– NY Times, GARDINER HARRIS, JULY 10, 2011
Why do medical schools value teamwork?
When the Institute of Medicine published “To Err Is Human: Building a Safer Health System” in 2000, medical schools were still training doctors to believe they were solely responsible for the outcomes of their patients. But when the report concluded that the high rate of medical error was mainly due to a lack of communication and dysfunctional teamwork, things started to change. The doctor-as-captain-of-the-ship paradigm had led to a combination of burnout, poor relationships with nurses and staff, and arrogance towards patients’ preferences.
Since then, medical leadership has worked to improve teamwork in medical practice and education. They looked to the examples set by commercial aviation, the military, firefighting, and other rapid response professions, where human error can result in the loss of lives. Research in these fields found that in high-risk settings, teams make fewer mistakes than do individuals. When teamwork exercises were brought in to prepare for trauma, anesthesia, and labor and delivery emergencies, hospitals saw improved patient outcomes and fewer errors.
Since then, medicine has placed the team at the forefront of training. Gone are the days of the solo-practitioners who handle everything on their own. Physicians are expected to work together with other physicians, nurses, mid-level providers (PAs, NPs, CNMs), technicians, medical assistants, care coordinators, behavioral health specialists, insurance experts, physical/occupational therapists, nutritionists, social workers, and others. It takes more than one set of skills to solve most medical problems, and no one person can have all the skills and knowledge on hand.
What is teamwork in medicine?
Imagine you are a physician caring for Ms. W., a 35-year-old patient who was admitted six days ago for an acute pulmonary embolism. During her stay, you discovered that she has an inherited clotting disorder and must remain on anticoagulants for the rest of her life. However, she is uninsured and cannot afford the expensive medication you prescribed. You also just learned that the hospital wants you to send her home tomorrow. While you think she is ready for discharge from a medical standpoint, you are not sure how she is going to fare on her own.
Luckily, on the second day of her admission, Ms. W.’s nurse called social services, who helped her apply to a program that covers the cost of her medications. They also arranged for free home health visits the first week after discharge, to reduce the possibility that she will return to the emergency room. Later during her hospitalization, your PA was rounding and discovered that Ms. W. now has prediabetes, so a nutrition consult was called. The nutritionist learned that Ms. W. is depressed and craving junk food, because her favorite sport, rugby, is now off limits due to the blood thinners. The nutritionist shared this with her care coordinator, who arranged for her to see an occupational therapist to teach her safe ways to exercise. After a baseline mental and emotional health assessment, the discharge team arranged for Ms. W. to receive outpatient therapy to help her cope with her new health limitations.
Clearly, physicians today rely on the input and expertise of many individuals to plan and coordinate post-hospital care. But perhaps the biggest change to the healthcare team is realizing that the patient and their family are considered vital members. Without the patient’s buy-in, treatments are often ineffective. A physician cannot be successful unless their patients are comfortable voicing concerns and unafraid to question the reason behind decisions and treatments. The patient’s family is often enlisted to perform wound care or other essential tasks, and are taught to recognize when to bring the patient back in. Making the family a recognized part of the team is often the key to an uncomplicated recovery. As doctors, we can’t go home with our patients to make sure they take their medication, but their families can.
The impact of improved teamwork in medicine
Lastly, our awareness of physician burnout has led to changes in the way doctors must communicate with one another. While it may seem obvious that physicians need to sleep and recharge in order to perform at their best, medical training programs have historically placed a low value on time off. The attitude of most health professionals was that a truly dedicated physician forgoes sleep to stay on duty for days on end. These days, medical students and residents are required to leave the hospital and rest, and failures of programs to enforce these requirements can result in severe penalties.
Besides the obvious safety issues, studies have shown that physicians trusting others to care for their patients leads to greater satisfaction among nurses and other team members, as well as better patient outcomes. This change in the patient-physician relationship may be concerning to some patients who worry what will happen if their physician is not always available. However, with a good team in place, patients soon discover that someone will always be there and that their physician is well-rested, recharged, and able to handle whatever challenges arise.
Teamwork in your medical school application
Fast forward to medical school, where the latest curriculum changes include dedicated teamwork training. Students and residents are being taught the skills to effectively sign-out patients to colleagues when they leave the hospital. Other skills such as collaboration, overcoming conflict, prioritizing, and recognizing others’ strengths are explicitly taught and assessed. Students practice code situations so that all team members know their role and can perform in high-stress situations. Med schools not only teach these effective teamwork traits, but they also screen for them at admission. The first place they look for the qualities needed for collaboration is in the teamwork essay.
So, how do you show that you are a team player? First, identify an experience (ideally less than two years ago) when you worked well with others. Potential teamwork situations include volunteering, tutoring/teaching, athletics, research, group projects in school, jobs in retail, the service industry, or other employment settings where teamwork is a key part of success. Situations such as shadowing, where you are not directly contributing, are not as effective.
If your team experienced some conflict, describe how you overcame it, making sure to attribute the problem to a communication issue rather than an individual (no blaming). If things went well and you don’t recall major issues, describe your channels of communication and how you ensured collaboration. Be sure to show your awareness of your teammates’ strengths. Medical schools seek people who recognize that the work of a team is better than that of a single individual. Show that you have that perspective.
In addition, try to broaden your definition of teamwork by including people who were not directly on your team, but who contributed to a successful outcome. In a work setting, were your customers or clients part of your team? In teaching, did you encourage trust and participation in your students? In a lab or for a school project, did you acknowledge the help from support staff or others who were not directly involved?
The teamwork essay is just the beginning of a school’s assessment of your collaborative skills. Schools will also evaluate your teamwork potential during the interview. They might assess your ability to be flexible, to recognize and admit when you don’t know something, or to work well with others. The increasing use of the MMI (multiple mini interview) helps identify applicants with an aptitude for cooperation and communication.
Schools ultimately want medical students who are not only able to excel in their academics, but who can work toward a common goal without letting their egos get in the way. Above all, they want students who are comfortable working on a diverse team, with a variety of strengths and skill sets. Only through teamwork, can we give patients the confidence, resources, and skills needed to succeed on their own.
10 ways to show your teamwork skills:
If you can answer “yes” to these questions, you’re well on your way to having the teamwork skills medical schools want to see.
- Do you value the contribution of all team members?
- Are you flexible and willing to change direction when needed?
- Do you listen to and accept constructive criticism?
- Do you avoid blaming others and instead look to systems issues when there is conflict?
- Do you share credit with others generously?
- Are you comfortable in both leadership and non-leadership roles?
- Do you see the strengths of others as complementary to your own?
- Are you open to further developing your teamwork skills?
- Do you believe teams accomplish more than individuals?
- Is respect for others a part of your personal value system?
Suzi Schweikert is a former UCSD School of Medicine adcom member who has mentored students in healthcare programs for over 20 years. She has a BA in English Lit from UCLA, an MD from UCSD, and an MPH from SDSU. Want Suzi to help you get Accepted? Click here to get in touch!
Related Resources:
• Navigate the Med School Maze, a free guide
• The Importance of Teaching Management in Medical School, a podcast episode
• “I’m Smart, Really I Am!” – How to Prove Character Traits in Your Essays
This article was originally posted on blog.accepted.com.
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