2

Multiprofessional learning

Interdisciplinary education and teamwork: a long and winding
road
Pippa Hall & Lynda Weaver

Purpose This article examines literature on interdisciplinary education and teamwork in health care, to discover the major issues and best practices.
Methods A literature review of mainly North American
articles using search terms such as interdisciplinary,
interprofessional, multidisciplinary with medical
education.
Main ®ndings Two issues are emerging in health care as
clinicians face the complexities of current patient care:
the need for specialized health professionals, and the
need for these professionals to collaborate. Interdisciplinary health care teams with members from many
professions answer the call by working together, collaborating and communicating closely to optimize patient
care. Education on how to function within a team is

Introduction
The aging population, the rising incidence and prevalence of cancer and other chronic diseases are shifting
the focus of medicine from the model of `cure' to one of
controlling symptoms, maximizing patients' level of
functioning and quality of life, as well as helping
patients and families cope with a long-term illness. The
increasing complexity of knowledge and skills required
to provide comprehensive care to these patients has
resulted in increasing specialization within the health
professions.1 Although this specialization allows for
in-depth exploration of issues by a speci®c discipline, it
means that no one health care professional can meet all
the complex needs of these patients.2
With increasing specialization, there is less opportunity for interdisciplinary exchange. It is more
comfortable to remain within one's own discipline
where communication is facilitated by specialized

Correspondence: P Hall, Assistant Professor, Department of Family
Medicine, University of Ottawa Institute of Palliative Care, 43
Á
Bruyere St, Ottawa, Ontario, K1N 5C8, Canada

essential if the endeavour is to succeed. Two main
categories of issues emerged: those related to the
medical education system and those related to the
content of the education.
Conclusions Much of the literature pertained to
programme evaluations of academic activities, and did
not compare interdisciplinary education with traditional methods. Many questions about when to educate, who to educate and how to educate remain
unanswered and open to future research.
Keywords Education, medical, *methods; interdisciplinary communication; patient care teams; quality
of health care; teaching.
Medical Education 2001;35:867±875

vocabulary, similar approaches to problem solving,
common interests and understanding of issues. This
discipline-speci®c view of the world is taught and
reinforced through the socialization processes of
educational experiences.3,4 Members of each specialty
and discipline have a theoretical basis through which
they interpret and address issues which arise in their
work. Petrie refers to this as the professional's `cognitive map', i.e. the whole cognitive and perceptual
approach embraced by the discipline.5±7 As these maps
become entrenched through repeated use, communication with other disciplines can become increasingly
challenging. Petrie states that `¼quite literally, two
opposing disciplinarians can look at the same thing and
not see the same thing'.5 The patient with complex
health problems, and his/her family, must interact with
a battery of specialists who may experience dif®culty
establishing effective communication among themselves. This communication becomes even more problematic as the socioeconomic pressures move care out
of institutions and into the community where health
care professionals are usually not in the same geographic location at the same time.

Ó Blackwell Science Ltd ME D I C AL ED U C AT I ON 2001;35:867±875

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P Hall & L Weaver

Key learning points
Education on how to function within a team is
essential if the endeavour is to succeed.
Interdisciplinary education must address role
blurring, group skills, communication skills,
con¯ict resolution skills for team members and
leadership skills for faculty.
Many questions about the effectiveness of
teamwork and best practices in teaching are yet
unanswered.

In summary, a dilemma emerges as clinicians face the
complexities of patient care: an increase in specialization of health professionals and an increase in challenges to collaboration between specialists. In many
facilities, the response to complex patient care is to
group different professionals together as health care
teams.

