Effective teamwork is paramount for the delivery of safe and reliable patient care. For high-level performance, team members must develop core teamwork competencies early in their careers. Although training approaches exist for professionals working in a clinical setting, a consensus on how best to deliver competency-based teamwork education to medical students beginning their healthcare careers is lacking. The Team FIRST curriculum consists of a series of five modules designed to inform, demonstrate, allow practice, and provide feedback to learners participating in role-playing and guided discovery experiences. The modules are designed to build confidence and competence in ten foundational teamwork competencies needed for clinical work and to prime learners for on-the-job teamwork training throughout their careers. Collectively, these modules provide up to ten hours of learning activities using medical scenarios, experiential learning, interprofessional activities, and practice giving and receiving patient handovers. Internally developed instruments assess participant reactions and self-efficacy beliefs (i.e., confidence) for all modules, as well as teamwork competencies needed for safe patient handovers in Modules 2 and 5. The curriculum and related learning activities are based on an iterative, user-centered, mixed-methods approach consistent with adult learning theory. The Team FIRST curriculum was delivered to five cohorts of medical students (n = 1,162) by 230 instructors between July 2023 and June 2024. Students reported significant improvement in self-efficacy from pre- to post-surveys in all modules. Competency-based teamwork skills were assessed in Module 2 (low-complexity handover) and Module 5 (moderate-complexity handover). Students appear to give and receive handovers more effectively in Module 5 (post-clerkship) despite the higher complexity. Our findings show the learning activities were well received, improved learner confidence in using teamwork skills, and established proficiency in entrustable professional activities (EPAs), like giving and receiving patient handovers (EPA 8). The Team FIRST education and implementation strategies improve student learning outcomes and produce a competency-based assessment for safe patient handovers. Institutional capacity for transferring teamwork skills to the clinical learning environment is enhanced by developing an experienced cadre of faculty from every department using an iterative, participatory design approach for curriculum development and implementation.

Importance:Patients undergoing cardiac surgery with cardiopulmonary bypass often require platelet transfusions for bleeding. Platelets are routinely stored at room temperature (20-24 °C) for up to 5 to 7 days; however, cold storage (1-6 °C) may allow for increased storage duration without loss of hemostatic function. Objective:To determine the maximum cold-storage duration, up to 21 days, for which cold-stored platelets (CSPs) are noninferior or superior in hemostatic efficacy to room-temperature platelets (RTPs) when transfused in actively bleeding patients undergoing cardiac surgery with cardiopulmonary bypass. Design, Setting, and Participants:A phase 3, multicenter, randomized, partially blinded, adaptive, noninferiority, storage duration-ranging trial conducted in pediatric and adult patients undergoing cardiac surgery with planned cardiopulmonary bypass at 27 sites in the US and Australia from December 2021 to March 2025. Statistical analysis was conducted from September 9 to October 3, 2025. Intervention:Patients were randomized 2:1 to receive CSPs with a maximum of 21 days of storage vs RTPs with a maximum of 7 days of storage. Main Outcomes and Measures:The primary outcome was a hemostatic efficacy score with values ranging from 1 to 5 and higher values indicating greater bleeding. The noninferiority margin was 1 point. The success criterion was met if at least 1 cold-storage duration of 7 days or more had a posterior probability of noninferiority of at least 97.5%. The secondary outcome was 24-hour chest tube output. Results:Of the 1000 patients who underwent platelet transfusion, 989 were included in the primary analysis (650 CSPs and 339 RTPs). The cohort had a mean (SD) age of 42.1 (30.1) years and 67.8% were male. CSPs were noninferior to RTPs for the primary outcome, with a probability of greater than 99.9% for all cold-storage durations. Pooled across storage durations, CSPs had a mean difference from RTPs of 0.09 (95% credible interval, -0.06 to 0.23). Median (IQR) chest tube output at 24 hours (8.9 mL/kg [5.2-15.4] for CSPs vs 8.4 mL/kg [5.5-15.9] for RTPs; difference in medians, 0.4 [95% CI, -1.0 to 1.5]) was not statistically different between study groups. In a post hoc analysis, as all storage durations were noninferior, considering the CSPs as a single group, the hemostatic efficacy score was similar between both groups: mean (SD) of 3.08 (1.15) CSPs vs 2.99 (1.10) RTPs. There were no differences in venous or arterial thrombotic events, transfusion-associated adverse events, acute respiratory distress syndrome, kidney failure, septic shock, and mortality between the study groups, except for increased reexploration rates in the CSP group. Conclusions and Relevance:For patients undergoing cardiac surgery, CSPs stored up to 21 days are noninferior to RTPs for the control of active surgical bleeding. Use of CSPs may allow for increased availability of platelets by reducing wastage and shortages and may allow for incorporation of platelets into inventory at locations where platelets cannot be maintained due to the 5- to 7-day shelf life of RTPs. Trial Registration:ClinicalTrials.gov Identifier: NCT04834414.

