The Downstate Team-Building Initiative (DTBI) is a year-long, extracurricular team-building program instituted at the State University of New York, Downstate Medical Center (SUNY Downstate) in 2000. DTBI unites students from the schools of medicine, nursing, physician assistants, physical therapy, occupational therapy, midwifery, and diagnostic medical imaging to learn about the challenges of building cohesive and effective health care teams. The students begin by undergoing training in methods of group decision making, conflict mediation, and alliance building across professional position and cultural identity. Subsequently, each cohort identifies and implements a health-related community action project and, in essence, functions as a team by accomplishing a team goal. Currently in its fifth year, the vision underlying DTBI is the creation of a model, student-level program to improve the abilities of future health care providers to work together in the delivery of quality care once they enter their respective professional realms.
Interdisciplinary friction in health arenas is well documented in medical literature, as is the need for more effective collaboration between health workers.1–3 The idea that teamwork among the health disciplines is crucial to patient care, team morale, and administrative efficiency is supported in numerous medicine, nursing, and public health journals.4–7 The 1998 Pew Health Commission report recommended instituting interdisciplinary competency requirements for all health professionals.8 More than half of the doctors surveyed in the report felt undergraduate medical education was an ideal time to institute interdisciplinary training.4 Although an increasing number of health professional education programs are incorporating the Pew Health Commission's recommendations, few documented attempts to formally teach interdisciplinary teamwork skills during undergraduate health education exist.9–15 DTBI is such as effort.
DTBI is unique in approach. Teams are built from an interdisciplinary as well as a multicultural perspective, acknowledging the intersection between the two. The student population at SUNY Downstate is remarkably diverse. The College of Medicine is 53% white, 30% Asian, 12% black, and 4% Latino; the College of Nursing is 70% black, 18% white, 7% Asian, and 4% Latino; and the College of Health Related Professions (CHRP, including physician assistants, physical therapy, occupational therapy, midwifery, and diagnostic medical imaging) is 58% white, 26% black, 9% Latino, and 6% Asian.16 Imbedded in this level of multiculturalism–wonderful though it is–are inherent mistrust and intergroup tensions born, in part, from the historical precedent of racial inequality in the United States and exacerbated by the continued disproportional representation of people of color in the uninsured and economically deprived classes. Despite the growing concern over cultural competency in health education programs, in 2000 only 8% of U.S. and Canadian medical schools had courses specifically aimed at addressing cultural issues.17 DTBI broaches intercultural relations directly with constructive outcomes.
“Culture,” in the context of DTBI, is used in an expansive sense to mean not only aspects of ethnicity or race but also the norms, customs, and values associated with sexual orientation, gender, class, and professional identity. Although racism in health care delivery is occasionally addressed in formal medical curricula, the intersection of homophobia and health care is often completely ignored.18 Yet, the problem is real. Prejudice is difficult to talk about. People often shy away from directly addressing discrimination issues for fear constructive outcomes will not be reached. DTBI participants, however, learn to address areas of difference within their group as well as to build on commonalties. By struggling through difficult issues together, the students establish strong relationships that are the foundation of a strong team.
One of the authors (JMH) designed the DTBI curriculum to draw from the enormous body of work in the fields of education, intercultural relations, and ethnic studies on pedagogical approaches to “diversity training” and multicultural alliance building.19 This report describes the DTBI program and evaluates its impact on participants after three years of implementation. DTBI was evaluated three ways: (1) an 11-point team development scale administered at each group meeting recorded students’ assessments of team-building progress; (2) a matched pre- and postintervention evaluation tool assessed the short-term impact of DTBI on participants; and (3) a narrative clinical follow-up survey investigated the impact of participation one and two years later.
Bases on the paragraph above, summarize the limitations of it and the suggestion to overcome the limitations.