How Teachers Meet in Interdisciplinary Teams: Hangouts, Distribution Centers, and Melting Pots.

PURPOSE: To explore team learning processes among interdisciplinary teacher teams in the development of integrated health professions education and to investigate students' perspectives on the quality of the educational courses.
METHOD: Using an exploratory, sequential mixed-methods design, the first author conducted 17 vignette-guided, semistructured interviews with teachers originating from diverse disciplines. These teachers worked in different courses of integrated, undergraduate health professions programs at the Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. The interview guide and vignettes were based on team learning research. The interviews sought to establish how interdisciplinary teacher team members work together on integrated curricula. The vignettes reflected constructs of team learning processes: sharing, co-construction, and constructive conflict. Data were collected between November 2017 and March 2018 and analyzed using template analysis. Sequentially, course evaluation data were used to provide a descriptive analysis of students' perspectives on educational quality (course organization, structure, learning effect, and alignment).
RESULTS: Three team approaches were identified. In fragmented teams or "hangouts," teachers individually worked on tasks that they were interested in, leaving their disciplinary mark. Framework-guided teams or "distribution centers" aimed to work within the given frameworks and organizational expectations, striving for disciplinary balance. Integrated teacher teams or "melting pots" used an interdisciplinary approach on all topics and put students at the center. Integrated teams reflected high-level team learning processes and were most satisfied with their (team)work. In contrast, fragmented and framework-guided teams mainly reflected low-level team learning processes. Students evaluated courses of integrated teacher teams highest on all investigated quality items (course organization, structure, learning effect, and alignment).
CONCLUSIONS: Successful interdisciplinary teacher teams are represented by an integrated approach with high-level team learning behavior and the best course evaluations. Therefore, health professions education management should actively encourage and facilitate integrated teacher teamwork.

In increasingly complex and interdisciplinary health care systems, there is a call for medical doctors who have learned to understand the importance and interdependence of multiple disciplines when working with individual patients.[1-3] Preparing graduates for these interdisciplinary health care settings requires interdisciplinary teaching.[4-6] Interdisciplinary teaching demands integrated curriculum setups, with teachers from different disciplines working together to prepare and deliver courses.[7] This desire for increased interdisciplinary teaching necessitates that teachers work in teams with highly specialized scientific and clinical domains. As a result, this imposes new ways of working on teachers, whose backgrounds often lie in applying traditional teaching methods and whose teaching experiences rely on offering course units strictly organized by distinct disciplines. To exemplify an interdisciplinary teacher team, imagine an undergraduate medicine course called Circulation and Breathing coordinated by a pharmacologist who works with a cardiologist, a pediatric pulmonologist, a respiratory physiologist, an anatomist, and an ethicist to bring this course to life. Research on health care teams consistently demonstrates that substantial effort, motivation, and training are required before team members can work together.[8] In one of the few studies to our knowledge of interdisciplinary teaching in medical education research, interdisciplinary team interaction processes were found to be complicated and vulnerable to various adverse influences, sometimes resulting in professional and personal conflicts mitigating team performance. The authors suggested that producing a good interdisciplinary course requires informed and purposeful actions from its team members to arrange necessary team interaction processes.[9] Research in undergraduate medical curriculum change describes the necessity of bringing the “right people” together at the right time to develop innovative programs.[10] However, informing and facilitating successful team interaction processes requires knowing which interaction processes occur in interdisciplinary teacher teams.

Integrated educational approaches are becoming the accepted standard in curriculum design.[4,5] Yet by and large, our knowledge on how to assure its development and implementation is merely drawn from experience.[7] Remarkably little empirical research has been conducted on teachers’ team processes in integrated health professions education and how they influence successful development and quality of integrated curricula. This situation significantly contrasts with other settings, for example, the field of management sciences,[11,12] with an abundance of published studies on team diversity, team processes, and team performance. Findings from these studies have informed our approach to studying interdisciplinary teacher teams both theoretically and methodologically.

