title: Teamwork assessment in internal medicine: a systematic review of validity evidence and outcomes.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Review is limited to quantitative assessments of teamwork in internal medicine.
  
  
  CONCLUSIONS
  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.
authors: Department of Medicine, Mayo Clinic, Rochester, MN, USA, havyer.rachel@mayo.edu.
authors: Rachel D A
authors: RD
authors: Havyer
authors: Majken T
authors: MT
authors: Wingo
authors: Nneka I
authors: NI
authors: Comfere
authors: Darlene R
authors: DR
authors: Nelson
authors: Andrew J
authors: AJ
authors: Halvorsen
authors: Furman S
authors: FS
authors: McDonald
authors: Darcy A
authors: DA
authors: Reed
mesh_terms: D002983:Clinical Competence; D004501:Education, Medical / Q000379:methods / Q000592:standards; D004521:Educational Measurement / Q000379:methods / Q000592:standards; D006801:Humans; D007388:Internal Medicine; D010348:Patient Care Team / Q000592:standards*; D063868:Patient Outcome Assessment; D015203:Reproducibility of Results