|Year : 2019 | Volume
| Issue : 1 | Page : 34-39
The impact of team training on perceptions of team functioning during 3rd year veterinary surgery
April A Kedrowicz, Sarah Hammond, Elizabeth M Hardie
Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
|Date of Web Publication||30-May-2019|
Dr. April A Kedrowicz
College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh 27607, NC
Source of Support: None, Conflict of Interest: None
Introduction: Team communication is paramount for success in veterinary medicine. Methods: This qualitative study explores the impact of team communication training on students' perceptions of performance and assessment of team functioning during junior surgery by comparing two different classes. The class of 2017 was not formally trained in team communication before their participation in junior surgery, while the class of 2018 participated in training offered through a dedicated team communication course. Results: Students' experiences as described in their own words revealed qualitatively different experiences and challenges associated with being a part of a year-long surgery team for both cohorts. Team training impacted students' ability to plan and organize their work, navigate disagreement, and facilitated a high level of cohesiveness. Conclusions: These findings suggest that team training makes a difference in students' experiences and enhances perceptions of communication, coordination, and collaborative processes.
Keywords: Communication, surgery, team training, teamwork
|How to cite this article:|
Kedrowicz AA, Hammond S, Hardie EM. The impact of team training on perceptions of team functioning during 3rd year veterinary surgery. Educ Health Prof 2019;2:34-9
|How to cite this URL:|
Kedrowicz AA, Hammond S, Hardie EM. The impact of team training on perceptions of team functioning during 3rd year veterinary surgery. Educ Health Prof [serial online] 2019 [cited 2019 Oct 16];2:34-9. Available from: http://www.ehpjournal.com/text.asp?2019/2/1/34/259388
| Introduction|| |
Team communication, collaboration, and coordination are important to medical practice, not only in terms of clinical outcomes,,, but also to relational and financial success.,
Team processes such as information sharing, planning, coordination, conflict management, and feedback ,, have an impact on patient outcomes ,, and team satisfaction and cohesion., In fact, the team process is critical to team effectiveness, even more so than high levels of expertise, resources, and commitment., Team processes and relational coordination facilitate task accomplishment in that team members develop strong relationships while working interdependently to accomplish a shared goal.,
To enhance the professional skill development of graduates, human, and veterinary medical colleges increasingly emphasize communication and collaboration as part of students' educational experience. The previous research supports these initiatives in that targeted training in the communication skills that facilitate coordination, and interdependent work can positively impact performance.,,,,,,,,,,,,,,,,,,,,
This project explores the impact of team communication training on students' assessment of team functioning in a 3rd year veterinary surgery course. The following question guided our analysis: How does team training impact students' experiences as part of a year-long surgery team?
| Methods|| |
We conducted a qualitative case study with two naturally occurring groups to assess the impact of teaching team communication on student assessment of team functioning during junior surgery. We compared two different classes: Those who completed junior surgery in 2015–2016 and did not receive formal team training, and those who completed junior surgery in 2016–2017 and did receive team training. The university's Institutional Review Board provided approval for this research.
Team communication training
To better prepare graduates for the increasingly collaborative nature of veterinary health care, a new team communication course was implemented in the first semester of the program. Each week students learned team communication topics emphasizing coordination and collaboration including communicating competently, team member styles, roles, and norms, task/process balance, leadership, culture and diversity, conflict management, feedback, and meeting management. Student learning was experiential including didactic instruction, guided practice, and analysis., Each class session (13 2-h sessions in total) began with a brief lecture/discussion of the day's topic, followed by an activity (e.g., role plays and case-based problem-solving) to practice team communication skills. A debrief followed each activity where students applied knowledge of team communication concepts to their team experience in class to solidify and extend their understanding. Students were introduced to the importance of reflection as it relates to learning and professionalism at the beginning of the semester and the importance of critical reflection was reinforced several times throughout the term to facilitate deeper self-awareness of the interplay between content, process, and perceptual skills. These activities were designed to enhance integration and application or course material to team experiences in this course, as well as other concurrent classes.