Theoretical Background

Teamwork has become a prominent feature in many organizational settings.[11] The same holds true for education,[13] and medical education specifically.[6,7] However, an incidental meeting of a group of teachers does not necessarily make them a team. A group can be defined as “a collection of individuals who perform similarly on complementary tasks as different individuals.”[14] Team researchers define groups as teams when there is a high level of interdependency, mutual accountability, and willingness to achieve a common goal.[11,15] Typical examples of teams can be found in sports (e.g., baseball), aviation (e.g., pilots), business (e.g., management teams), and health care (e.g., surgery teams). Within the educational setting, the occurrence of teamwork may be hindered by the long-standing culture and mindset of teachers, characterized by elements such as individualism and autonomy.[13,16] In health care, research indicates that every discipline has a different culture composed of values, beliefs, attitudes, customs, and behaviors with respect to teaching, research, and health care.[17] In the field of medical education, “territory” (i.e., domains of expertise and power) issues have been identified to possibly decrease or even prevent interdisciplinary teacher collaboration because they lead to a lack of interest to share practice areas and conflict resolutions.[18]

As mentioned, management sciences literature provides considerable expertise on successful teamwork.[11,12] This literature shows that the crucial difference between success or failure of teams depends on how people interact and create a working climate that makes it possible for teams to learn.[19,20] Many teams are put together while facing new challenges or are required to work together on new assignments they have never encountered before. Research on such teams, analyzing team learning behavior, explores how they build mutual understanding and shared cognition through the interaction among team members and the characteristics of their discourse.[21] This research has analyzed team learning processes focusing on sharing (exchanging knowledge, routines, or behaviors), co-construction (building shared meanings and engaging in shared knowledge, routines, or behaviors), and constructive conflict (uncovering diversity, negotiating, and ultimately integrating differences in viewpoints).[21] The perceived team performance will increase when a team works toward a convergence of meaning, defined as reaching mutually shared cognition.[21] The basis for team success lies in the integration of each professional’s knowledge and expertise, carving out professional territories, and ensuring more flexibility in sharing professional responsibilities. It has been consistently found that team learning processes are affected by the experienced level of psychological safety (feeling safe to speak up), cohesion (strong sense of belonging), potency (perceiving the possibility to achieve goals), and interdependence (goals can only be achieved through each other’s input).[19,21,22] Most research described above comes from disciplines outside education; the few studies performed in education emphasize leadership instead of team process challenges.[23,24] One can only guess what team learning processes are shown by interdisciplinary teacher teams in health professions education and how these processes influence the development and quality of courses.

We therefore sought to frame this study as team learning research and used team learning concepts to explore teamwork among integrated health care education teachers. We researched the following questions: how do interdisciplinary teacher team members work together on integrated curricula, and how does interdisciplinary teamwork influence the quality of these curricula? We conducted vignette-guided, semistructured interviews with interdisciplinary teacher team members from a range of academic disciplines, using template analysis. Lastly, we conducted a descriptive analysis of institutional student evaluation data to explore student perspectives on the quality of the produced courses.

Method

Methodology

This was a mixed-methods study with an exploratory sequential design.[25] First, qualitative interviews allowed us to explore teacher team learning processes and teachers’ perceptions about their course delivery. From November 2017 to March 2018, the principal investigator (S.N.E.M.) conducted semistructured interviews, guided by vignettes on team learning. She used an exploratory approach from a constructivist stance.[26] Data collection and analysis were characterized by an iterative process, using constant comparisons to explore inputs from the distinct scientific and educational domains. The research team used the findings to generate a conceptual model for different teacher team approaches, based on perceived levels of team learning behavior. Next, using this model, we grouped different courses according to their teams’ approach and retrieved data from the institutional student evaluation questionnaires for these courses to explore students’ perception of the course quality.

