How interdisciplinary teams can create multi-disciplinary education: the interplay between team processes and educational quality

Using a boundary crossing lens to understand basic science educator and clinical educator collaboration in instructional design

PURPOSE

Collaborations between basic science educators (BE) and clinical educators (CE) in medical education are common and necessary to create integrated learning materials. However, few studies describe experiences of or processes used by educators engaged in interdisciplinary teamwork. We use the lens of boundary crossing to explore processes described by BE and CE that support the co-creation of integrated learning materials, and the impact that this work has on them.

MATERIALS AND METHODS

We conducted qualitative content analysis on program evaluation data from 27 BE and CE who worked on 12 teams as part of a multi-institutional instructional design project.

RESULTS

BE and CE productively engaged in collaboration using boundary crossing mechanisms. These included respecting diverse perspectives and expertise and finding efficient processes for completing shared work that allow BE and CE to build on each other's contributions. BE and CE developed confidence in connecting clinical concepts with causal explanations, and willingness to engage in and support such collaborations at their own institutions.

CONCLUSIONS

BE and CE report the use of boundary crossing mechanisms that support collaboration in instructional design. Such practices could be harnessed in future collaborations between BE and CE.

Enhancing Team Learning through Leader Inclusiveness: A One-Year Ethnographic Case Study of an Interdisciplinary Teacher Team

PHENOMENON

Developing modern medical curricula requires collaboration between different scientific and clinical disciplines. Consequently, institutions face the daunting task to engage colleagues from different disciplines in effective team collaboration. Two aspects that are vital to the success of such teamwork are "team learning behavior" by all team members and "leader inclusiveness behavior" by the team leader. Team members display team learning behavior when they share information, build upon and integrate each other's viewpoints. The team leader can promote such team learning by exhibiting inclusiveness behavior, which aims to encourage diversity and preserve individual differences for an inclusive workplace, nurturing engagement in teamwork. There is a paucity of in-depth research on leader inclusiveness behavior in the field of medical education. This case study aimed to offer unique insight into how leader inclusiveness behavior manifests itself in a successful interdisciplinary teacher team, demonstrating team learning behavior in undergraduate medical education.

APPROACH

We conducted a qualitative, ethnographic case study using different but complementary methods, including observations, interviews and a documentary analysis of email communication. By means of purposive sampling, we selected an existing interdisciplinary teacher team that was responsible for an undergraduate medical course at Maastricht University, the Netherlands, and that was known to be successful. Chaired by a physician, the team included planning group members and tutors with medical, biomedical, and social sciences backgrounds as well as student-representatives. In the course of one academic year, 23 meetings were observed and recorded, informal interviews were conducted, and over 100 email conversations were collected. All data were submitted to a directed content analysis based on team learning and leader inclusiveness concepts.

FINDINGS

Leader inclusiveness behavior became evident from verbal and non-verbal interactions between the team leader and team members. Leader inclusiveness behavior that facilitated team learning behavior manifested itself in five actions undertaken by the team leader: coordinating, explicating, inviting, connecting, and reflecting. Similarly, team members facilitated team learning behavior by participating actively, speaking up behavior, and mimicking leader inclusiveness behavior. These behaviors demonstrated engagement and feelings of inclusion, and reinforced leader inclusiveness behavior by creating additional opportunities for the leader to exhibit such behavior.

INSIGHTS

This case study responds to the need for inclusive leadership approaches in medical education. Our findings build upon theoretical knowledge on team learning and leader inclusiveness concepts. By studying behaviors, interactions and documents we obtained in-depth information on leader inclusiveness. Our findings are unique in that they demonstrate how leader inclusiveness behavior manifests itself when leaders interact with their team members. This study provides health professionals who are active in education with practical suggestions on how to act as a successful and inclusive leader. Finally, the behaviors identified open up avenues for future professional development initiatives and future research on team leadership.

Supplemental data for this article is available online at here.

The team cohesion-performance relationship: A meta-analysis exploring measurement approaches and the changing team landscape

Team cohesion is an important antecedent of team performance, but our understanding of this relationship is mired by inconsistencies in how cohesion has been conceptualized and measured. The nature of teams is also changing, and the effect of this change is unclear. By meta-analyzing the cohesion-performance relationship ( k = 195, n = 12,023), examining measurement moderators, and distinguishing modern and traditional team characteristics, we uncovered various insights. First, the cohesion-performance relationship varies based on degree of proximity. More proximal measures –task cohesion, referent-shift, and behaviorally-focused– show stronger relationships compared to social cohesion, direct consensus, and attitudinally-focused, which are more distal. Differences are more pronounced when performance metrics are also distal. Second, group pride is more predictive than expected. Third, the cohesion-performance relationship and predictive capacity of different measures are changing in modern contexts, but findings pertaining to optimal measurement approaches largely generalized. Lastly, important nuances across modern characteristics warrant attention in research and practice.