Both groups were enrolled in junior surgery during their 3rd year of the curriculum. The course spanned both fall and spring semesters of 2015–2016 and 2016–2017.
The course organized students in teams of 2–3, in which each student surgeon was responsible for completing at least one feline ovariohysterectomy. Additional surgery experiences included feline castrations, canine ovariohysterectomies, and canine castrations. Students in this course had previously completed the 2nd year Principles of surgery course, during which each student acted as surgeon, assistant surgeon, and anesthetist in a canine ovariohysterectomy and castration experiences.
Each ovariohysterectomy experience had 15–21 students supervised by two surgery instructors, two anesthesiologists, and three technicians. Students were assigned to specific rotating roles within their teams: surgeon, assistant surgeon, and anesthetist. The roles rotated between the laboratory experiences, allowing each student the opportunity to experience each role at least once. The majority of the teams were comprised of three people, with each group completing a total of 5–6 surgery experiences. Each student completed a rubric to assess teamwork behaviors and wrote a reflective essay on their teamwork experiences and challenges during the last week of the spring semester.
To explore the impact of team training on team experiences participating as part of a year-long surgery team, we conducted a thematic analysis. Qualitative responses from the reflective essays were analyzed inductively using the constant comparative method. The first author compiled a list of all of the responses to the three open-ended questions about changes that occurred from sophomore to junior year, what the team did to make them a highly functioning medical team, and challenges they faced/areas for further development. The responses were compiled from students' reflective essays after all identifying information had been removed, thus blinding the researcher to student and course information. Qualitative data analysis consisted of three phases: open coding, axial coding, and selective coding. Open coding consisted of reading through each response to conceptualize the data by noting keywords and phrases. This first step of analysis resulted in breaking the data into discrete classifications that were named by assigningin vivo codes – using words and phrases the students used. The second phase consisted of axial coding, drawing comparisons between the specific keywords and phrases to develop broad, encompassing categories. Once the data were categorized, the researcher compared the preliminary categories with the class information that was recorded in a separate file for the sake of exploring similarities and differences across cohorts. Finally, the third phase of analysis allowed for more abstract relationships to emerge through uncovering repeated patterns within each cohort. Throughout each phase of analysis, the author engaged in perception checking and verification by (1) going back to the data and the participants' own words and (2) consulting with an independent researcher on the trustworthiness of the codes, categories, and themes.
| Results|| |
Ninety-three students completed their final team evaluation and reflection during 2015–2016 and eighty-five students completed their final team evaluation and reflection during 2016–2017. A close analysis of the data revealed four key themes that distinguished those who received team training from those who did not: (1) flexibility versus efficiency, (2) effective versus ineffective communication, (3) planning/preparation versus ad hoc development, and (4) continuous feedback and reflection versus constructive criticism.
Flexibility and role fulfillment versus efficiency and equality
While both groups pointed to the importance of a learning atmosphere during surgery, those with team training acknowledged that flexibility and everyone learning was more important than being the most efficient as these comments illustrate: “We sought to influence one another and made each surgery an opportunity for growth.” “We allocated tasks, so everyone had a chance to perform all the skills, but we did this in a less stringent manner than my previous team, so I was more comfortable seeking to perform tasks for which I wanted to improve my skills.”
Those who participated in team training attributed flexibility and role fulfillment as key components of what made them a highly functioning medical team as this comment illustrates: “We were prepared to help each other in their roles in addition to preparing for own.” Further, they were explicit about the fact that dividing things equally was not a key goal for them: “We all volunteered ourselves for tasks. We spent less time worrying about dividing things equally – keeping score tit for tat does not facilitate good camaraderie.” This flexibility often facilitated students' surgical skill development: “Each surgery week, we contacted each other early to choose surgery roles, which all members were very flexible and willing to compromise on; we discussed strengths and weaknesses and supported one another in working on tasks that we needed to practice.”
