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Interprofessional care
Huddle-Coaching: A dynamic Intervention for Trainees and Staff to Support Team-Based Care. Shunk et al, Academic Medicine, 2014; 89(2).
Reviewed by Maria Alkureishi

What was the study question?
Educators at the Veterans Affairs (VA) Medical Center in San Francisco sought to provide an authentic workplace learning experience for internal medicine residents, and incorporated them into their interprofessional team-based model of patient care called Patient Aligned Care Teams (PACTs). In so doing, their goals were to foster coherence of trainees as team members with interdependent tasks as well as to foster distributive leadership and teamwork skills.

How was the study done?
Trainees were integrated in groups of three (2 PGY-2s and 1 NP student) into PACTS, which consisted of a RN, LVN, medical clerk, and attending provider. Trainees were taught how to huddle (i.e., review schedule and anticipate needs of patients to be seen, troubleshoot problems, and plan for upcoming visits), and were given a check-list for a step-by-step approach. Teams huddled at the start of each clinic session, and "huddle coaches" reviewed expectations and provided feedback routinely on huddle & interpersonal teamwork skills.

What were the results?
End-of-year interviews with trainees revealed increased cohesion as a team, both personally and professionally. Huddling was viewed as the most exciting and inspiring part of their experience in clinic, and they identified ways to improve coordination & quality of patient care. Additionally, nearly all teams showed improvement in a Team Development Measure survey.

What are the implications of these findings?
As outpatient attendings, the huddle is crucial to creating a cohesive, team-based, efficient approach to the day. Formal education & integration of trainees into this process is a fantastic way to not only provide them very practical time management skills, but also to foster the opportunity for quality improvement and multidisciplinary collaboration with all members of the care team.

Editor's note: This approach may work in the inpatient setting as well to improve interprofessional interactions and, ultimately, patient care (SLB).

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