evaluation of Training. , 1975 .

[107]  G. Keenan,et al.  Norms and nurse management of conflicts: keys to understanding nurse-physician collaboration. , 1998, Research in nursing & health.

[108]  Carolyn M Clancy,et al.  TeamSTEPPS: Assuring Optimal Teamwork in Clinical Settings , 2007, American journal of medical quality : the official journal of the American College of Medical Quality.

[109]  J. Herrin,et al.  Poster 80: Team Functioning and Patient Outcomes: A Randomized Controlled Trial in Process Improvement , 2005 .

[110]  N. Ismail,et al.  Assessment of patient safety culture among healthcare providers at a teaching hospital in Cairo, Egypt. , 2012, Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit.

[111]  V. Curran,et al.  Influence of an interprofessional HIV/AIDS education program on role perception, attitudes and teamwork skills of undergraduate health sciences students. , 2005, Education for health.

[112]  L King,et al.  Perceptions of collaborative practice between Navy nurses and physicians in the ICU setting. , 1994, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[113]  Sunil Kripalani,et al.  Hospitalist handoffs: a systematic review and task force recommendations. , 2009, Journal of hospital medicine.

[114]  M. Uhari,et al.  Medical student abuse: an international phenomenon. , 1994, JAMA.

[115]  R Flin,et al.  Attitudes to teamwork and safety in the operating theatre. , 2006, The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland.

[116]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[117]  R. Fox,et al.  More to teamwork than knowledge, skill and attitude , 2010, BJOG : an international journal of obstetrics and gynaecology.

[118]  Lance Brendan Young,et al.  Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis. , 2011, Archives of internal medicine.

[119]  M. Ardahan,et al.  Professional collaboration in students of Medicine Faculty and School of Nursing. , 2010, Nurse education today.

[120]  Johanna I. Westbrook,et al.  Research Paper: Clinical Team Functioning and IT Innovation: A Study of the Diffusion of a Point-of-care Online Evidence System , 2003, J. Am. Medical Informatics Assoc..

[121]  C. Vincent,et al.  Quality Improvement in Multidisciplinary Cancer Teams: An Investigation of Teamwork and Clinical Decision-Making and Cross-Validation of Assessments , 2011, Annals of Surgical Oncology.

[122]  T. S. Willis,et al.  Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units. , 2011, Joint Commission journal on quality and patient safety.

[123]  S. Weingart,et al.  Developing a High-Performance Team Training Framework for Internal Medicine Residents: The ABC'S of Teamwork , 2011, Journal of patient safety.

[124]  Ch K Kydona,et al.  The level of teamwork as an index of quality in ICU performance. , 2010, Hippokratia.

[125]  Sallie J. Weaver,et al.  Does team training work? Principles for health care. , 2008, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[126]  S. Lindqvist,et al.  Introducing a post-registration interprofessional learning programme for healthcare teams , 2007, Medical teacher.

[127]  Kenneth D Cole,et al.  Organizational Structure, Team Process, and Future Directions of Interprofessional Health Care Teams , 2003, Gerontology & geriatrics education.

[128]  E. Sinz,et al.  Crisis Resource Management: Evaluating Outcomes of a Multidisciplinary Team , 2007, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[129]  Robert M Mentzer,et al.  Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. , 2007, Journal of the American College of Surgeons.

[130]  G. Demiris,et al.  Inviting the absent members: examining how caregivers’ participation affects hospice team communication , 2010, Palliative medicine.

[131]  Paula S Kent,et al.  Impact of the Comprehensive Unit-based Safety Program (CUSP) on safety culture in a surgical inpatient unit. , 2010, Joint Commission journal on quality and patient safety.

[132]  Marko Elovainio,et al.  Team climate and procedural justice as predictors of occupational strain. , 2002 .

[133]  D. P. Baker,et al.  Assessing teamwork attitudes in healthcare: development of the TeamSTEPPS teamwork attitudes questionnaire , 2010, Quality and Safety in Health Care.

[134]  H Purdie,et al.  Assessing the surgical skills of trainees in the operating theatre: a prospective observational study of the methodology. , 2011, Health technology assessment.

[135]  S. Downing.  Validity: on the meaningful interpretation of assessment data , 2003, Medical education.

[136]  Denis A. Evans,et al.  Geriatric Interdisciplinary Team Training Program , 2005, Journal of aging and health.

