Multidisciplinary Medical Team Meetings Research Articles

The nonverbal structure of patient case discussions in multidisciplinary medical team meetings

Meeting analysis has a long theoretical tradition in social psychology, with established practical ramifications in computer science, especially in computer supported cooperative work. More recently, a good deal of research has focused on the issues of indexing and browsing multimedia records of meetings. Most research in this area, however, is still based on data collected in laboratories, under somewhat artificial conditions. This article presents an analysis of the discourse structure and spontaneous interactions at real-life multidisciplinary medical team meetings held as part of the work routine in a major hospital. It is hypothesized that the conversational structure of these meetings, as indicated by sequencing and duration of vocalizations, enables segmentation into individual patient case discussions. The task of segmenting audio-visual records of multidisciplinary medical team meetings is described as a topic segmentation task, and a method for automatic segmentation is proposed. An empirical evaluation based on hand labelled data is presented, which determines the optimal length of vocalization sequences for segmentation, and establishes the competitiveness of the method with approaches based on more complex knowledge sources. The effectiveness of Bayesian classification as a segmentation method, and its applicability to meeting segmentation in other domains are discussed.

Physical space and information space: studies of collaboration in distributed multi-disciplinary medical team meetings

We conducted field studies with three multi-disciplinary cancer teams at three hospitals. We investigated distributed multi-disciplinary team meetings (MDTMs) at each setting focusing on the organisational context, existing collaboration technology facilities and the use and availability of digital medical information systems. Our results highlight how factors such as room size, team size, seating arrangements, display configuration and variations in preparing and presenting medical information clearly influence the dynamics of the conversation and information sharing in distributed MDTMs. Our analysis shows how these configurations, arrangements and practices arise and the implications they have for any technical interventions that might be introduced. We discuss how to configure a collaborative work space to support information sharing and communication in distributed MDTMs, such as a shared physical space facilitating interaction, a shared information space affording varied styles of medical information interaction and, importantly, configuring available technologies and resources to support collaboration in shared spaces without compromising local contexts.

Collaboration Within Different Settings: A Study of Co-located and Distributed Multidisciplinary Medical Team Meetings

This paper reports our findings from a study of multidisciplinary team meetings for the treatment and ongoing management of breast cancer patients. The focus of the fieldwork was the meetings within and between a large group of multidisciplinary health professionals from two hospitals in Sydney, a large public teaching hospital and a much smaller private hospital. The paper examines the common work of the meetings and the variation within and between local practices and sites in the doing of this work, both in the local settings of each hospital and in the video-mediated setting when the local meetings are linked. Variations in the physical setup of the meetings, the presentation of the patient cases and the preparation of images used in patient discussion are identified, traced to their various sources and examined within their particular sociotechnical context. This is followed by a discussion of how local variation contributed to the particular challenges of the video-mediated meetings as experienced by the participants and how they might be addressed. Our motivations are to contribute both to the growing case studies of multidisciplinary team meetings within healthcare settings and to the important work being done to generate conceptual and design approaches that can support the development and successful use of CSCW technologies across highly variable local settings.

Consequences of Participating in Multidisciplinary Medical Team Meetings for Surgical, Nonsurgical, and Supporting Specialties

This study examines the consequences for medical specialists of participating in multidisciplinary medical team meetings in terms of perceived clinical autonomy, domain distinctiveness, and professional accountability. These consequences may influence their willingness to cooperate and the quality of teamwork. The authors hypothesized that multidisciplinary medical team meetings would be more of a threat to the professional identity of surgical specialists than to the professional identity of nonsurgical and supporting specialists. A survey among 1,827 Dutch medical specialists supported the authors' hypotheses. However, a few specific specialties had response patterns that deviated from our expectations. The results are related to specialty choice, to the training of medical specialties, and to having a role in leading team meetings.

Information Sharing at Multidisciplinary Medical Team Meetings

Results of a study of multidisciplinary medical team meetings (MDTMs) are presented, with focus on information presentation, collaboration, sharing and decision-making issues. The MDTM forum is shown to be an important juncture in the patient care pathway where prior work is reviewed, future work is planned, and decisions are made by consensus. It is shown that while all participants perceive that they benefit from their attendance, the benefit for most active participants is directly proportional to their contribution. Record keeping of the decision agreed and the basis for that decision poses a challenge, particularly in the context of electronic patient record (EPR) keeping. This study also reveals the multi-faceted nature of the event and the fact that new knowledge is generated during the meetings. In addition to its main function in patient management, the MDTM has an educational role and fulfils hospital functions in planning and co-ordination of service delivery. These findings are analysed in terms of their implications for the information sharing needs of participants according to their roles; and requirements for technology support at individual, group and organisational levels are discussed.

Multidisciplinary Medical Team Meetings: An Analysis of Collaborative Working with Special Attention to Timing and Teleconferencing

In this paper we describe the process of a multi-disciplinary medical team meeting (MDTM), its functions and operation in colocated and teleconference discussions. Our goal is to identify the elements and mechanics of operation that enhance or threaten the dependability of the MDTM as a "system" and propose technologies and measures to make this system more reliable. In particular, we assess the effect of adding teleconferencing to the MDTM, and identify strengths and vulnerabilities introduced into the system by the addition of teleconferencing technology. We show that, with respect to the system's external task environment, rhythms of execution of pre-meeting and post-meeting activities are critical for MDTM success and that the extension of the MDTM to wider geographic locations with teleconferencing might disrupt such rhythms thereby posing potential threats to dependability. On the other hand, an analysis of vocalisation patterns demonstrates that despite difficulties related to coordination and awareness in video-mediated communication (evidenced by increased time spent in case discussion, longer turns, decreased turn frequency and near lack of informal exchanges) the overall case discussion structure is unaffected by the addition of teleconferencing technology into proceedings.