Plain Language Summary

Team cohesion is an important antecedent of team performance, but our understanding of this relationship is mired by inconsistencies in how cohesion has been conceptualized and measured. The nature of teams has also changed over time, and the effect of this change is unclear. By meta-analyzing the cohesion-performance relationship ( k = 195, n = 12,023), examining measurement moderators, and distinguishing between modern and traditional team characteristics, we uncovered various insights for both research and practice. First, the cohesion-performance relationship varies based on degree of proximity. Measures that are more proximal to what a team does – those assessing task cohesion, utilizing referent shift items, and capturing behavioral manifestations of cohesion – show stronger relationships with performance compared to those assessing social cohesion, utilizing direct consensus items, and capturing attitudinal manifestations of cohesion, which are more distal. These differences are more pronounced when performance metrics are also more distal. Second, despite being understudied, the group pride-performance relationship was stronger than expected. Third, modern team characteristics are changing both the overall cohesion-performance relationship and the predictive capacity of different measurement approaches, but findings pertaining to the most optimal measurement approaches largely generalized in that these approaches were less susceptible to the influence of modern characteristics. However, in some contexts, distal cohesion metrics are just as predictive as their more proximal counterparts. Lastly, there are important nuances across different characteristics of modern teams that warrant additional research attention and should be considered in practice. Overall, findings greatly advance science and practice pertaining to the team cohesion-performance relationship.

Working beyond disciplines in teacher teams: teachers' revelations on enablers and inhibitors

INTRODUCTION

Health professions education faces transitions from monodisciplinary to integrated education and from soloist teachers to interdisciplinary teacher teams. Interdisciplinary teamwork has been found complex and prone to conflict. Teachers' perceptions of why some teams work and learn as a real interdisciplinary team and others do not are lacking in this setting. We studied the factors that teachers perceive as enabling and/or inhibiting interdisciplinary team learning.

METHODS

In this exploratory, qualitative study, we conducted 17 semi-structured, vignette-guided interviews with teachers recruited from diverse disciplines in undergraduate health professions programmes at Maastricht University, the Netherlands, through maximum variation sampling. Team learning research informed data collection and template analysis.

RESULTS

We identified three themes representing the factors that teachers perceived to influence interdisciplinary team learning: 'alignment/misalignment with the educational philosophy' (regarding personal attributes, tendencies and motivation), 'leadership practices' (encompassing team vision, responsibility and reflection), and 'involvement in organisational processes' (covering organisational decision-making, support and learning opportunities). For interdisciplinary team learning in development of integrated education, teachers emphasised their personal ability to move beyond disciplinary boundaries. Shared team leadership enabled the creation of a shared vision, shared responsibility, and team reflection. Lastly, teacher involvement in educational management, peer support and learning was considered important.

DISCUSSION

To work beyond disciplines in health professions education, teachers should take an interest in integrated education, share responsibility and work in an environment where people continuously learn from others. Organisations can facilitate this by involving teachers in decision-making processes and providing faculty development aimed to foster shared leadership and team reflection.

Team learning in interdisciplinary research teams: antecedents and consequences

Purpose

Team learning is critical to interdisciplinary research teams (IDR teams) to use heterogeneous knowledge effectively. Nevertheless, team learning is rarely addressed in the IDR team literature. Also, few studies investigate the antecedents and consequences of team learning in IDR teams, leading to a lack of guidance for management practices. This study aims to investigate how team learning can be developed and how team learning influences team outcomes in IDR teams.

Design/methodology/approach

A questionnaire survey on 304 members of 37 IDR teams in a research university in China is conducted. Data are analyzed using a partial least square structural equation modeling.

Findings

The results support most hypotheses in general. For the antecedent variables, task interdependence, trust and constructive conflict positively affect team learning. For the outcome variables, team learning improves shared mental models, coordination quality and team performance significantly. Additionally, task uncertainty positively moderates the team learning-coordination quality relation and team learning-team performance relation. However, this paper does not find support for the moderating role of task uncertainty on the team learning-shared mental models relation.

Originality/value

To the best of the knowledge, this is the first study investigating the antecedents and consequences of team learning in IDR teams. A multidimensional measurement of team learning for the IDR team context is developed. This study investigates how team behavioral factors influence team learning and the effect of team learning on shared mental models, coordination quality and team performance. This study also explores the contingency role of task uncertainty in the effects of team learning.

How Teachers Meet in Interdisciplinary Teams: Hangouts, Distribution Centers, and Melting Pots

PURPOSE

To explore team learning processes among interdisciplinary teacher teams in the development of integrated health professions education and to investigate students' perspectives on the quality of the educational courses.