[137]  D. Walker,et al.  Nurse Self-Esteem and Collaboration with Physicians , 1987, Western journal of nursing research.

[138]  Jacqueline J Arnold,et al.  Enhancing nurse and physician collaboration in clinical decision making through high-fidelity interdisciplinary simulation training. , 2011, Mayo Clinic proceedings.

[139]  W. Doucette,et al.  Development and initial validation of an instrument to measure physician-pharmacist collaboration from the physician perspective. , 2005, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[140]  V. Arora,et al.  Professionalism in the era of duty hours: time for a shift change? , 2012, JAMA.

[141]  Nicole Leduc,et al.  Outcomes of Interprofessional Collaboration for Hospitalized Cancer Patients , 2008, Cancer nursing.

[142]  Sallie J. Weaver,et al.  The Anatomy of Health Care Team Training and the State of Practice: A Critical Review , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[143]  A. Mushlin,et al.  Association between nurse-physician collaboration and patient outcomes in three intensive care units. , 1999, Critical care medicine.

[144]  David E. Kern,et al.  A Systematic Review of Teamwork Training Interventions in Medical Student and Resident Education , 2008, Journal of General Internal Medicine.

[145]  Lester R. Bittel,et al.  TRAINING AND DEVELOPMENT HANDBOOK. , 1967 .

[146]  C E Phelps,et al.  The association between interdisciplinary collaboration and patient outcomes in a medical intensive care unit. , 1992, Heart & lung : the journal of critical care.

[147]  George Kuk,et al.  The team climate inventory (TCI) - four or five factors? Testing the structure of TCI in samples of low and high complexity jobs , 1997 .

[148]  R Flin,et al.  Anaesthetists' attitudes to teamwork and safety , 2003, Anaesthesia.

[149]  G. Agarwal,et al.  Self-reported teamwork in family health team practices in Ontario: organizational and cultural predictors of team climate. , 2011, Canadian family physician Medecin de famille canadien.

[150]  S. Raab,et al.  Residents' and Attending Physicians' Handoffs: A Systematic Review of the Literature , 2011 .

[151]  G. Hocking,et al.  Anaesthesia non-technical skills: Can anaesthetists be trained to reliably use this behavioural marker system in 1 day? , 2010, British journal of anaesthesia.

[152]  C. Cassel,et al.  Attitudes Toward Working on Interdisciplinary Healthcare Teams: A Comparison by Discipline , 2002, Journal of the American Geriatrics Society.

[153]  R. Flin,et al.  Interdisciplinary communication in the intensive care unit. , 2007, British journal of anaesthesia.

[154]  R. McCaffrey,et al.  The effect of an educational programme on attitudes of nurses and medical residents towards the benefits of positive communication and collaboration. , 2012, Journal of advanced nursing.

[155]  M. Leathley,et al.  Can staff attitudes to team working in stroke care be improved? , 2002, Journal of advanced nursing.

[156]  William Riley,et al.  Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital. , 2011, Joint Commission journal on quality and patient safety.

[157]  Scott Reeves,et al.  Structuring communication relationships for interprofessional teamwork (SCRIPT): A Canadian initiative aimed at improving patient-centred care , 2007, Journal of interprofessional care.

[158]  D. R. Brown,et al.  A predeployment trauma team training course creates confidence in teamwork and clinical skills: a post-Afghanistan deployment validation study of Canadian Forces healthcare personnel. , 2011, The Journal of trauma.

[159]  L. Quan,et al.  The Simulation Team Assessment Tool (STAT): development, reliability and validation. , 2012, Resuscitation.

[160]  Ara Darzi,et al.  Observational Assessment of Surgical Teamwork: A Feasibility Study , 2006, World Journal of Surgery.

[161]  W. B. Murray,et al.  Targeted Crisis Resource Management Training Improves Performance Among Randomized Nursing and Medical Students , 2011, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[162]  Sammei Tam,et al.  Assessing the safety and teamwork climate of intensive care staff , 2011, Connect: The World of Critical Care Nursing.

[163]  Samuel Messick,et al.  STANDARDS OF VALIDITY AND THE VALIDITY OF STANDARDS IN PERFORMANCE ASSESSMENT , 2005 .

[164]  M. Leonard,et al.  The human factor: the critical importance of effective teamwork and communication in providing safe care , 2004, Quality and Safety in Health Care.

