Maintenance of health care teams: Internal and external dimensions
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.
Some historical notes on interdisciplinary and interprofessional education and practice in health care in the USA
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.
Interprofessional conflict and medical errors: Results of a national multi-specialty survey of hospital residents in the US
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.
Who's caring for whom? Differing perspectives between seriously ill patients and their family caregivers
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.
A National Survey of Residents’ Self-Reported Work Hours: Thinking Beyond Specialty
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.
What terminally ill patients care about: Toward a validated construct of patients' perspectives
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.
Assistance from family members, friends, paid care givers, and volunteers in the care of terminally ill patients
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.
Building community: developing skills for interprofessional health professions education and relationship-centered care
In 1995, the National League for Nursing commissioned a Panel on Interdisciplinary/Transdisciplinary Education. The focus of the Panel's work was to examine educational issues that transcend the health professions and to make recommendations for future implementation of an interdisciplinary approach to addressing them.
Territoriality and power in the health professions
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.
Selected Characteristics of Graduate Medical Education in the United States
For the second year, the Department of Data Systems in the Medical Education Group of the American Medical Association gathered information on graduate medical education primarily by means of an electronic data collection system. Eighty-eight percent of 6622 programs surveyed responded, with 83% reporting detailed information on residents. Analysis of graduate medical education data shows that the number of residents increased by 34.9% from the academic years 1980-1981 to 1990-1991, while the number of graduate year 1 residents decreased by 2%.