Exploring Team Dynamics and Learning Environments in Health Systems Science Education: An Analysis of First-Year Medical Student Experiences

The need for team-oriented skills has become more pronounced as healthcare models become more complex. Many undergraduate medical education (UME) programs, particularly in Australia, Canada, and the United Kingdom, define teamwork as fundamental to physician training. U.S. UME programs, however, face challenges in defining and teaching teamwork competencies. Some programs have chosen to define and teach these competencies through curricula that require students to explore health systems science issues through team-based experiences in classroom-, community-, and project-based settings. This qualitative study aims to understand how first-year medical students experience and develop as team members. Students at two U.S. medical schools with team-based curricula were asked during one-hour focus groups to reflect on their teamwork experiences, environmental factors affecting their team performance, and their evolving views on the physician’s role in patient care. Focus group transcripts were coded and thematically analyzed using the Team Effectiveness (TE) framework, which assesses team function along eight dimensions (Real Team, Compelling Purpose, Right People, Sound Structure, Supportive Context, Team Communication, Collaboration, and Coaching). Thirty-nine students participated in 11 focus groups. Four themes emerged: (1) Structured classroom settings were ideal for safe practice and rapid team adaptation, (2) Less structured community- and project-based settings encouraged supportive team dynamics but were more challenging, (3) Balancing structure with flexibility was essential in developing teamwork skills, and (4) Teamwork reinforced key health systems science concepts, including relationship building, advocacy, and systems citizenship. Students also reported shifts in their perceptions of physician roles from independent to integrated decision-makers. Findings align with previous research on team effectiveness, supporting a health systems science curricular approach to helping students develop teamwork skills. However, attention must be paid to balancing structured guidance with flexibility to explore systems-related concepts and teamwork skills. Through teamwork, students’ identities evolved within 10 months, including redefinitions of their roles within a healthcare context. Teaching students how to work in teams within the context of a health systems science curriculum can help students identify with and recognize the importance of collaborative practice.