METHOD

Using an exploratory, sequential mixed-methods design, the first author conducted 17 vignette-guided, semistructured interviews with teachers originating from diverse disciplines. These teachers worked in different courses of integrated, undergraduate health professions programs at the Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. The interview guide and vignettes were based on team learning research. The interviews sought to establish how interdisciplinary teacher team members work together on integrated curricula. The vignettes reflected constructs of team learning processes: sharing, co-construction, and constructive conflict. Data were collected between November 2017 and March 2018 and analyzed using template analysis. Sequentially, course evaluation data were used to provide a descriptive analysis of students' perspectives on educational quality (course organization, structure, learning effect, and alignment).

RESULTS

Three team approaches were identified. In fragmented teams or "hangouts," teachers individually worked on tasks that they were interested in, leaving their disciplinary mark. Framework-guided teams or "distribution centers" aimed to work within the given frameworks and organizational expectations, striving for disciplinary balance. Integrated teacher teams or "melting pots" used an interdisciplinary approach on all topics and put students at the center. Integrated teams reflected high-level team learning processes and were most satisfied with their (team)work. In contrast, fragmented and framework-guided teams mainly reflected low-level team learning processes. Students evaluated courses of integrated teacher teams highest on all investigated quality items (course organization, structure, learning effect, and alignment).

CONCLUSIONS

Successful interdisciplinary teacher teams are represented by an integrated approach with high-level team learning behavior and the best course evaluations. Therefore, health professions education management should actively encourage and facilitate integrated teacher teamwork.

How Psychological Safety Affects Team Performance: Mediating Role of Efficacy and Learning Behavior

This article examines the mechanisms that influence team-level performance. It investigates psychological safety, a shared belief that the team is safe for interpersonal risk taking and a causal model mediated by learning behavior and efficacy. This model hypothesizes that psychological safety and efficacy are related, which have been believed to be same-dimension constructs. It also explains the process of how learning behavior affects the team's efficacy. In a study of 104 field sales and service teams in South Korea, psychological safety did not directly affect team effectiveness. However, when mediated by learning behavior and efficacy, a full-mediation effect was found. The results show (i) that psychological safety is the engine of performance, not the fuel, and (ii) how individuals contribute to group performance under a psychologically safe climate, enhancing team processes. Based on the findings, this article suggests theoretical and methodological implications for future research to maximize teams' effectiveness.

A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program

BACKGROUND

In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC) program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs) in Boston's most under-served communities, and increase medical student interest in primary care careers.

METHODS

The AoC is modeled in the form of a 'grants challenge', offering $20,000 to interprofessional student teams to develop an innovative solution that addresses a healthcare delivery need identified by CHCs. The program's initial two years were characterized by a four-stage process which included working with CHCs and crafting a request for proposals, forming interprofessional 20 student teams comprising students from across and outside of Harvard University, training students using a systems-based innovation curriculum, and performing program evaluation.

RESULTS

Our evaluation data from cohorts 1 and 2 of the AoC program demonstrate that we succeeded in training students as innovators and members of interprofessional teams. We also learned valuable lessons regarding creating better alignment with CHC priorities, extending the program cycle from 12 to 18 months, and changing the way funding is disbursed to 25 students, which will be incorporated in later versions of the program.

CONCLUSIONS

Based on our experience and evaluation data, we believe that this program is a replicable way to train students as innovators and members of interprofessional teams to address the current complex healthcare environment.

When feeling safe isn’t enough

In working to understand the predictors of experiential learning in teams, researchers have focused on one variable more than any other—psychological safety. In virtually all of this work, psychological safety is viewed as a direct predictor of team learning and, through team learning, of team performance. We suggest that this work has overlooked the critical effect the nature of the task environment has on the capacity of psychological safety to have beneficial effects. To investigate this, we conduct a comprehensive meta-analysis of studies examining the relationships between psychological safety, team learning, and team performance. We find that psychological safety is more strongly associated with learning and performance in studies conducted in knowledge-intensive task settings, that is, settings that involve complexity, creativity, and sensemaking. The results of this study suggest that psychological safety may be insufficient to stimulate learning in groups where the task environment does not require learning.

Enhancing team learning in nursing teams through beliefs about interpersonal context

AIM

This article is a report of a study that examines the relationship between team-level learning and performance in nursing teams, and the role of beliefs about the interpersonal context in this relationship.

BACKGROUND

Over recent years, there has been an increasing interest in the learning processes of work teams. Researchers have investigated the impact of team learning on team performance, and the enabling conditions for this learning. However, team learning in nursing teams has been largely ignored.

DESIGN

A cross-sectional field survey design was used.

METHODS

The sample comprises a total of 468 healthcare professionals working in 89 nursing teams at different public hospitals throughout Spain. Members of nursing teams participated voluntarily by completing a confidential individual questionnaire. Team supervisors evaluated nursing teams' performance. Data were collected over 2007-2008.

RESULTS

The results show a mediating effect of team learning on the relationship between beliefs about interpersonal context (psychological safety, perceived task interdependence, and group potency) and team performance.

CONCLUSION

Our findings suggest that beliefs about interpersonal context and team learning are important to effective nursing team performance.