Setting

We conducted this study in the undergraduate programs of the Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University. Education at FHML uses problem-based learning (PBL) and integrated curricula; courses are organized around central themes and address realistic problems from an interdisciplinary perspective. Teacher teams design, implement, and evaluate courses in biomedical sciences, health sciences, or medicine (on average 375, 250, and 316 students per cohort, respectively). Students from these 3 programs are enrolled in courses in their unique program. Teacher team tasks entail the design and organization of these courses including tutorials, lectures, assignments, reading materials, and (final) exam(s). The teams are fully accountable for the content and delivery of their courses. Teams consist of 4–7 members from a variety of academic disciplines such as clinicians, social scientists (e.g., psychology, public health), and basic scientists (e.g., microbiology, pharmacology). Every team is chaired by a coordinator. Teachers can apply to all available team vacancies and are either rejected or selected by the coordinator. Selected members are officially assigned by the FHML educational institute for the duration of 3 years. Therefore, teams’ compositions can change every academic year. Members’ departments are compensated for all education hours by the educational institute. Coordinators are evaluated based on students’ course evaluations in formal, annual meetings with their managers (either departmental or educational). The best evaluated course in each program receives an annual “Best Course” prize.

Participants

We used purposive, maximum variation sampling methods[25] to recruit participants for the interviews. Sampling was based on the membership of teams developing courses in the first bachelor year of the biomedical sciences or health sciences programs and the first and second years of the medicine program. Courses were in diverse developmental stages (running 2–7 years). We sampled teachers with a background in the medical, social, and basic sciences and aimed to ensure variety with respect to gender, age, professional discipline, teaching status, and formal role in the course team (e.g., coordinator, member). We included members when they had participated in a course team for a minimum of 1 year and were University Teacher Qualification[27] certified. This guaranteed that all members had sufficient background in PBL principles, instruction, assessment, and course development. We performed 17 interviews to achieve our information power.[28] Fifteen interviews resulted in understanding of the constructed themes, and no new information was obtained in 2 additional interviews; therefore, no additional interviews were performed. Moreover, we felt supported by previous research, where between 14 and 18 different team members had been interviewed.[23,24]

To gather students’ perspectives on course quality, we used institutional course evaluation data. The course evaluations follow commonly accepted procedures, administering standardized rating scales to students at the end of their course participation.[29] Response rates were above 68% (mean = 82.5, standard deviation = 7.7) with one outlier of 37%.

Data collection

The interview guide was constructed using literature on team learning processes (see Supplemental Digital Appendix 1, available at http://links.lww.com/ACADMED/A782).[19,21,22] We also developed vignettes that reflected constructs of team learning processes, based on the process definitions of Van den Bossche and colleagues[21] (see Supplemental Digital Appendix 2, at http://links.lww.com/ACADMED/A782). These vignettes were designed to prompt conversation. Authenticity of the vignettes was confirmed by 3 teacher team members and 1 educational researcher specialized in team learning. In addition, we conducted 1 pilot interview with a former teacher team member. Based on the pilot and the feedback on the vignettes, we constructed the final interview guide and vignettes. During data collection and analysis, additional revisions were made to further optimize the guide. All interviews lasted around 60 minutes. Interviews were audiorecorded and transcribed verbatim by a professional transcription service and then anonymized. Student evaluation data were retrieved from standard institutional evaluations performed at the end of the courses in the academic year in which the interviews took place, 2017–2018. We used items representing course quality elements: course organization, structure, learning effect (scores 1–10), and alignment of lectures with other educational activities (scores 1–5).

Data analysis

For qualitative data, we used template analysis. This allowed a priori codes to be defined, based on the sensitizing concepts of team learning as described above.[30] Our interpretation of data further depended on the positions of all researchers and the specific social context of the research.[30] The principal researcher (S.N.E.M.) and a student assistant independently analyzed the interview transcripts and discussed their codification and categorization of the data to resolve any discrepancies. Team learning processes appeared to vary strongly between interviewees, which was used as a starting point to categorize the data. The coding template was applied to later interviews, revised, and refined. After 9 interviews had been analyzed, the coders agreed that the coding template covered all text sections. Subsequently, researcher triangulation was applied by submitting the coding template to a peer researcher in team learning.[31] She supported our template after reading 3 prototype interviews. S.N.E.M. analyzed the remaining transcripts and applied the template to the full data set. The entire research team was involved in exploring relationships among categories, which facilitated raising the categorical analytic level to a more conceptual one, resulting in a conceptual model for interdisciplinary teacher team approaches. ATLAS.ti qualitative software, version 8 (Scientific Software Development GmbH, Berlin, Germany) was used to support data management during analysis.

