# Collaborative Micro-Practices of Expert Healthcare Dyads: Implications for Medical Education

## TL;DR

This study explores how expert healthcare pairs work together in high-pressure settings, offering insights to improve medical education.

## Contribution

The study introduces the Expert Dyad Framework, a new conceptual tool for understanding and teaching dyadic collaboration in healthcare.

## Key findings

- Four core collaborative strategies were identified: connectedness, situation awareness, physical communication, and reflective practice.
- The Expert Dyad Framework characterizes relational and cognitive behaviors essential for effective clinical partnerships.
- The study highlights the importance of micro-interactions in underpinning team performance in acute healthcare settings.

## Abstract

Despite widespread investment in teamwork training, coordination failures persist in acute healthcare environments. Traditional team-based education tends to focus on large teams or isolated technical skills, often overlooking the smallest and arguably most critical unit of collaboration: the healthcare dyad. This study explored how expert healthcare dyads; two individuals working closely in high-stakes clinical settings developed and sustained collaborative expertise. Furthermore, we considered how their practices might have an impact on health professions education.

We conducted a limited realist-perspective study comprising 10 semi-structured dyadic interviews (20 participants) of expert healthcare dyads in acute care settings. Participants were purposively sampled. Using template analysis, we began with a preliminary coding template based on relational coordination and distributed cognition, then iteratively revised it. We undertook deductive indexing using the template, followed by open coding of uncaptured data. Codes were charted, and our analytical framework constructed by clustering themes, and refining relationships. Interpretation was theory driven.

Using template analysis, we identified four core collaborative strategies: connectedness, situation awareness, physical communication, and reflective practice, all embedded in a foundation of trust. From these findings, we developed the Expert Dyad Framework (EDF), which characterizes relational and cognitive behaviors, comprising of collaborative micro-practices, essential to high-functioning clinical partnerships.

The expert dyad framework contributes a practice-informed conceptual tool for educators, highlighting dyadic collaboration as a developmental target for those conducting health professions’ education. This study extends existing models of teamwork by focusing on the micro-interactions that underpin team performance.