Health care teams
In practice, health care teams function somewhere
along a continuum of degrees of interaction among
team members and their degrees of responsibility
for patient care. Different points on this continuum
are represented by the multidisciplinary team,
the interdisciplinary team and the transdisciplinary
team.
The multidisciplinary team allows for each discipline
to independently contribute its particular expertise to
an individual patient's care. Traditionally, it has been
the physician who is responsible for prescribing the
contribution other disciplines could make and for
coordination of services.8 Team members work in
parallel to each other, and direct interdisciplinary
communication is minimal except through the physician in charge.9 Members of the team may be of the
same discipline/profession (e.g. a team of surgeons and
internists involved in the care of a patient with complex
health problems) or from different disciplines/professions (e.g. an orthopaedic surgeon, physiotherapist and
occupational therapist working with a patient who is
recovering from a fracture).
The interdisciplinary team refers to a team whose
members work together closely and communicate frequently to optimize care for the patient. The team is
organized around solving a common set of problems9 (as
opposed to being organized around a single physician)
and meets frequently to consult. Each member of the

team contributes his/her knowledge and skill set to
augment and support the others' contributions.10 Each
member's assessment must take into account the others'
contributions to allow for holistic management of the
patients' complex health problems.5 Team members
preserve specialized functions while maintaining
continuous lines of communication with each other,7
placing themselves somewhere in the centre of the continuum of interactions and responsibilities. Examples of
this type of teamwork are often seen in complex patient
care areas exempli®ed by palliative care,10,11 geriatrics9,12 and mental health.13 This type of work in clinical
practice is also referred to as `interprofessional'.14
In transdisciplinary work, the team is operating at the
opposite end of the continuum from multidisciplinary
teams. Roles of the individual team members are
blurred as their professional functions overlap. Each
team member must become suf®ciently familiar with
the concepts and approaches of his/her colleagues to be
able to assume signi®cant portions of the others'
roles.14
This discussion will only focus on what is known
about interdisciplinary education and teamwork in the
health care ®eld and will identify some of the many
questions raised along the long and winding road
towards excellence in patient care.

Review of the literature: interdisciplinary
education of the health care team
In the health care literature there appears to be a lack
of evidence addressing professionals' ability to learn
interdisciplinary team skills while working, without
formal education. The majority of publications were
from academic centres where educational programmemes were the focus of study. The literature search
was complicated by the inconsistent and myriad
terminologies used to describe health care professionals
working in team settings. Most literature reviewed was
from North America.
Interdisciplinary teamwork and education is a
recurring issue in the health care literature, a fact well
documented in the review article of Giardino et al.15
Between 1971 and 1981, there was a ¯urry of activity
on interdisciplinary work, as the American Nursing
Association and the American Medical Association
worked on a National Joint Practice Association. This
effort collapsed due to con¯icts, particularly concerning
issues of nurses' role expansion and salaries.16
Two main categories of issues emerge from the
literature: one pertaining to the system of education
and training of health care professionals and the other
to the content of interdisciplinary education.

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P Hall & L Weaver

1 System issues

Availability of interdisciplinary education
In 1976, Bloom & Parad found only 36% of mental
health training programmes had any interdisciplinary
training component, although interdisciplinary functioning at work was the rule rather than the exception.13
In 1982, McPherson & Sachs reported the results of a
survey to determine the extent to which interdisciplinary health team concepts were being taught in US
and Canadian medical schools.17 Less than 30% of the
105 responding schools had a formal undergraduate
programme or component for interdisciplinary teamwork. Only half of these were compulsory.
In 1992, the Centre for the Advancement of Interprofessional Education in the United Kingdom reported
the ®ndings of their May 1987±April 1988 national
survey of professional groups involved in education
(undergraduate, postgraduate and continuing education).18 Only 7% of the participants in the interprofessional educational activities were physicians (general
practitioners), the rest being nurses and allied health care
professionals. The report notes that interprofessional
educational endeavours are increasing in general.
Despite this apparent lack of opportunities, examples
of university-based interdisciplinary health-related
education programmes were found in the literature.
Topics taught in this interdisciplinary manner ranged
from oncology, health promotion, orthopaedics, and
geriatrics, to information and appraisal skill building.
Teams were made up of various combinations of
undergraduate and graduate students from medicine,
nursing, social work, psychology, pharmacy, dietary
sciences, library sciences, and health or public administration.
Timing of the interdisciplinary education intervention
Several studies suggest that learning to work in an
interdisciplinary milieu should occur early in the
education of the health care professional (e.g. within
the ®rst 2 years). Horak et al. suggest that the experience of shared learning at an early stage may better
facilitate interdisciplinary collaboration (considered by
Horak to be crucial to satisfactory patient outcomes)
among future health care professionals.19 Arnvaripour
et al. describe an interdisciplinary programme for second-year medical students, but recommend an even
earlier introduction to the topic.20 Headrick et al., in
two articles, recommend involving medical residents in
interdisciplinary projects which are relevant to their
needs, scheduled as part of their core programme and
begun early in their education to optimize the learning
experience.21,22

