Introduction:

In the past two decades, in order to achieve organization success, the emphasis on teamwork along with the organizational and individual factors, has significantly soared. Considering the boosted efficiency and productivity of an organization by teamwork, the shift toward team-oriented approach can increase the trust in health care organizations (2). Patient care is a complex process which one is not capable of handling it alone. All members of the health care team should be able to form a cohesive, coordinated and organized team to work together.

Traditionally, doctors, nurses and other health care professionals had worked as separate units. Despite the significance of teamwork in health care, most clinical units as a series of trades, work separately. The fact is that most members of these teams are rarely trained together. Furthermore, they are from diverse disciplines and training programs. Thus, they are less capable of teamwork. Teamwork is profoundly noteworthy for patient's safety and teams are committing fewer errors in comparison with individuals especially when team members know their responsibilities well (3).

The Institute of Medicine (IOM) had recommended all health care professionals to be trained for providing patient-centered care as members of inter-professional teams, with an emphasis on evidence-based practice, quality improving approaches and updated information (4). It seems that in our country, little attention had been paid to the importance of teamwork in designing and implementing curricula for health care fields (5, 6). The reason may vary to numerous reasons such as different curriculum of diverse fields, hidden curriculum, unfamiliarity of policy makers and academics about new educational strategies and performing educational programs single professionally as well.

Now it must be seen that academic education and students' confrontation with a variety of unpredictable conditions in the bedside and the intellectual maturity of the students during their studentship years is changing their views about teamwork? The purpose of this study is to determine whether the current educational system is capable of teaching teamwork and effective collaboration with other medical professional or not. Therefore, in this study it was tried to make a comparison between the perspectives of first term and the last term students in the fields of medicine, nursing, anesthesiology, radiology, laboratory science and midwifery.

Methods

This study is a cross-sectional study which was conducted in the Kurdistan University of Medical Sciences in 2011. The population of the study was the university students of medical universities and the sample was all the first-term and last-term students (410) in different fields such as medicine, nursing, medical laboratory, anesthesiology, radiology, operating room technician and midwifery . The data collection was RIPLS which is a standard questionnaire. After translation and checking face validity and content validity, it was confirmed by five experts. The reliability of the questionnaire was assessed by Cronbach Alfa Coefficient which was 0/86. The questionnaire included two perspectives: teamwork views and inner feelings regarding other disciplines. Five-point likert scale ranging from completely agrees (1) to completely disagree (5) was used. The total numbers of questions were 20 which included 12 questions on teamwork perspectives and 8 questions on inner feelings. The minimum and maximum scores were 20 and 100 respectively. The final questionnaire was distributed among the target population and was collected immediately. SPSS version 18 and descriptive tests like one way ANOVA and independent T test were used for data analysis.

Results

The total numbers of questioners were 400 of which 360 questionnaires were completed and returned to the researcher. 150 were male (46%) and 176 were female (54%). 177 (54/3%) were first term students and 149 (45/7%) were last term students. Among the respondents, 88 (27%) were medicine students, 59 (18/1%) were nursing students, 49 (15%) were medical laboratory students, 38 (11/7%) were anesthesiology students, 48 (14/7%) were midwifery student and 44(13/5%) were radiology student. The data analysis indicated that there was no significant statistical difference between the mean score of first term and last term students' respectively (p= 0.225). (Table 1)

In the team work perspective which included 12 questions, there was a significant statistical difference among students of different disciplines (p= 0.00). The highest mean scores of teamwork perspective were related to the students of midwifery, laboratory science, radiology, medicine, anesthesiology and nursing respectively in terms of inner feelings regarding other disciplines, there was a significant statistical difference among different disciplines(p= 0.00). The midwifery students had the best perspectives and the medicine and anesthesiology students had the worst perspective concerning other disciplines. The radiology, medical laboratory and nursing after midwifery students had the 2nd to 4th ranking.

The total medical students participated in the study were 88 of which 48 were first term and 40 were last term students. There was no significant statistical difference between first term and last term medicine students regarding teamwork and inner feelings concerning other disciplines (p > 0.05).

The total nursing students participated in the study were 59 of which 33 were first term and 26 were last term students. There was a significant statistical difference between first term and last term nursing students regarding teamwork (p=0.00). The last term students had a lower positive perspective regarding teamwork but there was no difference regarding inner feeling (p> 0.05).