Importance Patients undergoing cardiac surgery with cardiopulmonary bypass often require platelet transfusions for bleeding. Platelets are routinely stored at room temperature (20-24 °C) for up to 5 to 7 days; however, cold storage (1-6 °C) may allow for increased storage duration without loss of hemostatic function. Objective To determine the maximum cold-storage duration, up to 21 days, for which cold-stored platelets (CSPs) are noninferior or superior in hemostatic efficacy to room-temperature platelets (RTPs) when transfused in actively bleeding patients undergoing cardiac surgery with cardiopulmonary bypass. Design, Setting, and Participants A phase 3, multicenter, randomized, partially blinded, adaptive, noninferiority, storage duration–ranging trial conducted in pediatric and adult patients undergoing cardiac surgery with planned cardiopulmonary bypass at 27 sites in the US and Australia from December 2021 to March 2025. Statistical analysis was conducted from September 9 to October 3, 2025. Intervention Patients were randomized 2:1 to receive CSPs with a maximum of 21 days of storage vs RTPs with a maximum of 7 days of storage. Main Outcomes and Measures The primary outcome was a hemostatic efficacy score with values ranging from 1 to 5 and higher values indicating greater bleeding. The noninferiority margin was 1 point. The success criterion was met if at least 1 cold-storage duration of 7 days or more had a posterior probability of noninferiority of at least 97.5%. The secondary outcome was 24-hour chest tube output. Results Of the 1000 patients who underwent platelet transfusion, 989 were included in the primary analysis (650 CSPs and 339 RTPs). The cohort had a mean (SD) age of 42.1 (30.1) years and 67.8% were male. CSPs were noninferior to RTPs for the primary outcome, with a probability of greater than 99.9% for all cold-storage durations. Pooled across storage durations, CSPs had a mean difference from RTPs of 0.09 (95% credible interval, −0.06 to 0.23). Median (IQR) chest tube output at 24 hours (8.9 mL/kg [5.2-15.4] for CSPs vs 8.4 mL/kg [5.5-15.9] for RTPs; difference in medians, 0.4 [95% CI, −1.0 to 1.5]) was not statistically different between study groups. In a post hoc analysis, as all storage durations were noninferior, considering the CSPs as a single group, the hemostatic efficacy score was similar between both groups: mean (SD) of 3.08 (1.15) CSPs vs 2.99 (1.10) RTPs. There were no differences in venous or arterial thrombotic events, transfusion-associated adverse events, acute respiratory distress syndrome, kidney failure, septic shock, and mortality between the study groups, except for increased reexploration rates in the CSP group. Conclusions and Relevance For patients undergoing cardiac surgery, CSPs stored up to 21 days are noninferior to RTPs for the control of active surgical bleeding. Use of CSPs may allow for increased availability of platelets by reducing wastage and shortages and may allow for incorporation of platelets into inventory at locations where platelets cannot be maintained due to the 5- to 7-day shelf life of RTPs. Trial Registration ClinicalTrials.gov Identifier: NCT04834414

