Getting Health Professions Learners on the Same Page: Shared Mental Models to Support Clinical Teamwork

By: Leslie Carstensen Floren, PharmD, MA

L.C. Floren is associate professor, Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco (UCSF), and a current student in Health Professions Education in the Utrecht University-UCSF doctoral program.

A few years ago, I started to become keenly interested in interprofessional (IP) education, and I helped to develop and implement an IP workshop on medication safety. Together, small groups of third-year pharmacy and first-year medical students would role-play clinical cases, taking turns to interview and conduct a medication reconciliation for their “patients.” On several occasions during these sessions, I observed medical students asking the pharmacy learners questions that were focused mostly on dispensing (available drug strengths, normal doses, etc.), but they had few inquiries regarding drug interactions, management of side effects, or patient education. Not surprisingly, these medical students, still early on in their training, seemed to hold a somewhat narrow view of the pharmacist’s role.

At the same time, I began to think about how these learners from different backgrounds would likely only have limited exposure to one another through a series of IP workshops over the next few years. And, I began to wonder how our health-professionals-in-training would be able to develop the shared understandings necessary for effective collaborative work if they held limited conceptions (or had developed misconceptions) of one another’s roles, scope of knowledge, and skills or if they held dissimilar ideas about the scope of the work itself. My interest in shared mental models (SMMs) grew from my desire to better understand how members of IP health care teams—with different content knowledge and skills, different levels of clinical training, and different professional cultures and identities—come together, or “get on the same page,” to create a unified vision for their work. Importantly, I also wanted to explore how we, as health professions (HP) educators, might use the SMM construct to support HP trainees, from the earliest stages of their clinical training, to develop shared understandings with their teammates as a means of improving team performance and collaborative patient care.

Through our recent Academic Medicine review of SMMs in the HP education literature, we found that the SMM construct is complex and fraught with different interpretations and applications. Sometimes it represents a generalized “shared understanding” among team members (e.g., code team members understand that the basic purpose of their team is to respond to cardiopulmonary arrest) and other times it represents individually held, organized knowledge—including content and structure—that overlaps with the organized representations of other team members (e.g., each team member understands the code team structure and their own roles and responsibilities as well as those of their teammates). Not surprisingly, this definitional confusion leads to variability in the application of the construct and further complicates SMM measurement, which is already complex under the best of circumstances. In an attempt to bring clarity to the construct in the setting of health care, we thought it would be useful to propose a definition that would capture what most educators may agree is a mental model that is shared among health care team members, i.e., “a shared mental model is an individually held, organized, cognitive representation of task-related knowledge and/or team-related knowledge that is held in common among health care providers who must interact as a team in pursuit of common objectives for patient care.”

So, even with a specific definition of SMM in health care teams, the question remains: If the SMM construct is difficult to measure, can it still be useful for us as HP educators? I do believe that the SMM construct offers a useful way for educators to conceptualize shared knowledge and to design interventions to improve team performance outcomes. However, I have become skeptical of our ability to measure SMMs in teams as a tool for diagnosing suboptimal performance in the workplace or clinical learning environment. In fact, the substantial challenges surrounding SMM measurement—including documented logistical hurdles in real clinical settings and lack of generalizability—have prompted me to explore knowledge construction as a framework for understanding IP group performance that complements SMM. Work by Chi and Wylie has shown that the way in which group members interact and construct knowledge influences learning and task performance in laboratory and classroom environments. Applying this framework to IP health care teams could (1) offer a way to examine co-construction of knowledge (including knowledge about team roles, responsibilities, and tasks) in collaborative learning environments using a general interaction analysis approach, rather than context-specific instruments that would be required for measurement of either team or task SMMs and, (2) ultimately, allow for a more straightforward exploration of the connection between IP team learning and performance.

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