Teaching medical students multi-disciplinary team work through integrated course

Multidisciplinary team (MDT) working has been endorsed as the main mechanism to ensure truly holistic care for patients and a seamless service for patients throughout their disease trajectory and across the boundaries of primary, secondary, and tertiary care. However the effectiveness of each team needs to be continually evaluated to ensure that all the relevant disciplines are able to participate in the clinical management of patients. This article describes the work of the Cancer Services Collaborative at the Birmingham Women's hospital in the UK in promoting the development of a holistic MDT in parallel with the medical model.

Multidisciplinary team (MDT) working is essential to optimise and integrate services for people who are frail. MDTs require collaboration. Many health and social care professionals have not received formal training in collaborative working. This study investigated MDT training designed to help participants deliver integrated care for frail individuals during the Covid-19 pandemic. Researchers utilised a semi-structured analytical framework to support observations of the training sessions and analyse the results of two surveys designed to assess the training process and its impact on participants knowledge and skills. 115 participants from 5 Primary Care Networks in London attended the training. Trainers utilised a video of a patient pathway, encouraged discussion of it, and demonstrated the use of evidence-based tools for patient needs assessment and care planning. Participants were encouraged to critique the patient pathway, reflect on their own experiences of planning and providing patient care. 38% of participants completed a pre-training survey, 47% a post-training survey. Significant improvement in knowledge and skills were reported including understanding roles in contributing to MDT working, confidence to speak in MDT meetings, using a range of evidence-based clinical tools for comprehensive assessment and care planning. Greater levels of autonomy, resilience, and support for MDT working were reported. Training proved effective; it could be scaled up and adopted to other settings.

Este estudo teve por objetivo descrever acerca da aplicação das Práticas Integrativas e Complementares pela equipe multiprofissional no SAST de um município localizado no oeste de Santa Catarina. Trata-se de uma pesquisa qualitativa que utilizou como método de coleta a entrevista semiestruturada com dez profissionais do serviço. Os dados foram analisados por meio da Proposta Operativa de Minayo. A partir do processo de análise surgiram três categorias temáticas:1. O comprometimento da equipe é o nosso diferencial; 2. A gestão das Práticas Integrativas e Complementares (PICs): investindo em promoção da saúde; e 3. (Re) conhecimento das PICs: a importância da Política Nacional de Práticas Integrativas e Complementares. Considera-se que os objetivos foram alcançados, pois evidenciou-se o desenvolvimento do trabalho da equipe multiprofissional, no qual destaca-se como uma fortaleza e como um diferencial. Busca-se assistência qualificada, no ensino e na busca por saberes, na atenção para com as questões gerenciais e normas instituídas e na realização de educação e promoção da saúde.

To determine the extent to which three forms of multidisciplinary team (MDT) care in stroke rehabilitation meet the standards set by the United Kingdom National Service Framework (NSF). Consecutive assessment of the three forms of care was completed. The study included three groups of 25 stroke inpatients on the stroke rehabilitation ward. (1) A standard weekly MDT meeting using a standard form for documentation; (2) a standard MDT meeting using a newly devised form; and (3) a novel MDT ward round using the new form, and attended by doctors. MDT ward rounds result in significantly better consideration of patients' needs (median 7 per patient compared with 0 and 5 in phases one and two), enhanced SMART (specific, measurable, achievable, realistic and time framed) goal-setting (median 3 per patient compared to 1 in phases one and two); greater patient involvement (12 patients compared to 0 and 4 in phases one and two); and improved team working (measured using the team climate inventory) than do MDT meetings. In the present study, standard weekly MDT meetings did not meet the standards set for MDT care by the NSF. The use of a MDT ward round allows these standards to be achieved.

