What I wish I knew in residency about effective teamwork

Being a member of a team is central to every physician’s experience in residency, yet many learners entering their intern year might feel unprepared for it.

“It's something that probably doesn't come naturally to a lot of people entering residency,” said AMA member Stephanie Strohbeen, MD, an internist in her first year of private practice in Milwaukee.

“To get there, they had to fight through undergrad to make sure they were good candidates to get into medical school. And then in med school, they were competing with other people across the country to get into the residency spot they wanted,” Dr. Strohbeen said. “Certainly, there were study groups and advisers and family members providing support, but the way the system is set up, teamwork is not ingrained at that point.”

In an interview with the AMA, Dr. Strohbeen talked about what she wishes she knew in residency about effective teamwork. Among her recommendations: Teamwork should be present in every facet of your professional life.

The physician-led multidisciplinary care team is at the heart of patient care. Colleagues include physician assistants, nurse practitioners, nurses, pharmacists, social workers, medical assistants, case managers and other health professionals.

But it is critical to note that the multidisciplinary team is just one team each resident will be a part of.

Another is the resident care team, which includes interns, senior residents, chief residents, associate program directors and program directors.

“When something comes up that we can’t deal with on our own, we’re able to turn to them and feel that they're not necessarily making a solution for us, but they're teaching us how to help come up with a solution ourselves,” Dr. Strohbeen said.

In addition, the resident care team depends on its diversity.

“Everybody has a different perspective. Everybody has a different background,” she said. “Your strengths can help a co-resident through a difficult situation and vice versa. You have to be willing to open yourself up to ask for help.”

Plus, there are countless committees one can get involved in, both within the residency program and outside of it. For example, during residency, Dr. Strohbeen was a member of the AMA Resident and Fellow Section (AMA-RFS), the AMA Women Physicians Section and the AMA Minority Affairs Section. Since leaving AMA-RFS, she has joined the AMA Young Physicians Section and the AMA Private Practice Physicians Section.

“One of the biggest places where I found teamwork that helped with my feelings of stress and burnout was in the family I found in organized medicine, at both the AMA and the Wisconsin Medical Society. Even being on a rugby team helped.”

Then there is the team that includes patients and their family members or other advocates. Whether you are working with a relative or a friend or someone who holds power of attorney for health care matters for a patient, everyone’s feelings need to be accounted for.

Not that this is always easy.

“It’s important to make sure you tailor how you give information to members of that team based on their experience,” Dr. Strohbeen said. “Those conversations are so paramount, because they help ensure the patient doesn’t end up back in the hospital two weeks later.”

Learn more and earn CME with the online education module “What Makes Team-Based Care Effective?” It is one of 13 modules released as part of the AMA Health Systems Science Learning Series.

“Other things I wish I knew? Pharmacy!” Dr. Strohbeen said. “Our pharmacy colleagues are phenomenal, and I definitely relied on them a lot. But at first, I wondered if it was OK for me to ask for their help because, well, I was supposed to be the doctor, right?”

Pharmacists, like others, she noted, went to school for this express purpose: to help physicians manage their patients.

“It’s crucial to understand that we're all there for the safety of patients and to provide the best care possible,” she said. “Everybody has a different skill set and a different background, and there will be lots of situations where someone else should take the lead.”

Another case in point: transfers.

“As physicians, we’re not trained in transfers, but registered nurses and certified nursing assistants are. So, when a patient needs to be transferred, I absolutely defer to nursing, and they know I’m there if they need a helping hand. But again, everybody's goal is to keep patients safe, so if what I’m facing is something that I don't think I've been trained to do, then it's time to get somebody else on board,” she said.

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During Dr. Strohbeen’s residency, each intern was responsible for up to eight patients, while each senior resident was responsible for overseeing two interns. So, handoffs were vital.

“With good communication, when one intern is gone, the senior resident and the other intern can pick up seamlessly,” Dr. Strohbeen said, noting that documentation is an essential part of the process.

“It ensures that everyone on the team is familiar with each patient, so things don’t fall through the cracks,” she said.

"We need to rely on our colleagues to be able to step up when we notice that we’re reaching the end of our rope we need a helping hand,” Dr. Strohbeen said. “Life happens. It doesn't stop just because we're in residency. Life around us is going to keep going, and there are things that are going to happen in our personal lives that will take us away from training for a period of time.”

So, knowing you can rely on your teammates to take the wheel in your absence—knowing that your patients will be cared for—is vital.

“It’s important to know that it's OK that you're not there, and it’s just as important to not feel guilty that other people are being called in for an extra shift. That’s why everyone is there—to support each other and work as a team,” she said.

As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.

“As an intern, you're just trying to learn the hospital system and how to order things and how to work as part of a team,” Dr. Strohbeen said. “Then, during second and third year, as a senior resident, you have the opportunity to help guide the newer residents, to help them adjust.”

You will notice this shift in roles, especially in the team room.

“You have to learn to really trust each other, and that means being accountable,” she said. “You’ll go from learning teamwork to helping other people learn it.”

Learn more about the AMA Resident and Fellow Section, which gives voice to—and advocates on—issues that affect resident and fellow physicians.