[165]  W. Chaboyer,et al.  Australian hospital generalist and critical care nurses' perceptions of doctor-nurse collaboration. , 2001, Nursing & health sciences.

[166]  M. Hojat,et al.  The Jefferson Scale of Attitudes toward Physician–Nurse Collaboration: A study with undergraduate nursing students , 2008, Journal of interprofessional care.

[167]  Mei-Sing Ong,et al.  A systematic review of failures in handoff communication during intrahospital transfers. , 2011, Joint Commission journal on quality and patient safety.

[168]  W. Doucette,et al.  Factors affecting collaborative care between pharmacists and physicians. , 2005, Research in social & administrative pharmacy : RSAP.

[169]  R A Jones.  Nurse-physician collaboration: a descriptive study. , 1994, Holistic nursing practice.

[170]  L. Lemieux-Charles,et al.  What Do We Know about Health Care Team Effectiveness? A Review of the Literature , 2006, Medical care research and review : MCRR.

[171]  S M Shortell,et al.  Organizational Assessment in Intensive Care Units (ICUs): Construct Development, Reliability, and Validity of the ICU Nurse-Physician Questionnaire , 1991, Medical care.

[172]  J. Bramble,et al.  Team training can improve operating room performance. , 2011, Surgery.

[173]  M. Kivimäki,et al.  Team climate, intention to leave and turnover among hospital employees: Prospective cohort study , 2007, BMC Health Services Research.

[174]  J. Proudfoot,et al.  Job satisfaction of staff and the team environment in Australian general practice , 2007, The Medical journal of Australia.

[175]  Glenn Regehr,et al.  Evaluating Teamwork in a Simulated Obstetric Environment , 2007 .

[176]  L. S. Sterchi,et al.  Perceptions that affect physician-nurse collaboration in the perioperative setting. , 2007, AORN journal.

[177]  Peter J Pronovost,et al.  Improving patient safety in intensive care units in Michigan. , 2008, Journal of critical care.

[178]  James P Bagian,et al.  Differences in nurse and surgeon perceptions of teamwork: implications for use of a briefing checklist in the OR. , 2010, AORN journal.

[179]  Debra Nestel,et al.  Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM). , 2010, Resuscitation.

[180]  S. Cawthorn,et al.  Use of briefings and debriefings as a tool in improving team work, efficiency, and communication in the operating theatre , 2011, Postgraduate Medical Journal.

[181]  J. Sexton,et al.  Error, stress, and teamwork in medicine and aviation: cross sectional surveys , 2000, BMJ : British Medical Journal.

[182]  J. Falconer,et al.  The rehabilitation team: staff perceptions of the hospital environment, the interdisciplinary team environment, and interprofessional relations. , 1994, Archives of physical medicine and rehabilitation.

[183]  Andreas Fichtner,et al.  Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study. , 2009, Resuscitation.

[184]  D. Roblin,et al.  Translating Primary Care Practice Climate into Patient Activation: The Role of Patient Trust in Physician , 2008, Medical care.

[185]  J. Neal,et al.  ASRA Checklist Improves Trainee Performance During a Simulated Episode of Local Anesthetic Systemic Toxicity , 2011, Regional Anesthesia & Pain Medicine.

[186]  Jeffrey Braithwaite,et al.  A four-year, systems-wide intervention promoting interprofessional collaboration , 2012, BMC Health Services Research.

[187]  B. Mattsson,et al.  Working together — primary care doctors’ and nurses’ attitudes to collaboration , 2010, Scandinavian journal of public health.

[188]  Torgersen Ka,et al.  Examining collaborative relationships between anesthesiologists and certified registered nurse anesthetists in nurse anesthesia educational programs. , 1994 .

[189]  S. Lindqvist,et al.  Report on the implementation and evaluation of an interprofessional learning programme for inter‐agency child protection teams , 2009 .

[190]  D. Mohr,et al.  Team Effectiveness and Organizational Context in the Implementation of a Clinical Innovation , 2009, Quality management in health care.

[191]  John Cairns,et al.  Group dynamics in telemedicine-delivered and standard multidisciplinary team meetings: results from the TELEMAM randomised trial , 2006 .

[192]  David A. Cook,et al.  Predictive Validity Evidence for Medical Education Research Study Quality Instrument Scores: Quality of Submissions to JGIM’s Medical Education Special Issue , 2008, Journal of General Internal Medicine.