Introduction to Part 3 This part is concerned with the relationships, respectively, between professionals and patients, and between professionals of different kinds working together in multidisciplinary teams. “Person-centered practice” means different things in different contexts. Chapter 8, through the story of a woman, Brenda Forest, with early breast cancer, shows that in all its various meanings person-centered practice must include attention to the values – the needs, preferences, strengths and above all aspirations – of the particular person concerned. Person-centered practice, the chapter concludes, is nothing if it is not person- values -centered practice. Multidisciplinary team work has become increasingly the norm in many contexts in the ever more complex environment of modern healthcare. In part, this is because team members from different professions bring with them different skills and experience. In values-based practice, the concept of the multidisciplinary team is extended to include different team values . In Chapter 9, we illustrate the importance of team values in supporting balanced decision-making in a child safeguarding case. “Person-centered practice” and “multidisciplinary teamwork” are both very much among today's buzz words in health care. There are good reasons for this. Like any buzz word, they can become misused as empty mantras. But person-centered practice represents an important shift of focus away from the priorities of providers and back to the needs of individual patients and their families, while multidisciplinary teamwork is essential for the effective delivery of care that is genuinely person-centered. Values-based practice, as we will see in this part, both draws on and in turn contributes to the multidisciplinary delivery of person-centered care.

In engineering studies, there is a shift to new teaching methodologies with focus on the student involvement, like project-based learning. Project-based learning courses, however, often relay on a previous course where the technical background to be used in the projects is taught, requiring this way two terms for an area. In this paper, we consider a project-based course on computer network applications, which has been designed to cover both the technical and non-technical content in only one term. In the three years we have been teaching this course, our observation based on questionnaires is that the organization of the course allows to successfully reaching the course objectives. We feel, however, that we do not fully exploit the learning potential the course could have in the first few weeks of the course. We describe how the course is organized and the problems we have identified. We propose a project demonstration tool and describe how our solution improves towards our goals. With the proposed tool, the students should better obtain already in the very first days of the course a clear vision about the projects, allowing fully taking advantage of the opportunities which the course offers. format.

BackgroundType 1 diabetes is one of the most frequent long-term endocrine childhood disorders and the Swedish National Diabetes Register for children states that adolescents (12–18 years) constitute the most vulnerable patient group in terms of metabolic control. The aim of this study was to examine how a multidisciplinary team functions when caring for adolescents with type 1 diabetes.MethodsQualitative interviews were performed with 17 health professionals at a Paediatric Diabetes Care Unit in a Swedish university hospital. The interviews were analysed to gain insight into a multidisciplinary care team’s experiences of various organizational processes and circumstances related to the provision of person-centred paediatric diabetes care.ResultsBuilding long-term relationships with adolescents, the establishment of a multidisciplinary care team and ensuring adequate documentation are vital for the delivery of person-centred care (PCC). Furthermore, a PCC process and/or practice requires more than the mere expression of person-centred values. The contribution of this study is that it highlights the necessity of facilitating and safeguarding the organization of PCC, for which three processes are central: 1. Facilitating long-term relationships with adolescents and their families; 2. Facilitating multi-professional teamwork; and 3. Ensuring adequate documentation.ConclusionThree processes emerged as important for the functioning of the multidisciplinary team when caring for adolescents with type 1 diabetes: building a long-term relationship, integrating knowledge by means of multidisciplinary team work and ensuring adequate documentation. This study demonstrates the importance of clearly defining and making use of the specific role of each team member in the paediatric diabetes care unit (PDCU). Team members should receive training in PCC and a PCC approach should form the foundation of all diabetes care. Every adolescent suffering from type 1 diabetes should be offered individual treatment and support according to her/his needs. However, more research is required to determine how a PCC approach can be integrated into adolescent diabetes care, and especially how PCC education programmes for team members should be implemented.