869

Petrie, however, says that the individual embarking
on interdisciplinary teamwork must ®rst of all be
secure in his/her competency in his/her discipline.5
Mariano also states that a thorough knowledge of
one's own discipline is essential to understand
contributions to the team effort, and freedom to be
truly interdisciplinary only comes with security in
one's own discipline.2 This would suggest that early
interventions in undergraduate education would not
be appropriate and programmes should only be started
at the senior student23 or postgraduate level. Wahlstrom and colleagues describe an educational proÈ
gramme which integrates multiprofessional education
throughout the medical undergraduate curriculum.24
Obviously, the debate is unresolved.
Non-traditional teaching methods
Methods to teach interdisciplinary practice differ greatly
from traditional didactic lectures. Interdisciplinary
problem-based learning (PBL) and the service/learning
models are examples of two team approaches to
education.1,9,25 PBL, done in small-group format,
offers a means of integrating theory with clinical
components and demands knowledge acquisition, attitudinal and psychomotor skills from the learners.25 PBL
is a structured educational activity, usually employing
case presentations as the stimulus to learning. This
approach helps students learn to listen to each other and
to collaborate as they work to resolve the problems.26
The service/learner model uses a clinical setting
to challenge the learners to work together effectively
to address real clinical problems,23 patient education or
health dilemmas of under-serviced populations.9
Both these teaching methods support Petrie's
recommendation for ìdea dominance' if an interdisciplinary team is to succeed.5 Ìdea dominance' means
that a clear and recognizable idea must serve as a focus
for teamwork, rather than the traditional focus of each
member's domain of care. This would place the patient
at the centre of the team's focus. In addition, ìdea
dominance' emphasizes that the team members must
be able to recognize their success and achievements in
pursuing their goals. Not only must the project/idea
succeed, but each team member must perceive that he/
she is personally achieving something.
Teaching methods, such as critical appraisal and the
highly re¯ective or questioning techniques proposed by
some poststructuralists, including Cherryholmes,27
Lincoln,28 Tierney29 and Purdy,30 and by feminists
such as Bryson,31 Hoodfar32 and Manicom,33 can
confront traditional approaches, facilitate working
across professional and cultural differences and could
make signi®cant contributions to interdisciplinary


