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Developing the competency of ‘collaborative clinical practice’

Maha Pervaz Iqbal[1], Gary Velan[1], Anthony J O'Sullivan[1], Asela M. Olupeliyawa[2], Chinthaka Balasooriya[1]

Institution: 1. UNSW Australia, 2. University of Colombo
Corresponding Author: Dr Maha Pervaz Iqbal ([email protected])
Categories: Educational Strategies, Educational Theory, Learning Outcomes/Competency, Teaching and Learning
Published Date: 12/04/2019


With the increasing complexity of healthcare delivery and patient case mix, and the aging population, health professionals are expected to function more often and more effectively as members of multidisciplinary teams. Competency based medical education (CBME) advocates that the professional development of doctors should be fostered from the start of medical school through to medical practice and with continuing professional development. Strategies for developing teamwork among health professionals and students range from minimal, implicit to explicit (Earnest et al., 2017). Considering this continuum of medical education and the spectrum of educational strategies, we propose a framework for the programmatic approach which can be used in developing competence in ‘collaborative clinical practice’.     

Keywords: Collaborative learning; Competency based medical education; Teamwork

Framework for the development of competence in collaborative clinical practice

The framework (see Figure 1) illustrates a staged approach to developing competence in collaborative clinical practice. In every stage of medical education, the collaborative skills that students develop contribute and cumulate towards developing and maintaining the overall collaborative and teamwork competency.

Figure 1: Framework to guide the staged approach to developing the competency of ‘collaborative clinical practice’


Novice and junior medical students may begin to learn in formal (e.g. Problem based learning, Task based learning, and Case based learning) and/or informal small group activities (e.g. study groups) and thus develop skills in collaborative learning among peers. At this stage, there may be minimal focus on healthcare teamwork, with a stronger emphasis on aspects such as the five elements of cooperative learning (which include positive interdependence, individual accountability, face to face promotive interaction, social skills and group processing) (Johnson and Johnson, 1999). The development of these skills support the subsequent development of skills needed for collaborative clinical practice. As students’ progress, interprofessional learning may occur ad hoc when students participate in clinical workplace learning activities or this may be offered within the formal curriculum (e.g. classrooms or simulated learning contexts). Such opportunities may aid in developing students’ skills in collaborative learning within interprofessional groups in a more explicit manner (1), focusing on attributes such as mutual respect and shared decision making.  Medical students in their clinical placements have the opportunity to develop collaborative learning skills in clinical workplace contexts. They gradually integrate both horizontally and vertically as team members within the clinical practice teams and start to develop skills in collaborative practice for patient care. It would be important to pay attention to the hidden curriculum to ensure that strategies such as role modelling focus on promoting attributes that lead to effective teamwork. The next important point is the transition to junior doctor, where educational instruments such as the T-MEX (Olupeliyawa et al., 2014), based on situated learning (see related theories in Table 1 below), have been found to facilitate the learning of teamwork behaviours such as recognising one’s limitations and communicating concerns effectively. Finally, trainees’ learning in the workplace or continuing medical education activities of practicing physicians can be supplemented by simulation-based training(Salas et al., 2005). In conclusion, a repertoire of activities may be designed and offered across the various stages of medical education to progressively develop students’ skills in collaborative learning and collaborative practice.  

Table 1: Stage of Collaborative learning and the appropriate educational theories

Stage of collaborative learning and contexts

Appropriate educational theories applicable to collaborative learning and teamwork  

Collaborative learning in a small group learning context


The social cognitive theory suggests a triadic relationship between the learner, the environment and the learner’s behaviour. It is important to consider that the relative influence of each factor varies for different activities, individuals and circumstances.  The individual learner brings his or her personal knowledge, skills, attributes and previous experience, and learns and interacts dynamically with all others in the setting, including teachers and peers (for example in collaborative learning groups) and with other contextual influences.

For detailed theory see: Bandura A. Social foundations of thought and action: A social cognitive theory: Prentice-Hall, Inc; 1986


Situated learning in communities of practice (COP) is about learning and development through active participation in various activities e.g. interprofessional groups and clinical teams. The members of COP would benefit by acquiring skills in collaboratively working together and learning at the same time. Every individual learner within the community needs to understand which skills, behaviours and competencies, are essential for effective participation. Students start by observing the community of practice and gradually begin to integrate in the group/team functioning, starting with legitimate peripheral participation.

For detailed theory see: Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation: Cambridge University Press; 1991.

Collaborative learning in interprofessional groups in classroom or simulated context

Collaborative learning in teams during student clinical placements or junior doctor supervised training placements


Collaborative practice in clinical teams in workplace context

Take Home Messages

  1. Health professionals are expected to function effectively as members of multidisciplinary teams.
  2. Competency based medical education (CBME) advocates that the professional development of doctors should be fostered from the start of medical school through to medical practice and with continuing professional development.
  3. The framework for the programmatic approach which can be used in developing competence in ‘collaborative clinical practice’ outlines a spectrum of educational startegies for developing students' skills in collaborative learning.  