[193]  W. Doucette,et al.  Collaborative working relationships between pharmacists and physicians: an exploratory study. , 2004, Journal of the American Pharmacists Association : JAPhA.

[194]  Sara A. Brallier,et al.  Development of an Attitudes toward Health Care Teams Scale , 1999, Evaluation & the health professions.

[195]  Rhona Flin,et al.  Rating non-technical skills: developing a behavioural marker system for use in anaesthesia , 2004, Cognition, Technology & Work.

[196]  J. Herrin,et al.  Team functioning and patient outcomes in stroke rehabilitation. , 2005, Archives of physical medicine and rehabilitation.

[197]  K. Hyer,et al.  Measuring attitudes related to interdisciplinary training: Revisiting the Heinemann, Schmitt and Farrell 'attitudes toward health care teams' scale , 2000 .

[198]  Nick Sevdalis,et al.  Observational Teamwork Assessment for Surgery (OTAS): Refinement and Application in Urological Surgery , 2007, World Journal of Surgery.

[199]  M. Biros,et al.  Research utilization and interdisciplinary collaboration in emergency care. , 1999, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[200]  M. Eccles,et al.  Factors predicting team climate, and its relationship with quality of care in general practice , 2009, BMC health services research.

[201]  M. Makary,et al.  Teamwork in the Operating Room: Frontline Perspectives among Hospitals and Operating Room Personnel , 2006, Anesthesiology.

[202]  D. Rintala,et al.  The innovative rehabilitation team: an experiment in team building. , 1986, Archives of physical medicine and rehabilitation.

[203]  L. Nasmith,et al.  Building capacity for interprofessional practice , 2012, The clinical teacher.

[204]  P. Kemper,et al.  Effectiveness of classroom based crew resource management training in the intensive care unit: study design of a controlled trial , 2011, BMC health services research.

[205]  V. Arora,et al.  Systematic Review: Association of Shift Length, Protected Sleep Time, and Night Float With Patient Care, Residents' Health, and Education , 2010, Annals of Internal Medicine.

[206]  Cecilia Canales,et al.  High fidelity simulation based team training in urology: a preliminary interdisciplinary study of technical and nontechnical skills in laparoscopic complications management. , 2012, The Journal of urology.

[207]  V. Arora,et al.  Building continuity in handovers with shorter residency duty hours , 2014, BMC medical education.

[208]  P. Bower,et al.  Team structure, team climate and the quality of care in primary care: an observational study , 2003, Quality & safety in health care.

[209]  J. Baggs.  Development of an instrument to measure collaboration and satisfaction about care decisions. , 1994, Journal of advanced nursing.

[210]  W. Gijselaers,et al.  Impact of simulator training and crew resource management training on final-year medical students' performance in sepsis resuscitation: a randomized trial. , 2012, Minerva anestesiologica.

[211]  D. Beech,et al.  Health Professions Education: A Bridge to Quality , 2004 .

[212]  Bridget C. O’Brien,et al.  The impact of an interprofessional standardized patient exercise on attitudes toward working in interprofessional teams , 2012, Journal of interprofessional care.

[213]  Martha Reeves,et al.  Evaluation of Training , 1993 .

[214]  Torsten B Neilands,et al.  The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research , 2006, BMC Health Services Research.

[215]  Mark Fleming,et al.  Investigating interpersonal competencies of cardiac surgery teams. , 2006, Canadian journal of surgery. Journal canadien de chirurgie.

[216]  M. Buljac-Samardžić,et al.  Interventions to improve team effectiveness: a systematic review. , 2010, Health policy.

[217]  P. Schyve.  Editorial: Teamwork—The Changing Nature of Professional Competence , 2005 .

[218]  Diane B. Wayne,et al.  Improving Teamwork: Impact of Structured Interdisciplinary Rounds on a Medical Teaching Unit , 2010, Journal of General Internal Medicine.

[219]  W. Doucette,et al.  Exploring stages of pharmacist-physician collaboration using the model of collaborative working relationship. , 2011, Journal of the American Pharmacists Association : JAPhA.

[220]  A. Bleakley,et al.  Towards culture change in the operating theatre: Embedding a complex educational intervention to improve teamwork climate , 2012, Medical teacher.

[221]  N. Jimmieson,et al.  Measuring Multidisciplinary Team Effectiveness in a Ward‐Based Healthcare Setting: Development of the Team Functioning Assessment Tool , 2011, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.