The total medical laboratory students participated in the study was 49 of which 31 were first term and 18 were last term students. There was a significant statistical difference between the mean score of first term and last term students regarding teamwork (p=0.00). There was no difference concerning inner feelings (p>0.05).

The total anesthesiology students participated in the study was 38 of which 18 were first term and 20 were last term students. There was no significant statistical difference between first term and last term students regarding teamwork and inner feelings concerning other disciplines (p>0.05).

The total radiology students participated in the study were 44 of which 24 were first term and 18 were last term students. There was a significant statistical difference in both teamwork (p =0/00) and inner feeling (P=0/00) regarding other disciplines among first term and last term students.

The total midwifery students participated in the study were 48 of which 21 were first term and 27 were last term students. There was no significant statistical difference between first term and last term students regarding teamwork and inner feeling concerning other disciplines (p>0.05).

Discussion

According to the team description, team members must be aware of their duties in the team. Ambiguity in the team structure can lead to disagreement in teams about ability, duty allocation, members' roles in team and responsibility of members in the team (7). Thus, health care teams must have common goals and must cooperate to provide the best possible care for the patients. Moreover, they must be trained together so that everyone knows his or her role in the team. The solution to this issue seems to be inter-professional training. In fact, it is a kind of training that members learn together and from each other to increase collaboration and improving patient care (9). Studies in this field had shown that team-based trainings in the clinical environment will encourage learners to learn from peers (10). Marry et al. (2002) hold a course to train teamwork for the physicians and nurses. The goal of this project was to reduce adverse events in the hospital emergency departments which led to a reduction in clinical errors from 30% to 4% (11). Bradley et al. used inter-professional trainings for teaching CPR to doctors and nurses. The inter-professional group had better team performance and had more positive approach toward this type of education (12). In another study conducted by Momeni et al. (2010) in Kurdistan University of Medical Sciences on training CPR to improve team performance, the results indicated that CPR training inter-professionally was significantly more effective than the usual method (13). Lack of teamwork attitude in university students probably stems from single professional training and lack of teamwork experience with other disciplines. Taking the results of this study into account which indicated that the students' perspective had not changed concerning teamwork during their educations, it seems that the present educational system had no program for teaching knowledge and necessary approach regarding teamwork. Furthermore, another study conducted in Yazd University indicated that the condition of that university is not appropriate for teaching teamwork. These conditions include prioritizing teaching with new strategies of education such as problem solving, promoting critical thinking and encouraging students and teachers to learn new sciences (5). Other studies had shown that the infrastructure for team training is not ready in Iran as well.

By teacher training, promoting the cooperation spirit, creating teamwork attitude and motivation, it is possible to create necessary preparation among them. Another result of the present study indicated that there were diverse attitudes among students of different disciplines regarding teamwork. However, this difference may be related to identity, autonomy and professional status. The high tendency of midwifery students regarding teamwork was probably due to high sensitivity and responsibility of this disciplines toward the safety of the mother and child simultaneously.

With regards to inner feelings regarding other disciplines, the tendency of teamwork among the midwifery students had led them to have a positive attitude about other health care professionals and consider them as their own complementary. It is recommended to conduct further studies in other universities among other midwifes to prove this point more strongly.

The lack of tendency of nursing students for teamwork is about irresponsibility toward the patients and their families regarding the treatment and recovery process since they believed that physicians were responsible toward the patient.

It seems that lack of teamwork spirit and attitude among the students is due to the lack of understanding of the principles of teamwork, single profession training and lack of team work experience with other disciplines. Teaching principles of team work can solve this issue to a large extent. Therefore, adding teamwork principles to the medical students' curriculum, teaching some of the practical courses inter-professionally, team-based training, teaching the theoretical sciences by problem solving methods and discussion in small groups can be helpful. It must be considered that teamwork is different from task; however both are crucial for teamwork. In addition, in health care, knowledge and skills are not sufficient in performing tasks and it must go along with teamwork performance (14). Hence, teamwork training in universities is vital. Considering the obtained results for increasing productivity, strategies for teaching principles of teamwork and providing the students with teamwork attitude must be taken into account. Last but not least, studies had shown that teamwork training leads to improving listening skills, feedback, reactive and communication skills (15). Therefore, today's students as tomorrow's employees must be able to communicate with their colleagues as team members effectively and with patients and their families as clients efficaciously.

Acknowledgment

 The Authors would like to acknowledge the Kurdistan University of Medical Science as Financer of the project with code 118/1390.