Those without team training referenced efficiency and equal workload more frequently: “Everyone did their part to make the group more efficient…we spread the work out more evenly and fairly from lab to lab.” For some teams, inefficiency was a source of frustration: “At the beginning of the year, we were less efficient than we wanted to be and this led to frustration. We made changes to enhance efficiency including assigning roles for each procedure and this clarified expectations and improved efficiency.” Despite many students mentioning the importance of a learning atmosphere and helping team members improve, some juxtaposed inefficiency with learning as this comment illustrates:
One struggle (occurred) when trying to learn or do something (place catheter, take blood, or suture) and others would try to “be helpful” or give feedback/commands that were not really welcomed our helpful. It makes it harder sometimes… when you would like to try. This was a source of frustration (because); we ended up taking far more time than was necessary that day.
For some, the learning suffered because skills were assigned based on the individuals' strengths for the sake of efficiency:
Even though I wanted to know more about doing urine samples, the same person ran each of them because they were more efficient. Overall, the group dynamic worked with one another to get the job done, but I did not feel like the learning experience was equal among us.
While task assignment, work load distribution, and efficiency are certainly important to a team's (and patient's) success, it appears that team-trained students had a greater appreciation for flexibility and the sometimes inherent inefficiency that accompanies a learning atmosphere in which each individual has different experiences and strengths. Moreover, they recognized that role fulfillment, opportunities to practice, and the ability of others to “step in” when necessary allowed for both task completion and individual skill development through embracing the process.
Effective versus ineffective communication
Student responses also highlighted a key difference between the two groups in terms of communication. Those who participated in team training attributed communication, specifically, as a key component of what made them a highly functioning medical team: “We were in constant communication with one another and were able to work together and be flexible. Because our group communicated and compromised so well, we were able to take better care of our surgery animals.” This comment highlights not only the importance of effective communication but also frequent communication. Many of the students who participated in team training articulated the need for both frequent and effective communication, in particular, the importance of adapting communication to team members' styles as this comment illustrates:
(We had) frequent meetings that helped to establish clear lines of communication between us which we utilized before, during, and after surgery. It also helped all of us understand each other's communication styles which helped us tailor our messages to one another and make our team as effective as possible.
Not only was communication a contributing factor to team success, but also the relationship between communication and team functioning was reciprocal. Experiences throughout the year were both enhanced by communication and served to further skill development due, in part, to a focused effort by the students:
We have worked well together and tried to balance preparation, attention to detail, and fun through clear and open communication with a balance of responsibility. A lot of our learning is at the peer-to-peer level. Learning how to appropriately phrase suggestions and offer constructive feedback to one another has improved with every surgery. Beyond the scope of surgery skills, this class has taught me a lot about communicating with peers, resolving minor conflicts, and making sure everyone feels valued and understood…skills which are immensely important in practice.
In some contrast, those without team training cited communication as a key area that warrants further development, often citing it as one of the biggest hurdles for the group:
Our biggest downfall was communication. While we were all eager to help each other, this actually became a hindrance as we failed to assign tasks to ensure their completion. Specifics were forgotten as no one took responsibility for remembering and communicating such details.
Students expressed frustration with team members who avoided uncomfortable conversations or behaved passive-aggressively: “As a group, we did struggle with communication as we all were very passive aggressive.” Sometimes, the avoidance resulted from discomfort with conflict or providing feedback as these comments illustrate:
We did not always communicate well in the middle of surgery when it was more stressful. Sometimes, I got frustrated with one of my group members who tended to continually talk and critique us when he was well-intentioned but would not phrase the feedback constructively
Our communication could have been stronger. I wish, I had better communicated my thoughts and (my teammates) would feel comfortable telling me their opinions. I believe, we needed to build trust with one another.
This last comment is poignant as it connects trust to team communication. Interestingly, while trust and respect were mentioned specifically by only a few students in both cohorts, they were cited as key elements that contributed to team success by more students who participated in team training as compared to those who did not.
These reflections suggest a recognition of the importance of communication for students in both cohorts; those with team training were more likely to describe competent communication as a key to their success, whereas students without team training were able to recognize opportunities to develop and refine their ineffective communication.