Notes On Contributors

Maha Pervaz Iqbal, MBBS, MMed (Dundee), PhD (UNSW) is an Associate Lecturer at School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Australia.

Gary M. Velan, MBBS (Hons), DipHEd, PhD (UNSW) is a Professor and Head, Dept of Pathology, and Head of the Educational Research and Development Unit at the School of Medical Sciences, UNSW Medicine, UNSW Sydney, Australia.

Anthony J. O’Sullivan, MBBS, MD UNSW, FRACP, MHPEd is a Professor at St. George and Sutherland Clinical School and Program Authority for UNSW Medicine, UNSW Sydney, Australia.

Asela M. Olupeliyawa, MBBS, PhD (UNSW) is a Senior Lecturer in Medical Education at the Department of Medical Education, Faculty of Medicine, University of Colombo, Sri Lanka. 

Chinthaka Balasooriya, MBBS, PhD (UNSW) is Associate Professor and Director of Medical Education Development at the School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Australia.




Earnest MA, Williams J, Aagaard EM. (2017). 'Toward an Optimal Pedagogy for Teamwork'. Academic Medicine. 92(10):1378-1381.

Johnson DW, Johnson RT. (1999). 'Learning Together and Alone: Cooperative, Competitive, and Individualistic Learning.' Allyn and Bacon.

Olupeliyawa A, O’Sullivan A, Hughes C, Balasooriya C. (2014). 'The Teamwork Mini-Clinical Evaluation Exercise (T-MEX): A Workplace-Based Assessment Focusing on Collaborative Competencies in Health Care.' Academic Medicine. 89(2):359-365.

Salas E, Sims DE, Burke CS. (2005). Is there a “big five” in teamwork? Small group research. 36(5):555-599.




There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (

Ethics Statement

This paper illustrates a framework for developing the collaborative competency in medical education and therefore no data was collected. All the relevant literature has been cited.

External Funding

Postgraduate Research Scholarship: Australian Postgraduate Award (APA) Scholarship for PhD in Medical Education at UNSW, Australia.


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Ken Masters - (27/07/2019) Panel Member Icon
An interesting paper on developing the competency of ‘collaborative clinical practice’. The authors present a model for such development.

While the proposed model appears interesting and valuable, there is much work on the paper that I would like to see:

• The Abstract reads more like an Introduction (and even contains a citation). The abstract needs to be a succinct summary of the paper.
• Much of the current Abstract can be used to form the basis of an Introduction, although this will need to be expanded, especially beyond the single citation. It appears that some of the text after Figure 1 might also be better positioned before Figure 1 as part of this Introduction.
• Figure 1 is very complex. It is probable that the authors have worked with it for some time, and so the components and flow appear very obvious. For the reader reading this paper the first time, however, understanding the various components is not a trivial affair. There is a single block paragraph following Figure 1, but it is difficult to relate aspects of the text to stages and components of the model – in short, the authors are expecting their readers to work too hard. Table 1 does appear to elaborate to a large extent on this, but, again, it is difficult to match the items in Table 1 with the items in Figure 1. For example, both the figure and the table have elements that are identified as four stages and contexts, so one would assume that the table is an explanation of the figure. When one reads the descriptions, however, there is no match, so it is unclear as to whether the table is to be read as an explanation of the figure or not.

I would strongly recommend that, after Figure 1, the authors place Table 1, matching the descriptions (if, indeed, Table 1 is a description of Figure 1), and leading the reader through the stages. In doing so, the authors give a detailed, step-by-step (in tabular or numbered list form) description of the Figure’s stages and components. In effect, teach the model to the reader as you would teach it to a class.

• The paper has no Conclusion or reflection or considerations of limitations. The paper simply stops. It really does need to be rounded off properly.

• Finally, the citations in Table 1 should also conform to the standard citations in the Journal’s style, rather than a placing of the full references in the body of the paper.

So, I think that the authors have given the model a great deal of thought and work, but the presentation in the paper is very problematic, and does need a great deal of attention.
Possible Conflict of Interest:

For Transparency: I am an Associate Editor of MedEdPublish

Subha Ramani - (12/04/2019) Panel Member Icon
I enjoyed reviewing this model for interprofessional learning grounded in educational theories. The authors rightly argue that one of the core clinical competencies in medical education today is working on interprofessional clinical teams. They are also accurate in recommending that this learning should span the continuum of clinical training- from undergraduate to continuing professional development. Their framework does offer a step by step approach to teaching and assessing teamwork competencies consistent with developmental level of the learner.
I have 2 comments:
1. Are the authors really describing programmatic assessment when they talk about learning across the continuum of professional development? Programmatic assessment refers to formative, short and multiple segments clinical assessment of competencies at multiple stages of training. I am not entirely sure learning and assessment across undergraduate, postgraduate and continuing professional development can be classified as programmatic assessment.
2. I would like to see more emphasis on how medical trainees can learn together with other health professions trainees. Although we talk about the importance of interprofessional learning, most health professions still learn in their unique educational environment and once they arrive at the clinical placements they are expected to be collaborate.
I like the model and think the authors can further develop the framework to inform other health professions educators how they could structure true interprofessional learning.