[The following notes were generated by Sandra Haudek, PhD.]
The Spring 2022 IAMSE Webinar Seminar Series, titled “To Infinity and Beyond: Expanding the Scope of Basic Sciences in Meeting Accreditation Standards” continued with its fourth seminar on Thursday, March 24, 2022, titled “Towards Integrated Medical Education: Getting the best out of interdisciplinary teacher teams and leaders”. In this session, Mirjam oude Egbrink, Professor of Implementation of Educational Innovations and Vice Dean Education, and Stephanie Meeuwissen, an internal medicine resident, both from Maastricht University Medical Centre in the Netherlands, presented their research on interdisciplinary teacher teams working on integrated medical education.
Dr. Egbrink started by summarizing the shifting landscape of healthcare due to increased medical knowledge and technology and the increased presentation of patients with multiple chronic diseases that all together require a higher level of complexity and a growing need for collaboration between different health care professions. To address this shift, the Maastricht University Faculty of Health Medicine and Life Sciences has implemented an interdisciplinary, problem-based curriculum for undergraduate students. In contrast to traditional discipline-specific curricula, they organized their integrated curriculum by thematic case-based blocks, each 4-10 weeks long, in which students engage in small-group sessions focusing on relevant healthcare-related to real-life problems to stimulate meaningful and deep learning. Each thematic block includes contributions from a series of disciplines. Since these topics include basic, social, and clinical sciences, the educators who develop and organize these individual blocks need to come from different disciplines. At Maastricht University, these groups of teachers are called Planning Groups and consist of 3-5 faculty from different departments, including a team leader. With over 50 departments and over 300 blocks, this involves a complex organization.
Until recently, there was no data on how these Planning Groups functioned, how team members worked together, and how integrated and meaningful the content was. Therefore, Dr. Egbrink and her team studied the following questions: 1) How do interdisciplinary teacher teams function when working on an integrated curriculum? 2) How does their teamwork influence the quality of education? 3) What are important factors influencing team functioning? 4) How can we promote the successful functioning of interdisciplinary teacher teams?
Dr. Meeuwissen continued by asking, “What makes a successful team?” The answer is not self-evident as any team, not just medical teams, are complex and prone to conflicts. Literature on management sciences and business is rich in information about team learning. Team success depends on how members interact with each other. Team learning depends on how the team builds upon each other’s knowledge and experience. Team learning behavior depends on sharing information among team members in an open and respectful environment that leads to co-construction of content that further evolves to constructive conflict management. Constructive conflict is about the negotiation of different experiences, perspectives, and knowledge not leading to a conflict but agreement. Team learning influencing factors are based on individual (personal), team (interpersonal), and organizational knowledge, skills, and attitudes. Team learning outcomes and innovation are also better in high-level team learning .
When Dr. Meeuwissen’s team surveyed the faculty participating in the Planning Groups, they identified three different team approaches . (1) Fragmented Team (“Hangout”): Team members shared their discipline but did not work with each other’s experience or build upon each other’s expertise. (2) Framework-guidance Team (“Distribution Center”): Team members built on each other’s knowledge and stayed outcome-centered. The team leader was more in charge of the different perspectives. (3) Integrated Team (“Melting Pot”): Teams worked well together, incorporated members’ knowledge, skills, and attitudes. The team leader and members together created student-centered education. When Dr. Meeuwissen measured the quality of education as perceived by students, they found that fragmented teams scored lowest in organization, structure, and learning effects. By contrast, the integrated teams scored highest in all aspects (organization, structure, learning effects, and cohesion). Team members confirmed these results since members of integrated teams were most satisfied with their work. They concluded that different team approaches produced varying levels of outcomes. An integrated team approach should be encouraged as they demonstrated the highest team learning levels.
Dr. Meeuwissen then discussed enabling and inhibitory factors that influenced interdisciplinary teacher team functioning . They found several personal characteristics and team dynamics that influenced their respective team approach. (1) In the fragmented team, personal alignment was dominant, including members’ attributes, tendencies, and motivation. In essence, members in these teams did not align with the educational philosophy of integration, rather emphasized discipline-center education. (2) In framework-guided teams, team leadership was evident since leaders and members had a vision, took responsibility, and regularly reflect on their work. (3) Integrate teams, in addition to team-leadership attributes, also incorporated organizational processes like decision-making.
To investigate “What makes a successful team leader?”, Dr. Meeuwissen and her team observed (interactions and written correspondence) and interviewed select teams over a year . She found that success was associated with the team leader’s inclusiveness behavior. Such inclusiveness included coordinating, explicating, inviting, connecting, and reflecting. The team leaders were on task, knew exactly what was going on, were mindful of deadlines, knew the different backgrounds, personalities, capabilities, and emotional states of all team members, gave clear and explicit directions and made sure each member was heard and contributed to the work. In return, team members’ participated actively, spoke up, and even mimicked the leader’s inclusiveness. In alignment with the literature, her results indicated a paradigm shift in health professions’ education leadership.
Lastly, Dr. Meeuwissen discussed how they set up a faculty development program on leadership identity formation for interdisciplinary teacher team leaders . They used the method of Design-Based Research, which anchors on theoretical principles: competence-based learning, workplace learning, learning by doing, small-group learning, and tailor-made learning. The leader identity development process is an iterative, collaborative & continuous process that integrates knowledge, broader views on leadership, application, and reflection.
Dr. Meeuwissen summarized that leadership is an important asset that determines the culture and structure of the organization, a leader identity program can convert teachers’ views on leadership, thoughts on education and leadership are important to change behavior, all teams are groups but not all groups are teams, and that soft elements of interdisciplinary teams can have hard consequences for education.
The presentation lasted 35 minutes. Drs. Egbrink and Meeuwissen then responded to many questions from the audience: if there was a difference in team behaviors between individuals of different demographics. How did you determine which team falls into which category? Did you make any interventions when you found a low-performing team?
- Meeuwissen, S.N.E., Gijselaers, W.H., Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. When I say… team learning. Medical Education. 2020;54(9):784-5.
- Meeuwissen, S.N.E., Gijselaers, W.H., Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. How teachers meet in interdisciplinary teams: hangouts, distribution centers and melting pots. Academic Medicine. 2020;95(8):1265-73.
- Meeuwissen, S.N.E., Gijselaers, W.H., Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. Working beyond disciplines in teacher teams: teachers’ revelations on enablers and inhibitors. Perspectives on Medical Education. 2021;10(1):33-40.
- Meeuwissen, S.N.E., Gijselaers, W.H., van Oorschot, T.D., Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. Enhancing Team Learning through Leader Inclusiveness: a One-Year Ethnographic Case Study of an Interdisciplinary Teacher Team. Teaching and Learning in Medicine (2021);33(11).
- Meeuwissen, S.N.E., Gijselaers, W.H., de Rijk, A.E., Huveneers, W.J.M, Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. When Theory Joins Practice: Teachers’ Leader Identity Development in Health Professions Education. Medical Teacher (2021). Published online. doi:10.1080/0142159X.2021.2015532