Planning/preparation versus ad hoc development
Planning and preparation were described as key elements to success for the team-trained cohort. This included discussing goals, developing work plans, and in some cases, working individually to prepare for surgery. Team and individual goal setting were important elements to team functioning as this student explains: “At the start, we made surgery plans and discussed our personal goals and what each person wanted to gain and/or improve on during the semester.”
Others specifically mentioned the importance of discussing previous experiences, working preferences, and sharing individual goals to be held accountable:
Something that really helped our group dynamic was meeting as a group before the first surgery day. We discussed what worked well previously, shared preferences on how each person learned best, and what 1–2 aspects they want to improve on. Using this information, we created a verbal reward system to complement each other while reaching our goals and acknowledge exceptional work.
Planning and preparation were crucial elements of a positive team experience that allowed for the anticipation of potential issues and contingency planning:
”Because of our work at the beginning of the year, we were able better anticipate each team members' needs in each particular position and work to make that job easier for them.”
Those without team training cited planning and preparation as areas that warranted further development as this comment illustrates: “One area in which we can improve is allocating more attention to planning beforehand what materials and supplies will need to be collected during the surgical setup and preparation.”
Beyond mere mentions of planning as an element to improve, some students referenced individual preparation by team members as a hindrance to maximizing team performance during surgery:
The most challenging aspect is that not all team members were always well-prepared for their assigned task. Some team members clearly took more advantage of the lunchtime practice sessions and spent more time watching videos and really learning the procedures before laboratories.
This student's comment illustrates one crucial difference between the two cohorts: “Our group improved greatly over the course of the semester. Our first surgery showed us that improved communication and goal setting was needed.” Inherent in this comment is the recognition that planning, and in particular goal setting, would be beneficial to team functioning. Relatedly, other members of this cohort were more likely to express that their team “developed over time” or “figured out how to work together by the end of the year,” a phenomenon that was not characteristic of the responses of those who had participated in team training. For example, students acknowledged such things like, “we became more cohesive as the year progressed” and “we grew over the past year and learned how to work together.” While it is encouraging that teams grew as result of working together, these comments also imply that students simply had to “figure it out on their own” as opposed to being equipped with a skill set to guide them and help navigate some of the more common hurdles associated with collaboration and coordination.
Continuous feedback and reflection versus constructive criticism
While both groups cited feedback as something they would like to continue to work on, the team-trained cohort cited an appreciation for feedback, even under positive circumstances, and specifically mentioned formal debriefing/reflective sessions for the entire team as something they would like to do more frequently. In most instances, these students expressed comfort with both providing and receiving feedback, but acknowledged that they could be more active in deliberately seeking feedback: “While we worked well as a group, we could work on being more proactive about seeking feedback and identifying ways to improve our performance.” This seemed to be particularly true under conditions of positive performance as this comment illustrates: “When the group succeeded and things went well, we didn't really go over improvement areas or aspects that might have improved despite a positive performance. Would like to work on this.”
Finally, several team-trained students acknowledged the importance of more broad-based reflection or review sessions, beyond the level of individual feedback: “We are not afraid to give positive or constructive feedback. Providing feedback has really improved our group dynamic and communication. I would like to review process at the end of the day to reflect on what went well and what did not.” Inherent in some comments is the notion that the supportive team structure is precisely what facilitated reflective practice and enhanced skill development: “(I would like) a wrap-up session or debrief right after surgery rather than waiting for the next time, we meet to discuss things when they are fresh on the mind. I want to continue to improve my skills and competencies through purposeful reflection and practice but may also need to push myself to the edge of my comfort zone while I have an excellent team and support structure.”
As mentioned previously, those who did not participate in team training also cited feedback as a key aspect of teamwork that they would like to improve; however, they were more likely to mention opportunities for their team to develop the ability to provide and receive constructive criticism. Many students cited opportunities for learning how to phrase feedback more appropriately as this comment illustrates: “One group member would continually talk and critique us when he was well-intentioned, but would not always phrase the feedback constructively.”