This study evaluates the relationships between individual and team-level factors in influencing burnout among clinical healthcare providers. Focusing on psychological safety, perceived autonomy, perceived team effectiveness, and emotional intelligence, the research aims to understand how these elements contribute to the prevalence and severity of burnout symptoms. Using electronic questionnaires analyzed through Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM), the study sampled 180 healthcare providers from one large US medical center. The study results found that psychological safety significantly decreases levels of burnout, particularly emotional exhaustion. The results on team effectiveness suggest a complex relationship with burnout, with different dimensions having varied impacts. The study did not find support for the negative prediction of burnout by perceived autonomy and emotional intelligence, contrary to expectations based on prior research. These findings have practical implications for healthcare management, stressing the importance of psychological safety and effective team dynamics in reducing burnout. Overall, this study contributes significantly to understanding burnout in healthcare, emphasizing the critical role of team structures and individual emotional resilience in managing workplace well-being.

Interprofessional teamwork is vital to effective patient care, and targeting healthcare learners earlier in their education can lead to greater improvement in confidence and competence in teamwork skills. Despite this, institutions have continued struggling to integrate competency-based interprofessional teamwork curriculum in undergraduate health care professions’ education. The current article provides guidance related to design, implementation, and assessment for institutions seeking to implement competency-based teamwork education and training strategies for healthcare students. Guiding principles and strategies for curricular design focus on conducting thorough interprofessional needs analyses and building transportable, evidence-based competencies that apply across professions. For implementation, key principles center on strategies to ensure adequate professional representation and faculty development. Assessment considerations focus on building infrastructure for evaluation that spans professional schools. These strategies aim to create a robust, effective, and sustainable IPE curriculum that enhances collaboration and teamwork among future healthcare professionals. By addressing the key areas of design, implementation, and assessment, this article offers comprehensive guidelines for advancing interprofessional education. We believe incorporating the key guiding principles and strategies from this paper will enable institutions to integrate teamwork education and training more effectively into undergraduate healthcare training, which will facilitate institutions’ ability to ensure learners are “team ready” as they transition into the workforce after graduation.

Systems thinking and teaming are two domains in health systems science. Health systems science is an emerging third science of health care education and has been recently adopted by the American Medical Association to prepare individuals for the challenges of twenty-first-century medicine. Given the complexity of health systems, a better understanding of systems thinking allows learners to see the "big picture" and how the parts in a system are related to the whole system. Teaming is a domain that teaches skills required for groups of interdependent individuals to achieve high reliability in the health care they provide. There is an opportunity to use systems thinking to better understand the relationships of teamwork competencies to health system outcomes. Team training is an effective means for increasing communication. The authors present a causal model that graphically illustrates relationships between teamwork competencies as well as relationships to other important health system factors such as preventable medical errors, and clinician and organizational outcomes. This model enables a holistic understanding of teamwork competencies and its expected effects.

Interprofessional healthcare team function is critical to the effective delivery of patient care. Team members must possess teamwork competencies, as team function impacts patient, staff, team, and healthcare organizational outcomes. There is evidence that team training is beneficial; however, consensus on the optimal training content, methods, and evaluation is lacking. This manuscript will focus on training content. Team science and training research indicates that an effective team training program must be founded upon teamwork competencies. The Team FIRST framework asserts there are 10 teamwork competencies essential for healthcare providers: recognizing criticality of teamwork, creating a psychologically safe environment, structured communication, closed-loop communication, asking clarifying questions, sharing unique information, optimizing team mental models, mutual trust, mutual performance monitoring, and reflection/debriefing. The Team FIRST framework was conceptualized to instill these evidence-based teamwork competencies in healthcare professionals to improve interprofessional collaboration. This framework is founded in validated team science research and serves future efforts to develop and pilot educational strategies that educate healthcare workers on these competencies.

© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. Healthcare providers are expected to communicate, coordinate and collaborate with people both within and outside their formal team on a regular basis, often with individuals from different professions, specialties or teams. Continuous ‘teaming’ is the norm. Almost everyone involved in the provision of healthcare must therefore possess teamwork competencies in addition to clinical expertise. Fortunately, research has matured to the point where the drivers of team effectiveness are increasingly clear. For example, in highly effective teams, team members possess shared mental models about roles, priorities and the situation; communicate information that others need and confirm their understanding; engage in mutual performance monitoring and backup behaviours and make it safe for others to speak up and ask questions. The research is also clear about the efficacy of team debriefs. During a debrief, team members reflect on a recent experience, discuss what went well, identify opportunities for improvement and agree on what they will do going forward. A debrief can be conducted after a training event (eg, a simulation), work experience (eg, treating a patient) or time period (eg, end of a shift). Teams that engage in debriefs generally outperform others 3 because debriefs promote learning and enable teams to adjust. Individuals also benefit from participating in debriefs, in part by developing transportable teamwork competencies they can use whenever teaming is required. Research has examined how to optimise team debriefs. In this issue of BMJ Quality & Safety, Kolbe et al observed and analysed over 18 000 interactions that occurred during 50 team debriefings in the simulation centre of a large urban academic medical hospital. The debriefs followed three highrisk anaesthetic training scenarios and averaged 49 min in duration. Participants were all employed as anaesthesia care providers and the debriefs were led by clinical simulation educators who were trained in simulationbased education. The researchers conducted a detailed microanalysis of communications and behaviours among and between team members and debriefers, illuminating patterns of interactions that occur during debriefs. For example, they revealed how debriefers’ use of feedback and openended questions encouraged participants to verbalise their thoughts and mental models. Overall, their study yielded insights about how to structure and facilitate a constructive debrief, including how to balance inquiry and advocacy, and it reinforced the need to explore how debriefs work. While there is a need for further research, we would argue that enough is already known to merit an increased use of team debriefs, both in educational and clinical settings. In this commentary, we compare debriefing in education and clinical practice, highlight a few universal debriefing guidelines while acknowledging the need for purposedriven practices, endorse the call for building debriefing skills by Kolbe et al, and suggest three specific research needs.

Children with medical complexity (CMC) often have lengthy medication lists and are at risk of experiencing suboptimal medication management. This tool tutorial describes a novel and pragmatic strategy for the development and implementation of medication rounds, a model that promotes medication safety for hospitalized CMC. An interprofessional group designed and implemented a pharmacy-led medication rounding care model, in which clinicians and pharmacists partner weekly to conduct reviews of all patient medications on a general pediatrics CMC team using a comprehensive checklist. This approach fosters medication safety for hospitalized CMC and could be adapted to other complex inpatient populations.

BackgroundHandoffs are ubiquitous in modern healthcare practice, and they can be a point of resilience and care continuity. However, they are prone to a variety of issues. Handoffs are linked to 80% of serious medical errors and are implicated in one of three malpractice suits. Furthermore, poorly performed handoffs can lead to information loss, duplication of efforts, diagnosis changes and increased mortality. MethodsThis article proposes a holistic approach for healthcare organisations to achieve effective handoffs within their units and departments. ResultsWe examine the organisational considerations (ie, the facets controlled by higher-level leadership) and local drivers (ie, the aspects controlled by the individuals working in the units and providing patient care). ConclusionWe propose advice for leaders to best enact the processes and cultural change necessary to see positive outcomes associated with handoffs and care transitions within their units and hospitals.