To explore outcomes of interdisciplinary teamwork, we analyzed students’ course evaluations for those courses with the teachers we interviewed. Based on our conceptual model, we categorized the different courses according to the 3 identified teacher team approaches. This categorization was used to descriptively analyze student evaluations using SPSS statistical software, version 25.0 (SPSS, IBM Corp., Armonk, New York). We specifically compared students’ ratings on the quality indicators mentioned above.

Reflexivity

The research team consisted of a medical doctor working as a PhD candidate (S.N.E.M.); an educational scientist working as professor in education at the School of Business and Economics (W.H.G.); an educational scientist with a focus on quality assurance, working as deputy director of the FHML Educational Institute (I.H.A.P.W.); and a physiologist working as professor in medical education and scientific director of the FHML Educational Institute at Maastricht University (M.G.A.o.E.). S.N.E.M. was trained in behavioral interviewing and conducted all interviews. I.H.A.P.W. and M.G.A.o.E. were only allowed access to themes and anonymized quotes. This was communicated explicitly to all participants to reduce possible reluctance that could have affected the participants. S.N.E.M. and W.H.G. did not have any practical involvement with the interdisciplinary teacher teams under study. The research team was curious how interdisciplinary teams worked together and what team learning processes they reflected. The research team did not expect to find the major differences that appeared between different teams.

Ethical considerations

This study was approved by the Dutch Association for Medical Education Ethical Review Board (NVMO ERB-948).

Results

Detailed information about interviewees can be found in Table 1, as well as Supplemental Digital Appendix 3 (available at http://links.lww.com/ACADMED/A782). Three dominant teacher team approaches were identified as prototype teacher teams in integrated health professions education: fragmented, framework-guided, and integrated. In the following section, we will discuss these different approaches and their characterizing elements: focus of work, feeling of responsibility, teachers’ commitment, feeling of identity, psychological safety, boundary setting, team learning behavior, and teachers’ perspectives on both teamwork and the produced course. We illustrate key concepts with representative quotations from interviewees (identified by interview number, INT) and provide an overview of main outcomes. Next, course evaluations are presented, grouped according to the different team approaches. In general, the team composition in terms of disciplinary representation was not related to team approach. Also, no relation seemed apparent between different team approaches and educational programs. Team members mentioned some examples illustrating that team approaches could change because of changing team conditions and compositions. We included these examples to show how a team formed and how team learning processes and the team approach in which they are reflected can fluctuate over time (Figure 1).

Table 1

Demographic Characteristics of 17 Teacher Team Members From Various Disciplines and Educational Programs, From a Study of Interdisciplinary Team Processes and Outcomes, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands, November 2017–March 2018

Figure 1

Conceptual model regarding interdisciplinary team approaches and teacher team learning, developed from interviews with teacher team members from various disciplines and educational programs, from a study of interdisciplinary team processes and outcomes, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands, November 2017–March 2018. Team learning processes are represented along the horizontal arrow as a continuum of processes, but most dominantly reflecting the perceived team learning process per team approach.