Despite comfort with providing positive feedback to one another, group dynamics sometimes prohibited students from seeking out feedback as one student explained: “We were able to give positive feedback to each other for various tasks accomplished, but we were not proficient in seeking feedback to improve. There were also far more negative comments and sarcasm than is appropriate.” In rare instances, students struggled with feedback in part because of trust issues and authority. One student describes how a team member's skepticism with advice offered from the rest of the team impacted feedback: “We struggled with disagreement and receiving feedback. One member, rather than take the advice of her assistant surgeon, would call over the doctor to ask for affirmation and only then would accept that she was wrong.”
Students' experiences and comfort with feedback were qualitatively different between the two cohorts. Students without prior practice in providing and receiving feedback lacked proficiency, while those who learned how to provide and receive feedback as part of team training, felt comfortable with performance feedback. In most cases, these students desired more feedback, even under positive circumstances, and also communicated a preference for more holistic review and process reflection.
| Discussion|| |
The exploration of students' experiences as described in their own words revealed qualitatively different experiences and challenges associated with being a part of a year-long surgery team for both cohorts. While it was promising to see students in both groups describe elements related to team coordination, communication, development, and an appreciation for the importance of feedback, the subtle differences between the cohorts are noteworthy. First, team-trained students had a greater appreciation for flexibility and patience with inefficiencies stemming from individuals' varying experiences and strengths. Taking their reflections holistically, it appears that the emphasis on planning and preparation, as well as discussions of individual strengths and weaknesses helped clarify goals and understanding of tasks that facilitated development of a supportive, flexible atmosphere. Second, prior training in communication competence, generally, and feedback and conflict management, specifically, impacted students' team experiences such that students with prior training cited communication as a strength and felt comfortable navigating disagreements and providing and receiving feedback, process skills that have an impact on patient outcomes and team satisfaction and cohesion.,
While these results point to the impact of team training on student performance, we acknowledge that students' reflections on team experiences and challenges are subjective and could be enhanced with the addition of facilitator or peer accuracy checks. It is also possible that students' reflections were positively biased given the timing of this graded exercise at the end of a year-long experience, resulting in a halo effect with respect to their collaborative skills. The team-trained cohort could have been implicitly biased to report better teamwork, particularly since they have assessed their communication competence in other courses. Finally, as with any class, the cultures of the two cohorts were different – both as a natural byproduct of the individuals who comprised the groups, and also due to the fact that each class had a different educational experience and was aware of the shift in the curriculum. To further enhance our understanding of the impact of team training on performance, future research should explore students' team communication through objective observation of team behavior, for example, through coding of videotaped team interactions.
| Conclusions|| |
In closing, we see two key implications as a result of this research. First, team training makes a difference in students' experiences and enhances perceptions of competence in communication, coordination, and collaboration. Second, reflective practice enhances students' ability to critically evaluate their own and their team members' performance and to make sense of experiences in more nuanced and well-developed ways. Collectively, the results of this research suggest that team training positively impacts team processes and experiences, with the potential to have profound implications on patient outcomes and team satisfaction.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American Animal Hospital Association. The Path to High Quality Care: Practice Tips for Improving Compliance.
Lakewood, CO: American Animal Hospital Association; 2003.
American Animal Hospital Association. Compliance: Taking Quality Care to the Next Level. Lakewood, CO: American Animal Hospital Association; 2009.
Salas E, DiazGranados D, Weaver SJ, King H. Does team training work? Principles for health care. Acad Emerg Med 2008;15:1002-9.
Moore IC, Coe JB, Adams CL, Conlon PD, Sargeant JM. The role of veterinary team effectiveness in job satisfaction and burnout in companion animal veterinary clinics. J Am Vet Med Assoc 2014;245:513-24.
Lewis RE, Klausner JS. Nontechnical competencies underlying career success as a veterinarian. J Am Vet Med Assoc 2003;222:1690-6.
Fernandez R, Kozlowski SW, Shapiro MJ, Salas E. Toward a definition of teamwork in emergency medicine. Acad Emerg Med 2008;15:1104-12.
Reddy MC, Jansen BJ. A model for understanding collaborative information behavior in context: A study of two health care teams. Inf Process Manage 2008;44:256-73.