Patient handoffs involve the transition of information and responsibility for care from one health care provider to another. They occur frequently during a patient's perioperative care continuum, potentially introducing communication errors that could result in harmful, even fatal consequences. The perioperative environment poses distinct challenges to team communication and patient safety, which in turn leaves the surgical patient uniquely vulnerable to adverse events.The best way to achieve safe, coordinated handoffs throughout the perioperative continuum has yet to be established. However, a variety of theoretical principles, methods, and interventions have been used successfully in operative and nonoperative contexts among multiple disciplines. Informed by a literature review, the authors describe a conceptual framework for the development, implementation, and sustainment of a multimodal perioperative handoff improvement bundle. The conceptual framework presented here begins with overarching objectives for patient-centered handoff improvement efforts. The article outlines theoretical principles that could be used to guide and inform future multimodal interventions, as well as health care system factors to consider. Further, the authors propose employing data-driven quality improvement and research methodologies to conduct, measure, achieve, and sustain long-term success. Finally, this report describes essential evidence-based interventional components to employ.Future efforts to improve handoff safety in the perioperative environment will require a comprehensive evidence-based approach. The authors believe the conceptual framework presented here outlines essential components for success. It integrates proven theoretical frameworks, consideration of system factors, data-driven iterative methods, and synergistic patient-centered interventions.

Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.

BACKGROUND:Improving the reliability of handoffs and care transitions is an important goal for many health care organizations. Increasing evidence shows that human-centered design and improved teamwork can lead to sustainable care transition improvements and better patient outcomes. This study was conducted within a cardiovascular service line at an academic medical center that performs more than 600 surgical procedures annually. A handoff process previously implemented at the center was poorly adopted. This work aimed to improve cardiovascular handoffs by applying human factors and the science of teamwork.METHODS:The study's quality improvement method used Plan-Do-Study-Act cycles and participatory design and ergonomics to develop, implement, and assess a new handoff process and bundle. Trained observers analyzed video-recorded and live handoffs to assess teamwork, leadership, communication, coordination, cooperation, and sustainability of unit-defined handoff best practices. The intervention included a teamwork-focused redesign process and handoff bundle with supporting cognitive aids and assessment metrics.RESULTS:The study assessed 153 handoffs in multiple phases over 3 years (2016-2019). Quantitative and qualitative assessments of clinician (teamwork) and implementation outcomes were performed. Compared with the baseline, the observed handoffs demonstrated improved team leadership (p < 0.0001), communication (p < 0.0001), coordination (p = 0.0018), and cooperation (p = 0.007) following the deployment of the handoff bundle. Sustained improvements in fidelity to unit-defined handoff best practices continued 2.3 years post-deployment of the handoff bundle.CONCLUSION:Participatory design and ergonomics, combined with implementation and safety science principles, can provide an evidence-based approach for sustaining complex sociotechnical change and making handoffs more reliable.

SIGNIFICANCE:Perioperative handoffs interconnect the preoperative, intraoperative, and postoperative phases underlying surgical care to maintain care continuity -yet are prone to coordination and communication failures.OBJECTIVE:To synthesize evidence on factors affecting the safety and quality of perioperative handoff conduct and process.MATERIALS AND METHODS:A search of PubMed, EMBASE, and CINAHL was conducted to include observational, descriptive studies of preoperative, intraoperative, and postoperative handoffs published in English language, peer-reviewed journals. Data analysis was informed by the Systems Engineering Initiative for Patient Safety (SEIPS) framework describing the relationship between the work-system, work processes, and outcomes. Study quality was assessed using the Quality Scoring System.RESULTS:Twenty-three studies were included. Eighteen studies focused on postoperative handoffs, with one on preoperative, three on intraoperative and only one that looked at preoperative/postoperative handoffs combined. The SEIPS framework elucidated the complex inter-related factors (enablers and barriers) related to perioperative handoff safety. While some studies found that the use of standardized handoff tools and protocols and interdisciplinary teamwork were frequently-reported enablers, other studies identified the lack of structured handoff tools and protocols, poor teamwork and communication, and improper use of documentation tools were top-cited barriers affecting handoff quality. Suggestions to ensure handoff safety and quality included implementing structured handoff checklists and protocols and building interprofessional teamwork competencies for effective communication.DISCUSSION AND CONCLUSION:Our review highlights an urgency to develop more holistic sociotechnical solutions that can create and sustain a balance between technical innovations in tools and technologies and the non-technical interventions/training needed to improve interpersonal relations and teamwork competencies - taken together, can improve the quality and safety of perioperative handoff practice.

