Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Improve teamwork with better selection of medical trainees

Joshua Liao, MD
Education
February 18, 2015
Share
Tweet
Share

Amid the many ongoing changes to health care, it’s clear that better teamwork is needed in American medicine. Calls for stronger interdisciplinary collaboration have permeated position statements and policies, and organizations have begun redesigning care processes to include novel team-based approaches. Emerging data continue to affirm that strong teamwork and communication can increase the value of care.

Of the many efforts to improve teamwork, however, one potential area for significant improvement remains: the selection of medical trainees.

Traditionally, there has been little debate about how to evaluate academic competency in medical education. Grade point averages in undergraduate science classes and scores on the MCAT are widely accepted benchmarks for medical school admissions, as STEP board scores and clinical rotation grades are for residency applications. Nuances based on an applicant’s background certainly still exist. Humanities and bioscience majors must be evaluated differently, as must medical students with health policy or basic science experience. However, differences are still interpreted largely within the context of standardized testing and grading metrics.

For better or worse, this hasn’t been true in the evaluation of personal competencies. Despite conceptual agreement about the characteristics that future physicians should embody (e.g., compassion, empathy, interpersonal skills, and emotional awareness), there is still relatively poor agreement about how to “get there” by relating progressive development of those traits with the selection process. Some data suggest that specific qualities are linked with positive admissions outcomes while other data reveal that in fact dozens upon dozens of different personal characteristics are considered.

This variability poses a challenge for building stronger clinical teams. In selecting and training learners, no educator would deny the importance of interpersonal skills or the ability to work well on teams. Evaluations throughout medical school and residency training appropriately include assessments of whether a trainee is a “team player,” and the admissions process itself in large part aims to ensure a good applicant-program fit.

The problem is not mainly that we fail to recognize teamwork as a key part of training and clinical care. More of the issue lies in how we frequently understand and define the phrase “being a team player.” Medical education has traditionally been siloed: Medical, nursing, pharmacy, and physical therapy students learn along parallel, non-intersecting paths. Residency training is similarly marked by divisions between disciplines. If teams are always conceptualized within traditional care structures, progress will be slow. Instead, we need creative approaches to shift focus away from individual clinicians and specialties toward group skills and collective performance. A number of groups are beginning to make progress along these fronts, and more is needed.

Beyond framing problems, however, lies an even more central issue: the underlying (and inadvertent) discordance between what we say we value in choosing medical trainees and what we actually convey through our actions.

A quick glance at common medical school application requirements underscores this point. Most lists include heavy doses of biochemistry, cell biology, physics, and other natural sciences — requirements that make good sense. Upon further consideration, however, glaring omissions emerge. The courses and experiences that enable reflection, social awareness, and teamwork (e.g., ethics, psychology, social studies, humanities, and volunteerism) are often encouraged for admission but are not required or codified in the selection process. Recognizing the need to choose strong team players and communicators is one thing; hardwiring these values into our decisions is another.

To be clear, a solid grasp of pathophysiology is part of the foundation of good doctoring, and much good has come from in-depth biomedical investigation. However, almost all medical students can attest to hours poring over biochemical pathways, histological stains, and intricate regional anatomy (brachial plexus, anyone?), only to hear professors and mentors quip: “Oh, don’t worry, you’ll forget almost all of this by the time you begin residency” or “You learn all of that now, but a lot of it isn’t clinically relevant.” A few years of residency training rapidly validate this suspicion, affirming that much of the pathophysiology we learn is (either willfully or inadvertently) lost along the way.

More than a criticism of specific disciplines, then, this should be a recognition that underemphasized domains in trainee selection can counteract efforts to build better teams, that there is room to replace things that “won’t be clinically relevant” with skills that decidedly will, and that we can do better in aligning our explicit values with our implicit priorities about team players. If we truly mean to train physicians who work well with others and put the interests of the group ahead of their own, perhaps we need to adjust the kind of applicants we target. Change will be incremental, but worthwhile.

To encourage progress, educators can employ several strategies, including modification of admissions requirements, careful “blurring” of roles, implementation of group evaluation and benchmarks, and use of teamwork-focused interviews. By adding more rigorous non-science requirements and placing premiums on experiences in teamwork and collaboration, institutions can both implicitly and explicitly reinforce their importance. By shifting certain roles away from individuals and toward groups, more emphasis can be placed on what the team — not any one person — can accomplish for collective patient good (e.g., diagnosis or the creation of management plans). By creating group evaluations and benchmarks, educators can underscore that teams should comprise whoever is required to accomplish the task at hand (not just those in a similar specialty) and that the group dynamic results from each member’s individual contributions. By focusing on questions related to teamwork (e.g., “Tell me when you sacrificed your own good for that of a team; describe the biggest mistake and achievement you’ve made as a member of a team”) rather than individual merit (e.g., “Tell me about your greatest accomplishment or strength”), educators can better approximate how an applicant will mesh with a diverse group of colleagues.

Regardless of strategy, one thing is clear to those who recognize the importance of excellent clinical teams: Change often occurs out of necessity. If pathways to becoming a doctor continue to largely demand individual achievement — years of compiling stellar individual test scores, grades, accomplishments, distinctions, and expertise — it will be hard to convince many learners of the need to change at all.

That we still have great gains to make in interdisciplinary teamwork speaks to the fact that “every system is perfectly designed to get the results it gets.” To reap the benefits of better communication and teamwork, we must mind what we sow. To use these rewards to produce better patient outcomes, we must improve teamwork by testing new ways of selecting medical trainees.

ADVERTISEMENT

Joshua Liao is an internal medicine fellow and can be reached on Twitter @JoshuaLiaoMD and his self-titled site, Joshua Liao. This article originally appeared in ACP Internist.

Prev

How to get your doctor to do what you want

February 18, 2015 Kevin 12
…
Next

3 ways parents quash the kindness in their kids

February 18, 2015 Kevin 8
…

Tagged as: Hospital-Based Medicine, Residency

Post navigation

< Previous Post
How to get your doctor to do what you want
Next Post >
3 ways parents quash the kindness in their kids

ADVERTISEMENT

More by Joshua Liao, MD

  • How fee-for-service shapes your doctor’s decisions

    Jonathan Staloff, MD & Joseph H. Joo, MD & Joshua Liao, MD
  • Lessons from the meeting of different value-based concepts

    Joshua Liao, MD
  • Are hepatits C drugs too expensive? Analyzing the pros and cons.

    Joshua Liao, MD

More in Education

  • Why medical schools must ditch lectures and embrace active learning

    Arlen Meyers, MD, MBA
  • Why helping people means more than getting an MD

    Vaishali Jha
  • Residency match tips: Building mentorship, research, and community

    Simran Kaur, MD and Eva Shelton, MD
  • How I learned to stop worrying and love AI

    Rajeev Dutta
  • Why medical student debt is killing primary care in America

    Alexander Camp
  • Why the pre-med path is pushing future doctors to the brink

    Jordan Williamson, MEd
  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 16 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Improve teamwork with better selection of medical trainees
16 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...