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P Hall & L Weaver

communication. These methods are unfamiliar to most
faculty, particularly those in the health care professions.
Introducing these concepts to faculty in practical and
useful ways will be a challenge.
MacDonald suggests physicians are reluctant to
participate in certain educational activities, such as role
play, small-group problem-based learning and practicum experiences, which have been shown to have an
impact on their behaviour.34 Without these interactive
learning tools, practising interdisciplinary work would
be dif®cult.
Need for faculty development
In addition to non-traditional teaching methods, faculty
face other educational concepts and issues which
require new knowledge, attitudes and skills when facilitating interdisciplinary education.35 McPherson and
Sachs examined programmes which used concepts
from behavioural and management sciences to teach
group process skills, team roles and functions, and
health care content.17 They emphasized the need to
prepare students for the interpersonal dynamics
required in the integrated approach to health care
planning and management. However, the physician
educators were not familiar with the concepts used in
the behaviour sciences and management.
The interdisciplinary undergraduate programme
reported by Horak, O'Leary and Carlson at George
Washington University and George Mason University
(known as the George Team) illustrates the extensive
amount of time, dedication and skill required by the
faculty to successfully implement this type of programme.19 Motivating faculty to become interested in
new programmes and approaches to education is an
ongoing challenge, requiring change-implementation
strategies, such as those facilitated by tools and
management approaches used by continuous quality
improvement (CQI) programmes.36±38 As Bruhn25 says,
¼no change will occur unless members of a system
feel it is safe to give up old responses and learn new
ones. The change must ®t the total learning environment and be integrated into the total system if it is
to survive¼
Many of the innovative interdisciplinary service/
learner projects mentioned above are in preventive
health and health maintenance in primary care,
particularly for low socioeconomic groups, which may
be considered low pro®le medical domains. McPherson
& Sachs suggest that the lack of interest in developing
interdisciplinary educational programmes is related to
this, and to a general reluctance to embrace new
ideas.17 The need exists, then, for more training and

motivational incentives for physician educators to
become involved in these programmes, as well as an
increase in the use of non-physician educators to teach
interdisciplinary skills.
Institutional support
If they are to succeed, interdisciplinary teams require
support from the administration of the educational
and clinical institutions involved5,26,35 and, as Petrie
notes, from their peers.5 Mariano reinforces the need
for institutional commitment to interdisciplinary
collaboration, mentioning not only the time necessary
for team process and development, but issues of space
and physical proximity of team members,2 which are
even greater dilemmas for health care professionals
in the community. Administration's acknowledgement of the success of an interdisciplinary project, as
well as the individual accomplishments of team
members, provides important positive feedback for the
team and can signi®cantly contribute to the project's
success.
Participants' characteristics
Most of the educational projects reviewed involved
learners who volunteered to participate in an interdisciplinary educational activity. Groups showed high
participation rates by women, perhaps re¯ective of the
higher proportion of women in disciplines such as
nursing, physiotherapy, etc. The number of participants was small in most projects, although the group
described by Horak et al. showed increasing rates of
participation over the 2 years of the project.19 Latimer
and colleagues, discussing McMaster University's daylong interdisciplinary palliative care course, reported
high levels of both learner and faculty satisfaction;39
however, the participation rate of medical students
had been decreasing over the previous few years.
Those interested in, or with an appropriate skill base
in, interdisciplinary work may self-select to participate.
Positive evaluation results may indicate this bias, or
the intensive supervision by and contact with faculty.
Faculty members were given minimal dedicated time
or ®nancial rewards for this work, indicating they were
generally highly motivated and committed. Indeed,
they may represent a very small proportion of faculty
with a predisposition for acquiring the skills, knowledge and attitudes necessary for this type of programme.
Petrie states that participants in interdisciplinary
teamwork must have a taste for new adventure.5 To be
an effective team, members must all be excellent
within their disciplines, aware of the stringencies of
their respective disciplines, yet ready to leave this



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P Hall & L Weaver

safety to embark on the relatively uncharted course of
interdisciplinary work. They must also be willing to
pursue excellence in this new domain with similar
rigour.
2 Content issues

