May 6, 2016

Teaching Team Work and Cooperation: Critical Skills in Healthcare Today

by Matthew Levit, Doctor of Pharmacy Candidate, Class of 2018, University of Maryland School of Pharmacy

Traditional instructional models stress the importance of individualism, but many educators and schools have begun to emphasize cooperative learning methods.1 Cooperative learning is an integrative learning model that seeks to educate students through activities that promote social learning and leadership experiences.2,3 Cooperative learning has its origins in social interdependence theory. According to this theory, the learning outcomes of an individual are determined by their own actions as well as the actions of others.3 Cooperative learning builds on this theory by postulating that learning occurs best through social engagement.4

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Cooperative learning is more than just working together in a group. Students learn by using their social and interpersonal skills to achieve an academic goal.1 Cooperative learning is commonly used in a variety of practice-based settings including service learning, integrative internships, and continuing education (CE) seminars.5 In some of these settings, students receive academic credit and solve real-world problems.5 For example, students rotating on an interprofessional team may encounter a patient that suffers from multiple comorbidities (e.g. diabetes, hypertension, and neuropathic pain). One student in the group may be adept at diabetes management.  Another may have experience managing patients with high blood pressure.  And another may be very knowledgeable about neuropathic pain. Collectively, the students learn from each other and are more likely to successfully complete the academic exercise.

There are five key elements to the cooperative learning model. These include positive interdependence, individual and group accountability, face-to-face promotive interaction, interpersonal and small group skills, and group processing.1,6 Positive interdependence requires that every member of the group value each other’s contributions.1 Interprofessional healthcare teams must have positive interdependence in order to fully utilize each member’s unique contributions to the patient’s care. Individual and group accountability requires that each member of the group is accountable for one’s actions and all must contribute to the completion of the assigned task.6 An evaluator should discipline students who do not contribute because it is detrimental to the group’s overall success. Interpersonal and small group skills include effective leadership and communication, building trust, making clear decisions, and managing potential conflicts.1 Face to face promotive interactions require learners to share resources as well as support and encourage their teammates success.6 Group processing requires communication among group members. Members should be encouraged to express any concerns they have with each other for the overall benefit of the group.6

One example of an instructional method that uses the five key elements of the cooperative learning model is the jigsaw technique.3,5 In this method, students are assigned a topic and placed into two groups: a home group and an expert group. Students in the home group go to the expert group to learn a particular topic and then go to another group to teach that particular subject.3 This technique promotes contributions from each member of the group (positive interdependence and face to face interaction) as well as accountability for each member’s actions (individual and group accountability). Educators that use this model expect their students to support each other’s learning as well as understand that each member of the group must be able to teach a piece of the subject matter to others. In addition, students are expected to communicate effectively with each other using verbal and non-verbal communication (interpersonal and small group talks and group processing).3,5  This certain isn’t the only example of cooperative learning.  Several other cooperative learning methods exist [See previous blog essay regarding the Processed Oriented Guided Inquiry Learning (POGIL) method].

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In healthcare today, interprofessional healthcare teams are practicing cooperative learning.7 In the past, different specialties would work independently and had little appreciation or understanding regarding the unique contribution that other members of the health care team could make.  If students start collaborating in the classroom with their peers, then perhaps this will translate to working with other healthcare professionals.7 Health professions educators have an important role in helping students become effective members of a team. In order to implement cooperative learning, educators must promote instructional methods that use the 5 key elements of the cooperative learning model. For example, in the classroom setting, an educator can design case-based group exercises (interpersonal and small group skills and group processing). Students should be encouraged to work in small groups so that everyone has a chance to participate (face-to-face promotive interaction) and learn from each other. During these clinical exercises, the instructor can require that each student to write a reflection on how they contributed to the group’s work as well as evaluate peers (positive interdependence and individual and group accountability). This reflection will allow the educator to see how well collaborative learning is working and student comments can be used to make changes. In practice-based settings, preceptors and other healthcare instructors can encourage interprofessional healthcare teams to use this model of learning when “rounding” in the hospital or during interprofessional meetings in clinic.4,7 Evaluations of their experiences can be used to individualize students’ needs and provide an overall framework for future collaborative work. The ultimate goal every educator should stress when using cooperative learning strategies in healthcare is to promote optimal patient care.

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Cooperative learning is a model for developing and implementing instructional activities that helps students to develop social learning and leadership skills. 2,3 Educators and students in the health professions must become proficiency in these skills in order to effectively manage complex patients through team-based collaborations.4,7

  1. Salam T, Greenberg H, Pitzel M, Cripps D. Interprofessional education internships in schools: Jump starting change. Journal of Interprofessional Care. 2010; 24(3): 251 – 263.
  2. Stavenga de Jong JA, Wierstra RF, Hermanussen J. An exploration of the relationship between academic and experiential learning approaches in vocational education. British Journal of Educational Psychology 2006; 76(1): 155-169.
  3. Johnson DW, Johnson RT. An Educational Psychology Success Story: Social Interdependence Theory and Cooperative Learning. Education Educational Res 2009; 38(5): 365 – 379.
  4. Budgen C, Gamroth L. An overview of practice education models. Nurse Education Today 2008; 28(1): 273 – 283.
  5. Schul JE. Revisiting an Old Friend: The Practice and Promise of Cooperative Learning for the Twenty-First Century. Soc Studies 2011; 102(1): 88 – 93
  6. Basak T, Yildez D. Comparison of the effects of cooperative learning and traditional learning methods on the improvement of drug-dose calculation skills of nursing students undergoing internships. Education Educational Res 2014; 73(3): 341 – 350.
  7. Mitchell P, Wynia M, Golden R, et al. Core principles and values of effective team based health care. 2012; Discussion Paper, Institute of Medicine, Washington, DC.