Introduction/Background A massive haemorrhage can be a rare but serious complication of paediatric trauma and obstetrical cases. In order to optimize the management of massive haemorrhages, a protocol was implemented at our centre. However, recent audits showed that necessary improvements were to be made to many aspects of its application. Our objective was to evaluate the application of a massive hemorrhage protocol and the ability to work in interdisciplinary teams using simulation and targeted training. We also aimed to evaluate confidence levels of different team members to apply the protocol and to hold their role in an interdisciplinary team during a crisis situation. Methods Prospective observational study held at the simulation lab and at the blood bank of a tertiary mother-child health care facility in 2012. Participants were nurses, respiratory therapists, orderlies, anesthetists, obstetricians, pediatric emergency physicians, intensivists and hematologists, as well as blood bank technologists. Pediatric emergency/intensive care and obstetrical/anesthesia teams were submitted to high-fidelity (HF) simulated pediatric trauma and post-partum massive hemorrhage scenarios respectively (SimbabyTM (Laerdal) and NoelleTM (Gaumard)). Blood bank technologists were videotaped and telephone conversations between them and participants at the simulation lab were recorded for review. If hematologists were consulted, they were called back by the blood bank chief technologist and asked to answer questions relevant to the application of the massive hemorrhage protocol (MHP). Each participant was asked to hold their usual role in an interdisciplinary team. Scenarios were developed, programmed and run by experts in each field. Targeted training consisted of a debriefing session and a presentation reviewing the MHP and teamwork skills. Documents on MHP, as well as a key article on crisis resource management were distributed during the first session in order to prepare for the post session two weeks later. Confidence questionnaires were filled out during both sessions. All sessions were videotaped and four blinded independent trained raters assessed the performances. Raters were blinded to the pre/post phase and were not involved in the study. For the application of the massive hemorrhage protocol performances, raters used a checklist derived from the original protocol by experts in the field. For the ability to work in teams, raters used the Mayo High Performance Teamwork Scale. Blood bank technologists were evaluated using a checklist derived by transfusion experts rating necessary steps for preparing and delivering blood products in cases of massive haemorrhages. Scores on performances of the application of the protocol, as well as teamwork performances were recorded. Means and standard deviations of scores for performances were calculated for each scenario. Pre and post training scores were compared using an ANOVA test to assess differences in means. Descriptive statistics of items on the confidence questionnaire were calculated prior to and following training. To assess differences in confidence levels, a Mann Whitney test was used. An alpha of 0.05 was set for all statistics. Results A total of 62 healthcare professionals involved in 8 interdisciplinary teams (4 obstetrics/anaesthesia and 4 paediatric emergency/intensive care) as well as 8 blood bank technologists and 8 haematologists participated in the study. Following training, scores for the application of the protocol improved by 24% (95% CI 10-39). Scores for the ability to work in teams improved by 17% (95% CI 6-28). Confidence levels in the ability to apply the protocol and work in teams improved by 13% (95% CI 11-16). Notable were confidence improvements in leadership and communication skills as well as role and task assignment. Conclusion Targeted training involving HF simulated scenarios and protocol review improved participant ability to apply the massive haemorrhage protocol and to work in interdisciplinary teams. Confidence levels improved among participants from all disciplines. Disclosures None.

Objective To explore the work content of nurses in menopause multidisciplinary outpatient team so as to summarize the nursing work well and improve the quality of nursing work. Methods This study used case study of qualitative research. From June 2018 to August 2019, we selected 10 relevant personnel in Menopause Multidisciplinary Teamwork (MDT) Outpatient Department at Beijing Shijitan Hospital of Capital Medical University to interview MDT outpatient nurses about the work content. Data were collected with the method of personalized depth interview and observation, and data were analyzed with the method of content analysis. Results A total of 5 themes were extracted by analyzing data including the MDT outpatient work flow management, comprehensive evaluation and diagnosis by interdisciplinary, menopause knowledge education for patients, formulating and implementing the plan of individualized continuous nursing as well as participating in MDT publicity, promotion and team development. Conclusions Nurses take part in effective flow management, comprehensive health evaluation, enriching menopause knowledge education, formulating and implementing the plan of individualized continuous nursing as well as MDT publicity, teaching and research in MDT outpatient work to make MDT outpatient flow simple and efficient, improve patients' health knowledge, medical compliance and satisfaction. Key words: Nurses; Menopause; Multidisciplinary teamwork; Outpatient Department; Work content; Qualitative research