Fragmented teams: “Hangouts”

Some interviewees mentioned a fragmented way of teamwork. These team members described a discipline-centered focus of working. Despite a given task for the team, individual team members worked on something they were truly interested in and left their disciplinary mark on the course. They only felt responsible for their “own” part of the course. These teachers did not set priorities to physically attend meetings, were not all committed to fulfill an educational role (i.e., tutor, lecturer) in their course, and, as such, were not involved in the practical implementation of the course as a whole. Members’ strong individual identity was also manifested as they emphasized the important borders of disciplines. They further showed little interest in change or innovation of their course. This way of working resulted in the envisioning of a “hangout,” especially since no clear plans or structured guidelines were expressed:

I also think, in the end, that the coordinator didn’t really have a clear picture of what the course was going to look like exactly so it took its organic shape a bit gradually. That’s how it developed. There wasn’t really a plan behind it. (INT-1)

Members’ level of psychological safety was described to be rather low. Fragmented teams were characterized by not seeking controversy through constructive conflicts. Rather, they avoided any conflict and tried to be harmonizing:

So, of some, to be honest, of some tasks I do think like gosh, would I do it like that?… Okay, so you do have the power, as a coordinator, to express that kind of doubt [about a discipline-centered case]. But sometimes I do have the impression, to keep the peace or something, yes. Yes, that’s the difficult thing, people are, they feel that they have their own domain. And they are experts in that, that’s where you want to respect them. (INT-3)

In general, members of these teams mentioned sharing thoughts or opinions, without starting a true dialogue. Discussions were even felt as a negative way of interaction. Responses showed that the further the course was developed, the less members engaged in team conversations. Also, typical for these participants was their satisfaction with the course if they managed the course in a timely fashion. Dissatisfaction was also manifested, mainly because of doubt about their teamwork or related to the common thread of the course:

But a host of different choices could be made in that biology part. But at a certain point you just leave it like that. That’s when you think, oh, well, somehow that may be relevant. So that will then be the responsibility of the biologist.… So one person knows a lot about Nutrition Center guidelines. That food pyramid, oh, God, well, he can construct a case on that. And another person is an expert in the domain of the elderly.… Although in the end you do keep asking yourself: “Won’t students think it’s too heterogeneous?” “Are we too ambitious?” So I am in constant doubt about that. (INT-3)

Framework-guided teams: “Distribution centers”

Other teams worked as framework-guided teams. Their work was generally outcome centered, within the given frameworks posed by the organization. These teams strongly monitored whether they worked within the given expectations and learning outcomes. They guarded a clear balance between the different disciplines to develop a multidisciplinary course. Individual, professional identity could therefore only partly influence the course:

But the end goals were already there and we had a blueprint, so we had to comply with those.… I think that if I hadn’t been there, that course still would have looked the same. (INT-5)

Typically, the tasks were distributed within their team to enable every member to work on a task aligned to their own discipline. This brought to mind “distribution centers.” Course frames or so-called intended learning outcomes were created by the educational management. These clear frames and outcomes enabled team members to coordinate the exchange and use of expertise:

Sometimes we slowed some things down, because a certain discipline was starting to prevail. So it’s not that we don’t value each other’s expertise, but it really must be a multidisciplinary course. That way, no discipline can stand out so to speak. (INT-11)

Apart from sharing and building upon or modifying each other’s input, these team members also had discussions with each other. Team members mainly mentioned processes of constructive conflict during the framing of the course, though not during more executive phases:

So I think yeah, you must be careful to keep the meetings stay functional. And to achieve something. (INT-5)

Conflicts could arise if team members were asked to work together closely on the same task:

What happens then is that they go like “that is my domain and I want to [put] my—I do not want to lay a quail’s egg, I want to lay an ostrich egg in there.” (INT-6)

These team members illustrated the content of the course to be “stable,” though they were not always satisfied about the functioning of the team and the demarcation of disciplines by its individual team members.

Integrated teams: “Melting pots”

Lastly, we identified integrated teams. These teams worked together in an interdisciplinary way, moving beyond their own disciplines, and melting boundaries between disciplines. They were characterized by the image of a “melting pot.” They typically put students at the heart of their work. These members felt that they could be part of discussions regardless of the topic, reasoning that students were also asked to understand the course as a whole. They considered executive functions (e.g., tutor, lecturer) in their course very important to experience the whole content of and order within the course and to have short connections with students enrolled in their course. They also felt a distinctive commitment to and motivation for working in education, even in their own time:

Because I want to provide good education. That is my policy. Yes, so sometimes that is correcting things even in the evenings or weekends too, yes, that’s part of [it]. (INT-12)

