Does one size fit all? Perspectives on optimizing healthcare professionals’ collaboration in stressful situations and implications for training design

Healthcare professionals often work in acute situations where they must collaborate with unfamiliar team members under high pressure. Such situations can be stressful, and may disrupt attention, decision-making and collaboration. Theories on attentional control and stress explain how individual characteristics and situational factors influence performance under pressure. Although healthcare education increasingly prepares students to perform under pressure, knowledge about stress, team performance, and training is fragmented. This thesis aims to bring different perspectives together to better understand how healthcare teams collaborate under stress and how this can be improved through training. The first perspective in this thesis involves examining literature on stress and teams from disciplines beyond healthcare. The analysis shows that team stress is primarily caused by time pressure, performance pressure, and role ambiguity. These stressors can lead to a narrowed focus of attention, reduced situational awareness, and unclear responsibilities. At the same time, findings highlight the importance of shared cognitive processes within teams, such as shared mental models, transactive memory, and situational awareness. Collectively referred to as a “team brain”, these processes are strengthened through communication, especially under high-pressure conditions. Building on this, the following perspective involved the experiences by and observations of healthcare professionals participating in a resuscitation team. In interprofessional focus groups, participants indicated that resuscitations are often perceived as routine, yet specific circumstances such as subtle team dynamics can evoke significant stress. Limited insight into each other’s expertise, unclear roles and responsibilities, and a sense of uncertainty emerged as important sources of stress. This stress negatively affected team processes, for example through disrupted communication, and formation of subgroups, potentially leading to a vicious cycle of increasing stress and impaired collaboration. The subsequent observational study focused on communication behaviour in interprofessional resuscitation teams during a stressful simulation. In addition to a fixed set of communicative functions, teams demonstrated a dynamic and flexible communication style. We identified five communication styles ranging from structured and task-oriented to more relational and organic. Teams combined elements from different styles, suggesting the importance of being able to adapt communication to the context while maintaining shared understanding. Finally, the thesis explored how students believe collaboration under stress can best be taught. Two student perspectives emerged: one group viewed stressful situations as an opportunity for growth, while the other expressed concerns about failure and performance pressure. Across both perspectives, there was consensus on the importance of a psychologically safe learning environment. The findings emphasize that educational interventions must align with students’ personal and professional developmental stage. The overall synthesis shows that stress is strongly shaped by the team context, particularly in ad hoc teams where roles and expertise are not self-evident. For education, this implies that stress should be deliberately but carefully integrated into realistic simulations within a safe learning environment. Rather than adopting a one-size-fits-all approach, training should allow for variation between students. Future research may focus on further developing and testing these design principles in practice.