CONCLUSION
Our review shows there is limited positive evidence to suggest teamwork interventions improve patient outcomes. We discussed how certain elements of methodology (non-randomization, choice of outcome parameters) and study design (cohort size, training and follow-up times, training programme and subjects) may be the cause for non-significance. In order to justify future investment in teamwork training interventions, we call for more research using objective and standardised methodology.
Although cost-effectiveness of training interventions cannot be fully proven at present, a positive outcome should appear with the emergence of further high quality research. Promotion of teamwork training and teamwork mentality will also help to positively influence the culture within surgical training. Further reviews and metaanalyses should include quality studies, which can be assessed via scoring systems such as MERSQI or Newcastle-Ottawa Scale Education (NOS-E). We suggest that clinical outcome measures be used as endpoints, as they provide high threshold, objective and reproducible measures of effectiveness of interventional training, better than that of questionnaires or self-report scores. A unified, evidence-based training programme with consensus over training methodologies should then be established and adopted for widespread use. In particular, we suggest training time should be a minimum of two full days with a follow-up period of more than six months. There should be additional support and renewal of training material during this period.
