Havyer Rachel D A, Wingo Majken T, Comfere Nneka I, Nelson Darlene R, Halvorsen Andrew J, McDonald Furman S, Reed Darcy A
Department of Medicine, Mayo Clinic, Rochester, MN, USA,
J Gen Intern Med. 2014 Jun;29(6):894-910. doi: 10.1007/s11606-013-2686-8. Epub 2013 Dec 11.
Valid 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.
We 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.
Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams.
Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated.
Of 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.
Review is limited to quantitative assessments of teamwork in internal medicine.
There is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes.
有效的团队协作评估对于确定医生能力和优化患者治疗结果至关重要。我们系统回顾了已发表的用于评估普通内科及所有医学亚专业的本科、研究生和继续医学教育中团队协作的工具。
我们检索了1979年1月至2012年10月期间的MEDLINE、MEDLINE在研数据库、CINAHL和PsycINFO，纳入文章的参考文献以及四个专业会议的摘要。向两位内容专家咨询了其他研究。
纳入的研究描述了用于测量医学生、住院医师、专科住院医师和执业医师在单专业或多专业（跨专业）团队中团队协作的定量工具。
使用具有现有效度证据的既定框架提取工具效度和研究质量。两位作者独立提取30%的文章内容并计算一致性。
在12922条引用文献中，178篇描述了73种独特团队协作评估工具的文章符合纳入标准。评分者间一致性的组内相关系数为0.73（95%可信区间0.63 - 0.81）。研究涉及执业医师（142项，80%）、住院医师/专科住院医师（70项，39%）和医学生（11项，6%）。大多数（152项，85%）评估跨专业团队。研究在住院环境（77项，43%）、门诊环境（42项，24%）、模拟环境（37项，21%）和课堂环境（13项，7%）中进行。73种工具的效度证据包括内容效度（54项，74%）、内部结构效度（51项，70%）、与其他变量的关系效度（25项，34%）和反应过程效度（12项，16%）。态度和意见是最常评估的结果。13种（18%）工具直接考察了团队协作得分与患者治疗结果之间的关系。安全态度问卷和团队氛围量表的得分有充分的效度证据，并且与改善患者治疗结果相关。
本综述仅限于内科团队协作的定量评估。
对于几种已发表的评估内科团队协作的工具，有充分的效度证据。然而，很少有团队协作评估与患者治疗结果直接相关。