Professional role demarcation versus role blurring
As previously discussed, each health care professional
learns his/her traditional role through the education
process of his/her profession and discipline. The role
becomes an integral part of the individual's `cognitive
map'.5 Agreeing with Petrie, Hill formulates that health
professionals come to the health care team with
preconceived maps of their roles based on their learned
culture, beliefs and cognitive approaches in their speci®c disciplines.40 They have poor understanding of the
other person's roles or maps, which causes anxiety,
con¯ict and ineffectiveness as a team.
In teamwork, members should possess areas of
overlapping competencies and share responsibilities
depending on the model of practice. Mariano describes
this as `role blurring'.2 Several problems arise when role
blurring is not handled well. Some team members may
not realize the others' potential contribution to patient
care, and will underutilize their expertise. Consequently, members are not engaged to their full potential
and may feel resentful. Some members may even try to
do all the physical, psychosocial and emotional care
themselves, setting the stage for burnout, failure and
team con¯ict. Hill found that nurses in particular
experience role blurring as they struggle with con¯icts
between being a clinical nurse specialist and traditional
nurse, as well as with physicians' expectations of the
nursing role.40 Mariano suggests exercises to assist
team members to clarify each other's roles. These allow
team members to: (a) clarify role perceptions and
expectations; (b) identify their own professional
competencies as well as the competencies of other team
members; (c) explore overlapping responsibilities, and
(d) renegotiate role assignments.2
Johnson et al. describe a programme which experientially introduces medical residents to the nurses'
role.41 Working for one day alongside a nurse preceptor, the residents gained an appreciation for nursing
tasks, skills and knowledge. There was evidence that
communication skills of the participating residents
improved. At the opposite end of the spectrum,
Giardino et al. report on a 1985 study of medical students who did not receive interdisciplinary education.
Students' attitudes towards nursing became negative
after their 4 years of schooling, and only 20% realized

871

that `nurses had legitimate roles independent of physician orders and expectations'.15
Hall et al. report that both the physicians and allied
health care professionals in interdisciplinary palliative
care educational workshops indicated that the interdisciplinary experience was the most valuable aspect of the
programmes, and it would have an important effect on
improving care of the terminally ill in their communities.42 By working on case studies and clinical issues in
small groups, these participants gained insight into the
importance of understanding each other's roles. Wilson
points out that this appreciation can only become truly
evident by working with problems in the real world.43
Resistance to giving up clearly de®ned roles and
boundaries is fairly well documented. Critics such as
Ivan Illich, as discussed by Schon, de®ne a profession
È
as an inappropriate manipulation of knowledge which
disregards social injustices and mysti®es expertise.44
Professions tend to implement both procedures which
separate other disciplines from their own and measures
to restrict access to the discipline. Witz has called this
external and internal closure.45 The concept of
boundary work discussed by Gieryn actually contributes to the construction of the cognitive maps discussed earlier by forcing professionals to develop a
framework or paradigm with which to view the world.46
Interdisciplinary education and practice propose to
collapse the walls separating professionals.
Group skills
Weber & Karman describe the use of the Tuckman
model of group development with students to develop
their interdisciplinary team skills.47 The educator leads
students through different stages of `forming, storming,
norming and performing'. `Forming' refers to the
forming of task-oriented behaviour as the goals and
objectives for the team are de®ned. `Storming' is the
stage where the individuals and group react affectively
to the requirements of the task and to interpersonal
con¯icts. The `norming' stage is achieved when effective
cooperation between the team members occurs through
communication of ideas, opinions and information. In
the ®nal stage, `performing', collaboration between the
team members for task achievement is evident through
interdependence of relationships and contribution of
resources. As the individual learners develop their group
skills, the group matures to the performing level,
requiring little direction from the educator. The group
is then able to take on a task and independently carry it
through to completion. As the group matures, so do the
members' abilities to resolve con¯icts and remove barriers to goal achievement. This also illustrates the