Interviewees mentioned how sometimes team composition changed organically until only committed and motivated people remained, who had a mindset to work in a student-centered manner and who created a team identity, resulting in an integrative team approach. Integrated team members also expressed a shared sense of responsibility and decision making. Moreover, it was indicated that a directive style of team leadership could inhibit commitment and shared responsibility. One participant mentioned how the leadership style changed after replacement of the team coordinator:

I think that is a positive change. A less dominant person [as coordinator]. There is more consultation with others. I think that that is better. Because I co-induce them, I see that as a positive thing, those changes.… Considering something with less dominance, I see that as a good thing. (INT-14)

Additionally, integrated team members felt that moving beyond their disciplines made them learn. Indicative for these members was their awareness of and support for PBL approaches and their enthusiasm toward change and innovation:

For some people, it [education] is box ticking. So they just do it because they have to, but they are not committed. And this group is—like yes, it is really nice to do things “new.” So it is also nice to design that and see if it works. (INT-12)

Participants explained that as long as they used the content and argumentations in favor of students’ learning, they felt safe to speak up and were able to start discussions. They also explicitly mentioned to be open and attentive to each other’s thoughts:

Without the others I would never have been able to build it. Expert input, among other things, and also by enriching it. Making sure that you are not standing there telling your own story from your own narrow perspective, because gradually, we have forgotten a lot or lost sight of the things a first-year student should actually still construct.… And that you are corrected in those respects, that you allow each other to complement these things. (INT-2)

Integrated team members felt satisfied about both their teamwork and their educational course, mainly when they had introduced new topics or created a new, integrated part of the course. These members mentioned team learning processes up to working in constructive conflict, for example, when they did not understand each other’s input. The key ingredients for this achievement were perceived to be a student-centered focus of work and shared feelings of respect, equality, and interdependence. See Table 2 for an overview of the 3 approaches discussed narratively.

Table 2

Overview of Different Team Approaches and Characterizing Elements Based on Interviews With 17 Teacher Team Members From Various Disciplines and Educational Programs, From a Study of Interdisciplinary Team Processes and Outcomes, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands, November 2017–March 2018

Perceived course quality

As presented in Table 3, integrated teacher team courses scored the highest means on all 4 indicators for quality of education. On 3 out of 4 indicators (the organization, structure, and learning effect of the course), courses organized by fragmented teams scored lower than the framework-guided and integrated teams. In general, these data show that the courses that were developed by teams who reported higher team learning levels (integrated and framework-guided teams) showed on average higher student evaluation scores than teams who reported lower team learning levels (fragmented teams).

Table 3

Descriptive Statistics for Students’ Average Perceptions of Course Organization, Structure, Learning Effect, and Alignment of Lectures With Other Educational Activities, From a Study of Interdisciplinary Team Processes and Outcomes, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands, November 2017–March 2018a

Discussion

We conducted this study to develop an understanding of how interdisciplinary teams in integrated health professions education work together and how this influences the perceived quality of their courses. Three team approaches were identified: fragmented, framework-guided, and integrated. Different approaches showed different levels of team learning processes: sharing, co-construction, and constructive conflicts. Integrated teacher teams received the highest course ratings by students. We would like to share an important nuance concerning our findings: team approaches and team learning may change and develop, dependent on changes in composition, context, and time.[32]

Earlier studies have suggested that medical teacher teams that are conducive to high levels of team learning create better courses.[9] These findings are in line with general team learning literature that links co-construction and constructive conflicts to better products and more innovation.[12] This seems to resonate with our findings to such an extent that integrated team members who reported more team learning processes also expressed more satisfaction about their integrated course and the degree of innovation they achieved. Moreover, students’ ratings on course quality indicators were highest for courses conducted by integrated teams. Fragmented teams, in contrast, were characterized by low levels of team learning and less satisfaction about the level of integration in their courses. This went together with students’ evaluations being lowest for most quality indicators. Our findings indicate that integrated teacher teams are most successful in producing integrated courses that are well received by students.