In medical settings, interprofessional education (IPE) plays an important role by bringing students from multiple disciplines together to learn how to collaborate effectively and coordinate safe patient care. Yet developing effective IPE is complex, considering that stakeholders from different schools and programs are involved, each with varying curriculum requirements and interests. Given its critical importance and inherent complexity, innovative approaches to address these challenges are needed to effectively develop and sustain effective IPE programs. Systems engineering (SE) combines a lifecycle perspective with established interdisciplinary processes to develop and sustain large complex systems. The need for SE approaches to manage healthcare complexity has been recognized, but the application of SE to IPE programs has been limited. We believe that there is a significant opportunity for IPE programs to benefit from the application of SE. The common themes running through SE and IPE led us to ask if SE can be used to address IPE complexity and achieve desired IPE outcomes. We believe that SE could facilitate further development and sustainability of a recently developed healthcare curriculum. We also propose to use SE to accelerate and manage future IPE curriculum development, while better understanding the states of vital IPE-related components. We discuss a framework that considers transitions of key IPE elements. We believe that use of interdisciplinary SE processes and holistic perspectives and methods such as system thinking will improve the management of system challenges while addressing IPE’s inherent complexity and leading to better patient outcomes and more effective interprofessional collaboration.

BACKGROUND:Handoffs occur frequently in the medical domain and are associated with up to 80% of medical errors. Although research has progressed, handoffs largely remain inadequate. The absence of an appropriate conceptual model for handoffs hinders the purposeful design and evaluation of handoff procedures. This article presents a theoretical model of the major input, team process, and output variables that should be considered during a handoff.THEORETICAL MODEL BACKGROUND:The model integrates three theoretical frameworks that capture the various inputs, processes, and outputs surrounding handoff events through the lens of teamwork.OVERVIEW OF THE MODEL:Specifically, the model describes the environment, organization, people, and tools as inputs. Communication, leadership, coordination, and decision making serve as the processes, and the outputs are the organization, teams, providers, and patients.

INTRODUCTION: Ineffective structured communication in handovers can result in medical errors and patient harm. Common frameworks include SBAR and IPASS. Simulation-based education can improve competency in structured communication. The goal of this project was to increase student understanding of structured communication in the surgical learning environment. METHODS: Students participated in a pilot for an asynchronous, virtual simulation focused on structured communication prior to their surgical rotation. The simulation was embedded into an existing module for teaching other teamwork competencies. In the simulation, students watched didactic videos about structured communication, reviewed patient documents, listened to pre-recorded patient calls, and created handover statements for 2 simulated discharged postoperative patients using either SBAR or IPASS: (1) an ileocecectomy patient without complications, and (2) a cholecystectomy patient with complications. Before and after the activity, students completed a survey assessing knowledge of, attitudes toward, and confidence in skills relating to structured communication. RESULTS: 14 students piloted the simulation and surveys. Students demonstrated significant improvement in knowledge of IPASS components (p = 0.0159) and maintained a high level of knowledge of SBAR components (92.9% for pre- and post-survey) (Table). Attitudes toward the importance of structured communication in clinical practice improved on a 5-point Likert scale of strongly disagree to strongly agree, although not significant (p = 0.38209). Improvement to confidence in using structured communication was significant (p = 0.00082). Table. - Knowledge, Attitudes, and Confidence in Skills Before and after Virtual Handover Simulation Pre-survey Post-survey p Value Knowledge (% Correct) IPASS Knowledge 57.1% 100% 0.0159 SBAR Knowledge 92.9% 92.9% 1 Attitudes (Likert Scale, Strongly Agree to Strongly Disagree) % Agree 14.3% 7.1% 0.38209 % Strongly Agree 85.7% 92.9% Confidence in Skills (0-100) Average Confidence Rating 27.4 63.8 0.00082 CONCLUSION: Asynchronous, virtual simulations may improve student competency in structured communication. Further implementation of the piloted simulation must adapt to time limitations of students on surgical rotations to optimize completion and fidelity outcomes.