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P Hall & L Weaver

importance of the leadership skills of the educator or
team leader (see Leadership skills below).
Communication skills
As health care professionals face their patients' multidimensional problems, they can experience stress and
high emotions, and this can introduce tension between
team members.7,10 Elliott-Miller et al. discuss how
open, honest and clear communication among team
members can alleviate some of the stress.10 Others have
shown that communication skills can be learned.48
Mariano identi®es poor communication skills between
members of different disciplines as one of the major
factors preventing effective interdisciplinary teamwork.2 Universities and other educational programmes
have spent little time educating students on these skills.
Con¯ict resolution skills
Con¯ict resolution is an essential skill for all team
members to master at an early stage. Bloom & Parad
note that interdisciplinary practice does not necessarily
mean all members come with equal attitudes towards
tasks or take on equitable or reciprocal responsibilities.13 These value differences can cause con¯icts
between members.2 Con¯ict can also arise from differing goals of team members. This reinforces the
importance of Petrie's concept of `idea dominance' in
reducing goal con¯ict (see section above on Nontraditional teaching methods).5 Mishandled con¯icts
can make the team ineffective and dysfunctional.
McKenna used `role negotiation' methods to alleviate serious con¯icts that developed in a team as a
direct result of role blurring, and suggests that these
techniques be taught early in the development of a
team.8 Well-managed con¯ict resolution will facilitate
team growth and maturation.
Clark et al.,9 Fagin16 and Makaram26 point out that
the perceived status of individual team members can
potentially disrupt team harmony with issues of
authority, power and autonomy, as can members' personal characteristics. Con¯ict resolution skills can assist
in minimizing this problem, as can good communication skills.
Leadership skills
Leadership skills are particularly signi®cant for team
leaders and faculty who manage or facilitate interdisciplinary group work.47 The leader must be able to
identify different stages of the team's development and
implement appropriate leadership approaches. Early
stages require highly directive leadership, with high
emphasis on task and low emphasis on relationship
behaviour. As the team matures, the leader facilitates

the group's increasing ability to undertake tasks by
encouraging the team's sense of ownership and
responsibility. The next stage requires the leader to
delegate more, with low task direction and less socioemotional support. Finally, the group will mature,
become autonomous and assume full responsibility for
tasks and relationships within the team. Leadership for
different tasks may rotate among team members as the
needs and focus change.
In clinical settings, team membership is constantly
changing as members leave for various reasons and
are replaced. The changing membership challenges
team dynamics. Although there is no clear discussion
of this issue in the reviewed articles, the team leader
must be prepared to adopt the appropriate leadership
style necessary to lead the team to a new level of
maturity.

Discussion
Problems of health care are major and complex, both
on a clinical level and a management level. In Canada,
it is only over the past decade that serious attempts to
control health care costs have resulted in structural
changes that force health care professionals to examine
their practices.49 The complexity of patient care has
contributed to the increasing awareness that effective
interdisciplinary teams may help reduce costs by
reducing service duplication and minimizing unnecessary interventions. Regardless of cost, the interdependence and synergy of the team may also improve
patient outcomes and team members' individual job
satisfaction and performance.9,10
The key points from the current literature can be
interpreted as assumptions until further research tests
the theories. The assumptions suggested by this literature are as follows.
· There appears to be a consensus in the published
literature on the need for an interdisciplinary
component in health care professionals' education.
· There is no clear consensus on the ideal timing of an
interdisciplinary educational intervention.
· Faculty development must be provided to address
motivation to participate. This includes: opportunities for faculty to learn how to facilitate interdisciplinary education sessions, and learning skills from
management and behavioural sciences as well as
leadership skills.
· Teaching methods are non-traditional, and include
interdisciplinary problem-based learning (PBL), the
service/learning model, and teaching strategies from
feminist and poststructural theories.