This article explores multidisciplinary team working, inter-disciplinary, trans-disciplinary and effective collaborative practice in order to provide high-quality patient care. It discusses different views on collaboration, some of the issues around cross-discipline and multi-agency working and concerns around promoting 'high-quality' care. It also discusses the importance of evidence-based practice in multidisciplinary teams. Issues around good-quality care, clinical governance and the audit cycle in MDTs are addressed. The article highlights the importance of the 6Cs (care, compassion, competence, communication, courage and commitment) in MDTs if quality care is to be achieved. The article also explores advantages and limitations of multidisciplinary team working, trans-disciplinary working and inter-professional working in developing and delivering high-quality patient-centred care. Further research is needed on how clinical audits can help to improve how MDTs function in order improve the quality of service provided to clients.

We report here the different roles undertaken by the members of 10 multidisciplinary cancer teams in conveying information to patients during their care. Team members completed an Informational Roles Questionnaire measuring an individual's perception of their major role and that of their colleagues in giving information to patients. They also completed two standard psychological health measures, the General Health Questionnaire and Maslach Burnout Inventory. The information giving roles of the surgeon, oncologist, radiologist and clinical nurse specialist were well recognised by their colleagues; however, other team members' roles were more ambiguous and less well understood. The clinical nurse specialist provided the broadest information coverage for patients. Few professional groups regularly informed patients about clinical trials and family history and the clinical nurse specialist was often the only person to deal with patients' sexual well being, consequently these areas are likely to receive poor coverage. Probable psychiatric morbidity (GHQ⩾4) in teams ranged from 5 to 27%. High levels of emotional exhaustion were particularly apparent in team leaders and nurses and feelings of low levels of personal accomplishment were prevalent in the histopathologists and radiologists. Putative benefits to patients and healthcare professionals from multidisciplinary team working may not be realised without investment in team training.

IMPACT: Implement and evaluate a fellowship program to foster a new generation of entrepreneurial and collaboratively-minded team scientists, equipped with the knowledge and skills to innovate technology-based solutions for COVID-19 to advance human health OBJECTIVES/GOALS: Mount Sinai Targeted Healthcare Innovation Fellowship (THRIVE) is a 9-month program for participants from diverse professional backgrounds to develop HealthTech innovations related to COVID-19. The program is designed to provide an experiential team science platform for fellows to take an idea from concept to commercially viable innovation. METHODS/STUDY POPULATION: Following a competitive application process, 16 THRIVE fellows comprise four teams working collaboratively in an online forum with input from experts in the field. Success of the program will be evaluated by:assessing pre- and post- collaborative research orientation among THRIVE fellows using the ROI scale1using social network analysis (SNA) to investigate the social networks of THRIVE fellows to capture patterns of communication and collaboration related to innovation developmentexploring participant experiences of group formation, teamwork and collaboration related to innovation development using one-to-one semi-structured interviewdetermining team success in innovation development, measured by number of publications, funding awarded, provisional patents and viable products. RESULTS/ANTICIPATED RESULTS: Paired t-tests will determine whether collaborative orientation of THRIVE fellows changes pre- vs. post- program participation, indicating changes in attitude toward multidisciplinary team work. SNA will be used to describe structural patterns of communication that occur at individual and group levels. Network-level indices will provide insight into patterns of communication that exist in innovation development: degree centrality (number of connections per individual), betweenness centrality (number of bridges to others in a network), closeness centrality (closeness to others in a network). We will also test for associations between network characteristics and team success. DISCUSSION/SIGNIFICANCE OF FINDINGS: Understanding patterns of formal and informal relationships, interactions, and perceptions of the collaborative process among individuals in THRIVE teams will elucidate whether such a program can provide an effective forum for team science and innovation development related to COVID-19.

