In this “How-to”, we describe practical strategies for the intentional implementation of teamwork in health sciences courses with an emphasis in five areas: setting the foundation, peer evaluations, team reflections, seeking support, and self-reflections.
Team-based pedagogical approaches, commonly used in health sciences courses to prepare students for the collaborative nature of health professions, are associated with improvements in students’ academic performance (Kalaian & Kasim, 2017). Team-based methods allow students to practice skills, such as communication, delegating tasks, managing personalities and group dynamics, resolving conflict, and problem-solving (Lang et al., 2018; Tollison & Turner, 2018; Walker et al., 2019).
Team-based instruction is not without challenges. Students require instruction and practice to gain confidence to work in teams and to transfer those skills to future situations (Madsen et al., 2019; Salas et al., 2013). And although students recognize the professional benefits of teamwork, they may also face challenges when working in teams, including unequal contributions, difficulties working well together, and feeling unprepared to work in groups (Lang et al., 2018; Tucker, 2010; Walker et al., 2019).
Integrating teamwork into health sciences courses is important; however, instructors are sometimes unsure of how to support teams, assess contributions to group work, and manage difficult team dynamics. Therefore, we describe practical strategies for implementing teamwork in health sciences courses based on our evaluations in graduate public health courses (Lang et al., 2018; Walker et al., 2019).
An Approach for Fostering Effective Team Development
We present flexible strategies for integrating inclusive teamwork into health sciences courses through setting the foundation, peer evaluations, team reflections, seeking support, and self-reflection. We have implemented these strategies in classes of 20-50 students in teams of four to five people. Each step is grounded in findings from two prior studies examining students’ experiences working in teams, team dynamics, and learning (Lang et al., 2018; Walker et al., 2019).
Setting the foundation
To enable students to get to know their teammates, we start with an ice breaker that involves creating a team name and introducing the team to the class. Ice breakers allow adult learners to become acquainted, start to build comfort and trust, and encourage participation of all teammates (Chlup, 2010). Next, teams develop rules to guide their interactions and discuss expectations for working together. Common categories for team rules in our courses included communicating with teammates, creating space for everyone’s opinion, and plans for completing work.
Peer and self-evaluations
Peer and self-evaluations allow students to rate the quality and quantity of their own and their teammates’ contributions, including the degree to which teammates fulfill their roles, enhance team interactions, and contribute to assignments. We use an evaluation process adapted from Team-Based Learning procedures (Michaelsen et al., 2004). At the middle and end of the course, students confidentially assign each team member and themselves up to ten points. They justify their ratings in writing, reflecting on preparation, contributions, respect for other’s ideas, and flexibility. Ratings for each student are averaged and students receive their grade but not the peer comments unless requested. These two rounds of evaluations contribute to 5% of the students’ final grade.
In our courses, teammates often rate each other highly, with final ratings typically higher than those at mid-course. Comments on lower ratings focus on not being prepared, being distracted during class, not being open to others’ ideas, or not respectfully responding during disagreements.
At the midterm, we reserve 30-45 minutes in class for teams to reflect on how the team is working together and what, if any, changes are needed. At the end of the course, teams discuss the degree to which the changes improved team functioning.
We first set guidelines to facilitate supportive discussions, including ensuring space to critically examine how the team is working, framing comments constructively, actively listening to teammates, and treating one another with respect. Students first individually reflect on what the team does well, challenges, and potential solutions. The team discusses their responses and writes a summary of their discussion. The team also revisits their team rules and can make revisions. At the end of the course, teams provide suggestions for changes and tips to future students.
Teams may experience challenges from differences in personalities or working styles, microaggressions or insensitive comments, or personal or health-related issues, among others. When students bring issues to us, it is important to help students work through these situations, to actively listen, and to validate students’ experiences. We ask students how they would like to proceed – if they would like suggestions for addressing the situation and how they want to handle the situation, such as through a team discussion and/or the instructor facilitating a conversation with all or select team members.
Strategies for resolution may differ depending on the situation. For conflicting working styles, team members may discuss their approaches, if compromises are needed, and agree upon next steps. In the event of microaggressions or insensitive comments, we remind team members to support each other, to identify microaggressions, and not to put the burden of responding solely on the impacted student. If students experience personal challenges, they can alert the group (without having to disclose details) and the team can develop a revised timeline or reallocation of work as needed. We follow-up with individual students and/or teams to see if and how the challenge(s) were resolved and if additional support is needed.
A short self-reflection essay at the end of the course provides students with the opportunity to make connections between what and how they learned over the semester and provides instructors with feedback on which aspects of the course facilitated student learning and which can be adjusted (Klimova, 2014). We ask students to reflect on their experiences working with their team during the semester. In their reflections, our students describe realizations about the role of the team in their learning, the value of their contributions to their team, and their ability to apply course content and skills in future settings.
This five-step approach to developing effective team skills can be tailored to a variety of health sciences courses. These strategies enable student teams to set expectations early, promote communication, and take ownership over developing the team dynamic. Given the team-based nature of the health sciences fields (Lovelace et al., 2009; Thibault, 2015) and recent competencies for interprofessional collaboration in health sciences education (Interprofessional Education Collaborative, 2016), methods to integrate team skills into health sciences courses are needed. To prepare students to meaningfully contribute to a collaborative, diverse workforce, we recommend intentionally integrating strategies to support the development and practice of team skills into courses. Teaching team competency through these five areas of emphasis—setting the foundation, peer evaluations, team reflections, seeking support, and self-reflection—provides a helpful framework to do this, especially for early career faculty.
We thank our students for their hard work and commitment to their teams, and for their participation in our studies. The authors had no financial support for this work and do not have any financial conflicts of interest.
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Leslie Salas-Hernández phd, mph
Senior Research Associate at the Center for Policing Equity
Robin McGee phd, mph
Teaching Assistant Professor, Department of Behavioral, Social, and Health Education Sciences
Delia Lang phd, mph
Executive Associate Dean of Academic Affairs and Teaching Professor, Department of Behavioral, Social, and Health Education Sciences
Rollins School of Public Health, Emory University