Our research shows that not all teacher teams behave like a team. Fragmented and framework-guided teams could be considered as groups, as they performed tasks as a set of different individuals.[14] Such teams were not working interdisciplinarily but multidisciplinarily.[33] They work on the same project but in an independent way (as in fragmented teams) or they work in parallel[33] (more like framework-guided teams). The integrated teams proved that true interdisciplinary activities reflect a greater degree of collaboration amongst teachers. Moreover, framework-guided and integrated teams are possibly the only teams able to develop shared mental models as they reached co-construction and constructive conflict.[34] These findings show that the role of constructive conflict has potential and can stimulate teamwork in interdisciplinary teams. Similarly, Eichbaum called to rethink the role of conflict and presented approaches to effectively integrate conflict into teamwork in the health professions.[35] Interviewees from fragmented teams expressed conflict-avoidance behavior. This aligns with the dominant conflict-handling behavior of “safeguarding harmony,” also reflected in the behavior of clinical teacher team meetings.[36] However, absence of conflict may result in stagnation of group development.[21] Avoidance of interpersonal conflicts and negotiation, recognized in both framework-guided and fragmented teams, may therefore have hampered the group’s development toward integrated team functioning.

We found that low psychological safety especially applied for members from fragmented teams. This has been described as detrimental for team performance.[37] The importance of psychological safety[19,21,22] was supported in our findings about successful teams. A work environment in which people feel safe to speak up and learn from each other seems vital to achieve high team learning levels in interdisciplinary teacher teams.

Our findings show that in the development of integrated education, simply putting different disciplines together does not automatically result in integrated teamwork. Hence, integrated teamwork among teachers is not self-evident. Together with the fluctuating composition of teacher teams, it is of great importance to continuously invest in faculty development aimed toward helping teachers to work interdisciplinarily.

Methodological reflections and implications

Some of our study design decisions may have influenced the interpretation and transferability of our findings. It is possible that our participants, being teachers in a PBL environment, differ from other teachers based in different environments in their perspectives on education and in terms of accumulated experience on group work. Such aspects (e.g., the PBL setting) should be taken into account when transferring the results to other educational settings. Additionally, there is a need to gain more insights into how teams form and what factors influence teacher team learning processes as well as their team approach. This may help teams in managing the inherent complexities of their work. Such insights can also shed light on the alterations in team approaches that can occur when conditions change. Next, because teacher teams often do not meet all theoretical team criteria, the concept of “team entitativity” could be used in further research. Team entitativity presents teams as a continuum of interdependency and integration, ranging from an aggregate of individuals to a team,[22] as per Katzenbach and Smith’s definition.[15]

Practical implications

Our study demonstrates the importance of better understanding what makes interdisciplinary teacher teams work. It shows that teachers should become more aware of the limitations of traditional or discipline-centered work, cultivate the experience of how to share and exchange knowledge with colleagues from different disciplinary backgrounds, and understand that just sharing tasks among the different disciplines does not result in interdisciplinary, integrated teamwork. From a managerial point of view, it is essential that policies are developed that motivate team members to see the importance of integrated teamwork. Team coordinators should also discern the importance of psychological safety to create member engagement. Our findings may inform faculty development programs regarding how to prepare teachers for taking up new roles in teacher teams and provide the necessary skills to get the most out of teamwork.

Conclusions

This study aimed to unravel interdisciplinary teamwork in health professions educational practice and how this teamwork relates to the quality of coursework produced. Courses that were developed by integrated teacher teams received higher student evaluation scores than courses from framework-guided and fragmented teams. Our findings indicate that integrated work of interdisciplinary teams leads to better team satisfaction and better perceived quality of education. Therefore, health professions education management should actively encourage and facilitate integrated teacher teamwork.

Acknowledgments:

The authors wish to thank all interviewees for their time and openness. Special thanks to Tiemen van Oorschot for his assistance in data analysis, and Mieke Koeslag-Kreunen and Lianne Loosveld for helpful discussions.