Reddy MC, Spence PR. Collaborative information seeking: A field study of a multidisciplinary patient care team. Inf Process Manage 2008;44:242-255.
Gawande AA, Zinner MJ, Studdert DM, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery 2003;133:614-21.
Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: An insidious contributor to medical mishaps. Acad Med 2004;79:186-94.
Williams RG, Silverman R, Schwind C, Fortune JB, Sutyak J, Horvath KD, et al.
Surgeon information transfer and communication: Factors affecting quality and efficiency of inpatient care. Ann Surg 2007;245:159-69.
Apker J, Propp KM, Ford WS. Investigating the effect of nurse-team communication on nurse turnover: Relationships among communication processes, identification, and intent to leave. Health Commun 2009;24:106-14.
Hackman JR. The design of work teams. In Lorsch JW, editor. Handbook of Organizational Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1987. p. 315-42.
Hackman JR. Why teams don't work. In Tindale RS, Heath L, Edwards J, editors. Theory and Research on Small Groups. New York: Plenum; 1998. p. 245-67.
Gittell JH. Transforming Relationships for High Performance. Stanford, CA: Stanford University Press; 2016.
Aulisio MC, Woltenberg LN, Erlandson EF, Lorenson ME. Interprofessional leadership development for health profession learners: A program and outcomes review. Educ Health Prof 2019;2. [doi: 10.4103/EHP_1_19]. [Ahead of print].
Armour Forse R, Bramble JD, McQuillan R. Team training can improve operating room performance. Surgery 2011;150:771-8.
Wolf FA, Way LW, Stewart L. The efficacy of medical team training: Improved team performance and decreased operating room delays: A detailed analysis of 4863 cases. Ann Surg 2010;252:477-83.
Young-Xu Y, Neily J, Mills PD, Carney BT, West P, Berger DH, et al.
Association between implementation of a medical team training program and surgical morbidity. Arch Surg 2011;146:1368-73.
Weaver SJ, Rosen MA, DiazGranados D, Lazzara EH, Lyons R, Salas E, et al.
Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf 2010;36:133-42.
Deering S, Rosen MA, Ludi V, Munroe M, Pocrnich A, Laky C, et al.
On the front lines of patient safety: Implementation and evaluation of team training in Iraq. Jt Comm J Qual Patient Saf 2011;37:350-6.
Riley W, Davis S, Miller K, Hansen H, Sainfort F, Sweet R. Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital. Jt Comm J Qual Patient Saf 2011;37:357-64.
Salas E, Almeida SA, Salisbury M, King H, Lazzara EH, Lyons R, et al.
What are the critical success factors for team training in health care? Jt Comm J Qual Patient Saf 2009;35:398-405.
Salas E, Gregory ME, King HB. Team training can enhance patient safety – The data, the challenge ahead. Jt Comm J Qual Patient Saf 2011;37:339-40.
Canary DJ, Lakey SG. Managing conflict in a competent manner: A mindful look at events that matter. In: Oetzel JG, Ting-Toomey S, editors. The Sage Handbook of Conflict Communication.
Thousand Oaks, CA: Sage; 2006. p. 185-210.
Kedrowicz AA. The impact of a group communication course on veterinary medical students' perceptions of communication competence and communication apprehension. J Vet Med Educ 2016;43:135-42.
Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, NJ: PTR Prentice Hall, Inc.; 1984.
Kolb DA, Boyatzis R, Mainemelis C. Experiential learning theory: Previous research and new directions. In: Sternberg R, Zhang L, editors. Perspectives on Cognitive Learning and Thinking Styles. Mahmah, NJ: Erlbaum; 2001. p. 228-47.
Strauss A, Corbin JM. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. London: Sage; 1990.
Strauss A. Qualitative Analysis for Social Scientists. New York: Cambridge University Press; 1987.
Reader TW, Flin R, Mearns K, Cuthbertson BH. Developing a team performance framework for the intensive care unit. Crit Care Med 2009;37:1787-93.
Hodges B. Medical student bodies and the pedagogy of self-reflection, self-advancement, and self-regulation. J Curric Theor 2004;20:41-51.