Healthcare professionals must be able to work in multidisciplinary teams (MDTs). The purpose of this editorial is to explain how healthcare professionals (can) contribute to the effectiveness of MDT, through the use of activity theory (collective work activity shared by others who are motivated by a purpose mediated by tools in order to achieve a specific goal) and the associated idea of knotworking (method of tying, untying, and retying together seemingly separate threads of activity). The leading thesis here is that MDTs benefit from health professionals with well-established leadership skills, and also strong collaborative skills that enable them to transition fluidly between leadership roles as needed to advance patient care. Within activity theory, knotworking is the process of tying and untying various threads of activity and knowledge from across the MDT in order to accomplish specific objectives over time. Knotworking exemplifies the dynamic nature of MDT collaboration, which requires professionals to be productive in their environment. The viewpoints offered in this editorial contribute to a new perspective on MDTs, one that acknowledges distributed leadership and the importance of co-producing a successful partnership in a clinical setting.

Continuity of care is concerned with the quality of care over time. There are two important perspectives on this. Traditionally, continuity of care is idealized in the patient's experience of a 'continuous caring relationship' with an identified health care professional. For providers in vertically integrated systems of care, the contrasting ideal is the delivery of a 'seamless service' through integration, coordination and the sharing of information between different providers. As patients' health care needs can now only rarely be met by a single professional, multidimensional models of continuity have had to be developed to accommodate the possibility of achieving both ideals simultaneously. Continuity of care may, therefore, be viewed from the perspective of either patient or provider. Continuity in the experience of care relates conceptually to patients' satisfaction with both the interpersonal aspects of care and the coordination of that care. Experienced continuity may be valued in its own right. In contrast, continuity in the delivery of care cannot be evaluated solely through patients' experiences, and is related to important aspects of services such as 'case-management' and 'multidisciplinary team working'. From a provider perspective, the focus is on new models of service delivery and improved patient outcomes. A full consideration of continuity of care should therefore cover both of these distinct perspectives, exploring how these come together to enhance the patient-centredness of care.

Introduction. The primary health care system is facing the challenge of polymorbidity in aging population and a shortage of general practitioners. In many countries, advanced practice nurses can be a potential solution, since such specialists have the appropriate professional competencies and additional education which allows them to work autonomously and partly perform doctor’s role. At the same time, the organization of high-quality, patient-oriented and affordable medical care at the primary health care level is possible mainly through the work of multidisciplinary teams, which include not only doctors, but also qualified nurses.The purpose was to study the role of a nurse in a multidisciplinary team that provides primary medical care.Materials and methods. In this review, reporting method for systematic reviews and meta-analyses (PRISMA) was used. The search was carried out in eLibrary, PubMed, MEDLINE, Google Scholar bibliographic databases by keywords “primary health care”, “nurse”, “the role of a nurse”, and “multidisciplinary teams”. In addition, an analysis of Russian and foreign regulatory and methodological documents on official Internet portals with elements of information structuring was carried out.Results and discussion. All over the world, researchers emphasize the important role of nurses in the transition to new models of care and treatment aimed at improving the quality of medical services. For example, an extended access model was developed to improve the timely provision of medical services tailored to the needs and preferences of patients. Within the framework of the extended access model, nurses jointly work with family doctors and other specialists and manage patients with chronic diseases, thus reducing the number of visits to the doctor.Conclusion. There is a steady global trend towards teamwork in primary care medical organizations. Teamwork enables the provision of high-quality medical services, including those provided by enhanced practice nurses. The transformation of nursing practice in primary health care is considered a promising strategy to improve the quality and effectiveness of primary health care and address the unmet health needs of individuals, families and communities.