Progressive collaborative refinement on teams: implications for communication practices.

Area of Science:

• Medical Education
• Healthcare Communication
• Team-Based Care

Background:

• Medical teaching teams (MTTs) face challenges balancing education and patient care due to shifting membership, learner variability, and patient complexity.
• MTTs utilize communication practices, or genres (e.g., admission, progress, discharge notes), to support collective patient care.
• Understanding how these communication genres influence team collaboration is crucial for optimizing patient management.

Observation:

• A multiple case study observed 19 patient cases within three internal medicine MTTs, involving students, residents, and attending physicians.
• Data collection included observations and audio-recordings of discussions and chart documentation throughout hospitalizations.
• Constant comparative analysis identified patterns, with findings elaborated through a focus group.

Findings:

• MTTs employ 'progressive collaborative refinement' (PCR) to collectively enhance patient problem understanding and care strategies through case and data reviews.
• PCR is evidenced by documentation modifications, though modifications alone do not guarantee refinement.
• Fragmentation, characterized by conceptualization, documentation, and provider continuity issues, impedes PCR.

Implications:

• PCR is a key process for MTTs to deliver optimal patient care.
• Lack of provider continuity and communication genre gaps fragment conceptualization and documentation, hindering PCR.
• Defining and describing PCR can inform strategies to improve communication and teaching within MTTs.