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Developing a High-Performance Team Training Framework for Internal Medicine Residents: The ABC'S of Teamwork

Carbo, Alexander R. MD*†; Tess, Anjala V. MD*†; Roy, Christopher MD†‡; Weingart, Saul N. MD, PhD†§

Journal of Patient Safety: June 2011 - Volume 7 - Issue 2 - p 72-76
doi: 10.1097/PTS.0b013e31820dbe02
Original Articles

Objectives: Effective teamwork and communication can prevent error and mitigate harm. High-performance team training was developed in the aviation industry for flight crews and is being incorporated in health care settings, such as emergency departments, operating rooms, and labor and delivery suites. We translated and adapted high-performance teamwork and communication principles from other industries and other disciplines to an inpatient internal medicine environment.

Methods: We selected key principles from aviation and anesthesia crew training programs in 2004 and organized them into the ABC'S of teamwork. These included appropriate Assertiveness, effective Briefings, Callback and verification, Situational awareness, and Shared mental models. Based on this content, we developed a training session for internal medicine residents and faculty, and evaluated learners' patient safety attitudes and knowledge before and after training with a written survey.

Results: More than 50 residents participated in the module. The percentage of correct answers on a question related to key teamwork principles increased from 35% before training to 67% after training (P = 0.03). Before training, 65% of the residents reported that they "would feel comfortable telling a senior clinician his/her plan was unsafe"; this increased to 94% after training (P = 0.005). After the training session, residents were able to provide examples from their clinical practice that emphasized all of the ABC'S of teamwork.

Conclusions: Teamwork principles can be adapted from other disciplines and applied to internal medicine. After a single session, residents displayed greater knowledge of teamwork principles and reported changed attitudes toward key teamwork behaviors.

From the *Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center; †Harvard Medical School; ‡Division of General Internal Medicine, Brigham and Women's Hospital; and §Center for Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts.

Correspondence: Alexander R. Carbo, MD, Hospital Medicine Program, Palmer Baker Second Floor, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.