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In order to increase the body of empirical data on health care teams, a three year study of faculty and student teams who participated in the Team-TRAC Program at the University of Nevada, Reno,was undertaken. Three research methods were employed: participant observation, survey and self-report, and interaction analysis.

This paper describes the efforts of one medical school - The School of Medical Sciences of the University of Nevada, Reno - to institute an interdisciplinary educational program for students in the health field aimed at promoting better communication and collaboration in care.

The complex issues which health care teams face have contributed to the demise of a number of teams and to the disenchantment of many individuals, who voice a litany of complaints, including fatigue, frustration, interpersonal conflict, energy drain, burnout, and rapid turnover associated with teams. If health care teams are to avoid such pitfalls and gain acceptance, they will have to learn to attend to their own maintenance needs, both internal and external.

The origins and development of interdisciplinary health care teams in the US is traced from World War II successes with multidisciplinary medical and surgical teams to President Johnson's vision of The Great Society, in which the poor and underserved would have access to benefits of good health through the creation of community health centers located in areas of need. The concept of interdisciplinary teams of health professionals was espoused as a means for providing comprehensive and continuous care to such populations.

Clear communication is considered the sine qua non of effective teamwork. Breakdowns in communication resulting from interprofessional conflict are believed to potentiate errors in the care of patients, although there is little supportive empirical evidence. In 1999, we surveyed a national, multi-specialty sample of 6,106 residents (64.2% response rate). Three questions inquired about "serious conflict" with another staff member.

Although clinicians and researchers often rely on family members 'reports of a wide range of dying patients' symptoms and care preferences, available data indicate divergences between the two. We used a national sample to analyze patient-caregiver pairs to explore areas of concordance and nonconcordance about physical symptoms, communication with physicians, caregiving needs, and future fears. We also assessed whether identifiable patient or caregiver characteristics were associated with nonconcordance.

PURPOSE: To secure data from residents regarding residency work hours and correlates.

METHOD: A national, random sample of postgraduate year 1 (PGY1) and year 2 (PGY2) residents in the 1998-1999 training year was identified using the American Medical Association's Graduate Medical Education database. Residents completed a five-page survey with 44 questions and 144 separate data elements relating to their residency experience.

BACKGROUND: Citizens have conveyed to professionals that care at the end of life is less than optimal. Efforts to improve matters have tended to work in piecemeal fashion, on tangible more than personal aspects of care, and without the benefit of documented perspectives of those who face dying. Policy initiatives and clinical interventions need guidance from a broad framework that is validated by patients' perspectives.

BACKGROUND: In addition to medical care, dying patients often need many types of assistance, including help with transportation, nursing care, homemaking services, and personal care. We interviewed terminally ill adults and their care givers in six randomly selected areas of the United States (five metropolitan areas and one rural county) to determine how their needs for assistance were met and the frequency with which they received such assistance from family members and paid and volunteer care givers.

One of the most remarkable developments in the field of health care during the past several decades has been the rapid proliferation and growth of new health professions and occupations. Where physicians once stood virtually alone, other health workers now greatly outnumber them.  There is a greater need for primary care and in many cases these services can be effectively delivered by health care professionals other than physicians, such as nurse practitioners (NP), physician's assistants (PA) and certified nurse midwives (CNM).  Still, territorial and power conflicts endure.