Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, 6500, HB, Nijmegen, The Netherlands.
Department of Research and Development, Netherlands Comprehensive Cancer Organization, Goldebaldkwartier 419, Utrecht, DT, 3511, The Netherlands.
BMC Med Educ. 2022 Jun 27;22(1):502. doi: 10.1186/s12909-022-03570-w.
The optimal treatment plan for patients with cancer is discussed in multidisciplinary team meetings (MDTMs). Effective meetings require all participants to have collaboration and communication competences. Participating residents (defined as qualified doctors in training to become a specialist) are expected to develop these competences by observing their supervisors. However, the current generation of medical specialists is not trained to work in multidisciplinary teams; currently, training mainly focuses on medical competences. This study aims to identify barriers and facilitators among residents with respect to learning how to participate competently in MDTMs, and to identify additional training needs regarding their future role in MDTMs, as perceived by residents and specialists.
Semi-structured interviews were conducted with Dutch residents and medical specialists participating in oncological MDTMs. Purposive sampling was used to maximise variation in participants' demographic and professional characteristics (e.g. sex, specialty, training duration, type and location of affiliated hospital). Interview data were systematically analysed according to the principles of thematic content analysis.
Nineteen residents and 16 specialists were interviewed. Three themes emerged: 1) awareness of the educational function of MDTMs among specialists and residents; 2) characteristics of MDTMs (e.g. time constraints, MDTM regulations) and 3) team dynamics and behaviour. Learning to participate in MDTMs is facilitated by: specialists and residents acknowledging the educational function of MDTMs beyond their medical content, and supervisors fulfilling their teaching role and setting conditions that enable residents to take a participative role (e.g. being well prepared, sitting in the inner circle, having assigned responsibilities). Barriers to residents' MDTM participation were insufficient guidance by their supervisors, time constraints, regulations hindering their active participation, a hierarchical structure of relations, unfamiliarity with the team and personal characteristics of residents (e.g. lack of confidence and shyness). Interviewees indicated a need for additional training (e.g. simulations) for residents, especially to enhance behavioural and communication skills.
Current practice with regard to preparing residents for their future role in MDTMs is hampered by a variety of factors. Most importantly, more awareness of the educational purposes of MDTMs among both residents and medical specialists would allow residents to participate in and learn from oncological MDTMs. Future studies should focus on collaboration competences.
癌症患者的最佳治疗方案在多学科团队会议（MDTMs）中进行讨论。有效的会议需要所有参与者都具备协作和沟通能力。参会的住院医师（定义为正在接受培训以成为专家的合格医生）应通过观察他们的上级医生来发展这些能力。然而，当前一代的医学专家并未接受过团队合作方面的培训；目前，培训主要侧重于医学能力。本研究旨在确定住院医师在学习如何胜任地参与 MDTMs 方面的障碍和促进因素，并确定他们对未来在 MDTMs 中角色的额外培训需求，这是由住院医师和专家感知到的。
对参与肿瘤 MDTM 的荷兰住院医师和医学专家进行了半结构化访谈。采用目的性抽样方法，使参与者在人口统计学和专业特征（如性别、专业、培训时长、附属医院类型和地点）方面的差异最大化。根据主题内容分析的原则，对访谈数据进行系统分析。
共访谈了 19 名住院医师和 16 名专家。出现了 3 个主题：1）专家和住院医师对 MDTMs 的教育功能的认识；2）MDTM 的特点（如时间限制、MDTM 规定）；3）团队动态和行为。以下因素有助于学习参与 MDTMs：专家和住院医师除了 MDTM 的医学内容外，还承认其教育功能，上级医生履行其教学角色并为住院医师提供条件，使他们能够发挥参与作用（如做好充分准备、坐在内圈、承担指定的责任）。住院医师参与 MDTM 的障碍包括上级医生指导不足、时间限制、妨碍其积极参与的规定、等级制度的关系结构、对团队的不熟悉以及住院医师的个人特点（如缺乏信心和害羞）。受访者表示住院医师需要额外的培训（如模拟），特别是为了增强行为和沟通技巧。
目前，为住院医师准备未来在 MDTMs 中的角色的做法受到各种因素的阻碍。最重要的是，住院医师和医学专家都需要提高对 MDTMs 教育目的的认识，使住院医师能够参与并从肿瘤 MDTMs 中学习。未来的研究应侧重于协作能力。