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P Hall & L Weaver

· `Role blurring' is necessary for function as an interdisciplinary team, though there is much resistance
and confusion associated with rede®ning roles.
· Certain non-clinical skills must be learned by team
members: group skills, communication skills and
con¯ict resolution skills.
There appears to be little in the health care literature
which discusses the outcomes of learning from one
another in an interdisciplinary setting, although Fagin
notes that many physicians state that, during their
training, they learned from experienced nurses.16 Most
of the results presented here were from programme
evaluation (e.g. learner satisfaction), or indicated
increased knowledge in programme participants without a control or comparison group to determine whether the intervention was the best practice (or just one
of possible best practices). The majority of the participants in the reported interdisciplinary programme
evaluations were volunteers. There was no information
on the classmates who did not volunteer to take the
programmes, which could have further illuminated
some barriers.
Issues which relate to cognitive learning theory are
not addressed in this literature. Each profession and
discipline may have a predominance of individuals with
a particular set of cognitive learning skills and styles.
Their educational process will reinforce these skills.
Interdisciplinary education must therefore address not
only these different cognitive styles, but also teach
participants not to judge those with different styles as
being inherently superior or inferior.
The concept of interdisciplinary teamwork did not
originate in the university health sciences programmes,
but was formulated by front-line practitioners facing
the complexities of patient care. As it is increasingly the
responsibility of the university to educate health care
professionals, it is proposed by both graduates and the
community that students be better prepared for the
work they will be expected to do. These external pressures on the university system demand ¯exibility and
responsiveness from the educational process. The
university in western society is now a diverse educational community, with different colleges and specialized schools and, within each, there are increasing
numbers of departments and areas of special studies.
Kerr refers to this as `the multiversity' of modern academic life,50 which portrays the multiple silos under
one governance. Wilson suggests that this fragmentation in academia has resulted in further fragmentation
of knowledge.43 The physical layout and traditional
academic approach of universities are not conducive to
interdisciplinary concepts. Changing these structural

873

barriers will be challenging, and will probably only be
achieved through formal research evidence.
Despite the plethora of literature on interdisciplinary
education and teamwork, many questions are still
unanswered. Which patients truly bene®t from the care
provided by an interdisciplinary team?51 Do interdisciplinary teams actually provide more holistic and
effective care? Which health professionals should learn
how to work in an interdisciplinary team? Are there
certain cognitive skill sets which preclude learning and
functioning in an interdisciplinary way? Does every
health professional require all or some of the knowledge
and skills? If everyone requires at least some, which
ones are essential? How do the rigorous demands of
traditional disciplines apply to the interdisciplinary
setting? Are members of interdisciplinary teams more
satis®ed with their work, and, if so, why? When should
interdisciplinary education begin? Is there a continuum
of complexity to this type of work which would allow
for some educational interventions early in undergraduate training (e.g. communication skills, con¯ict
resolution skills, exercises to encourage interpretation
of a given situation with a new perspective), followed by
more complex levels of interdisciplinary work when
students are more competent and con®dent in their
respective disciplines? What values are involved in
interdisciplinary practice? What methods are most
effective for teaching interdisciplinary teamwork? What
is the best way of teaching nebulous but vital concepts,
such as the necessity of sharing the burden of care,
understanding equality in responsibilities and reciprocity, sharing a common goal, and trusting team members? Are there jurisdictional and medicolegal issues
which need to be addressed before collaborative and
effective teamwork can occur? Who should teach
interdisciplinary concepts and teamwork?
Further research is needed to answer these questions
and to test assumptions, beginning with exploratory
methods to determine the underlying concepts and
epistemology of interdisciplinary teamwork. Through
programmes such as those described at the undergraÈ
duate level by Carpenter23 and Wahlstrom,24 at the
postgraduate level by Leiba52 and Counsell et al.12 and at
the continuing educational level by Hall et al.,42 answers
to these and other emerging questions should begin to be
provided. The long and winding road ahead is exciting
and appears to have much to offer patient care.

Funding
The authors are grateful for the support they have
received from the AMS Wilson Senior Fellowship
which helped them complete this work.


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P Hall & L Weaver

Contributors
Dr Hall's interest and experience in interdisciplinary
teamwork and education led her to review the literature, assisted by Ms Weaver, who is the Evaluation and
Education Project Coordinator for the Institute of
Palliative Care. Together they developed the article,
with equal contribution.

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Received 14 March 2000; editorial comments to authors 1 August
2000; accepted for publication 19 September 2000


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