Individual Teamwork Observation and Feedback Tool (iTOFT)

National Center for Interprofessional Practice and Education's picture
Submitted by National Center... on Oct 6, 2016 - 11:49am CDT

Thistlethwaite, J.
Moran, M
Dunston, R.
Roberts, C.
Eley, D.
Bognossian, F.
Forman, D.
Bainbridge, L.
Drynan, D.
Fyfes, S.

The iTOFT is a work-based assessment tool of interprofessional teamwork behaviors.  It was created by a consortium of seven universities on three continents as a way to provide meaningful feedback to students and novice professionals. It was developed through a literature review of the existing teamwork assessment tools, a discussion of accreditation standards for the health professions, Delphi consultation, and field-testing with an emphasis on its feasibility and acceptability for formative assessment. There are two versions: the Basic tool is for students with little clinical teamwork experience.  It lists 11 observable behaviours under two headings: "shared decision making" and "working in a team." The Advanced version is for senior students and junior health professionals.  It has 10 observable behaviours under four headings: "shared decision making," "working in a team," "leadership," and "patient safety." The tool is broadly generic; it can be used across diverse clinical settings and with different types of teams.


Link to Resources
Descriptive Elements
Who is Being Assessed or Evaluated?: 
Instrument Type: 
Observer-based (e.g., rubric, rating tool, 360 degree feedback)
Source of Data: 
Health care trainees
Health care providers, staff
Notes for Data Sources: 

During field testing, 10 of the assessers were health professionals or educators, and 75 were student peers.

Instrument Content: 
Behaviors / skills
Notes for Content: 

The Junior version contain two scales:

  • Shared Decision Making (7 items)
  • Working in a Team (4 items)

The Senior / Novice Professional version contains four scales

  • Shared Decision Making (3 items)
  • Working in a Team (3 items)
  • Leadership (2 items)
  • Patient Safety (2 items)
Instrument Length: 

Each version is a two-page paper sheet with marking areas on the front, and descriptors for the scales and for the behaviours being observed on the back.  In addition to a few demographic checkboxes, the Basic version contains 11 items, the Advanced version contains 10 items.  During field testing, two-thirds of the episodes being observed took under 20 minutes.

Item Format: 
The qualitative scale consists of 4 check boxes: "not applicable," "inappropriate," "appropriate," and "responsive," with the latter representing the more positively engaged behavior. The marking sheet contains a large area for assessors to record qualitative feedback. There is also room for them to write down their "overall global impression" and "comments."
The iTOFT was designed to be completed during live observations of students involved in interprofessional teamwork in a wide array of clinical settings. It was field tested in: aged care and educational settings; clinical placements; and community clinics. However, as not enough real-life activities were available during the process, the authors also tested the tool during simulated activities including ward rounds.
The authors provided detailed descriptions with examples to guide assessors in marking each item as not applicable, inappropriate, appropriate, or responsive. They also provide detailed descriptions with examples of each behaviour being evaluated.
Open access (available on this website)
Notes on Access: 

Both iTOFT versions and the full project report are available freely on the OLT website (, together with a standalone resource pack for learners, educators and clinical teachers. The resource pack includes sections on the conceptual framework for feedback, and best practice for observation and feedback processes.


Psychometric Elements: Evidence of Validity
The team first reviewed the accreditation standards of 10 accredited health professions and specifically the learning outcomes / competencies / observable behaviors related to interprofessional and team-based care. The team searched the literature for existing tools by extending several well-known literature reviews, three by the Harvard Business School (e.g., Valentine, et al., 2015) and the Canadian Interprofessional Health Collaborative (2012). A total of 99 tools were identified, only 11 of which were objective assessments in work-based settings. Eight themes emerged from analysis of 481 items. After two rounds of Delphi discussions, 18 observable behaviors were identified in three categories: communication, cooperation, and coordination.
Response Process: 
The initial version (called iSTAT) was field tested at five sites. Data were collected from n = 132 episodes of teamwork, and n = 108 participating students. The initial scale (observed "rarely," "sometimes," "consistently") was inoperable given that the instrument records a single episode. Other changes based on field test experience was the development of two versions (junior and senior), and an intentional shift from summative to formative assessment.
Internal Structure: 
Factor analysis reduced the 18 behaviorally based items to 15. The internal consistency of this scale was 0.89.
Relation to Other Variables: