RESUMO
BACKGROUND: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. "Digital first" may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. OBJECTIVE: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. METHODS: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. RESULTS: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). CONCLUSIONS: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand.
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Letramento em Saúde , Medicina Estatal , Telemedicina , Humanos , Estudos Transversais , Telemedicina/estatística & dados numéricos , Adulto , Feminino , Masculino , Inglaterra , Pessoa de Meia-Idade , Letramento em Saúde/estatística & dados numéricos , COVID-19/epidemiologia , Inquéritos e Questionários , Assistência Ambulatorial/estatística & dados numéricos , Adulto Jovem , Idoso , AdolescenteRESUMO
INTRODUCTION: Like many countries, England has a national shortage of registered nurses. Employers strive to retain existing staff, to ease supply pressures. Disproportionate numbers of nurses leave the National Health Services (NHS) both early in their careers, and later, as they near retirement age. Research is needed to understand the job preferences of early-career and late-career nurses working in the NHS, so tailored policies can be developed to better retain these two groups. METHODS AND ANALYSIS: We will collect job preference data for early-career and late-career NHS nurses, respectively using two separate discrete choice experiments (DCEs). Findings from the literature, focus groups, academic experts and stakeholder discussions will be used to identify and select the DCE attributes (ie, job features) and levels. We will generate an orthogonal, fractional factorial design using the experimental software Ngene. The DCEs will be administered through online surveys distributed by the regulator Nursing and Midwifery Council. For each group, we expect to achieve a final sample of 2500 registered NHS nurses working in England. For early-career nurses, eligible participants will be registered nurses who graduated in the preceding 5 years (ie, 2019-2023). Eligible participants for the late-career survey will be registered nurses aged 55 years and above. We will use conditional and mixed logit models to analyse the data. Specifically, study 1 will estimate the job preferences of early-career nurses and the possible trade-offs. Study 2 will estimate the retirement preferences of late-career NHS nurses and the potential trade-offs. ETHICS AND DISSEMINATION: The research protocol was reviewed and approved by the host research organisation Ethics Committees Research Governance (University of Southampton, number 80610) (https://www.southampton.ac.uk/about/governance/regulations-policies/policies/ethics). The results will be disseminated via conference presentations, publications in peer-reviewed journals and annual reports to key stakeholders, the Department of Health and Social Care, and NHS England/Improvement retention leaders. REGISTRATION DETAILS: Registration on OSF http://doi.org/10.17605/OSF.IO/RDN9G.
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Enfermeiras e Enfermeiros , Medicina Estatal , Humanos , Grupos Focais , Projetos de Pesquisa , InglaterraRESUMO
Background: NHS 111 online offers 24-hour access to health assessment and triage. Objectives: This study examined pathways to care, differential access and use, and workforce impacts of NHS 111 online. This study compared NHS 111 with Healthdirect (Haymarket, Australia) virtual triage. Design: Interviews with 80 staff and stakeholders in English primary, urgent and emergency care, and 41 staff and stakeholders associated with Healthdirect. A survey of 2754 respondents, of whom 1137 (41.3%) had used NHS 111 online and 1617 (58.7%) had not. Results: NHS 111 online is one of several digital health-care technologies and was not differentiated from the NHS 111 telephone service or well understood. There is a similar lack of awareness of Healthdirect virtual triage. NHS 111 and Healthdirect virtual triage are perceived as creating additional work for health-care staff and inappropriate demand for some health services, especially emergency care. One-third of survey respondents reported that they had not used any NHS 111 service (telephone or online). Older people and those with less educational qualifications are less likely to use NHS 111 online. Respondents who had used NHS 111 online reported more use of other urgent care services and make more cumulative use of services than those who had not used NHS 111 online. Users of NHS 111 online had higher levels of self-reported eHealth literacy. There were differences in reported preferences for using NHS 111 online for different symptom presentations. Conclusions: Greater clarity about what the NHS 111 online service offers would allow better signposting and reduce confusion. Generic NHS 111 services are perceived as creating additional work in the primary, urgent and emergency care system. There are differences in eHealth literacy between users and those who have not used NHS 111 online, and this suggests that 'digital first' policies may increase health inequalities. Limitations: This research bridged the pandemic from 2020 to 2021; therefore, findings may change as services adjust going forward. Surveys used a digital platform so there is probably bias towards some level of e-Literacy, but this also means that our data may underestimate the digital divide. Future work: Further investigation of access to digital services could address concerns about digital exclusion. Research comparing the affordances and cost-benefits of different triage and assessment systems for users and health-care providers is needed. Research about trust in virtual assessments may show how duplication can be reduced. Mixed-methods studies looking at outcomes, impacts on work and costs, and ways to measure eHealth literacy, can inform the development NHS 111 online and opportunities for further international shared learning could be pursued. Study registration: This study is registered at the research registry (UIN 5392). Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information.
NHS 111 services help people who need health advice or care by telephone (using the 111 number) and online (using the web on a smartphone or a computer). Demand for general practitioner and emergency care services keeps increasing, and there are concerns that sometimes people do not use the right services for the health problems that they have. NHS 111 can direct people to services and give advice that helps them carry out more self-care. Previous research suggests that not everyone finds online services easy to use. There is a worry that NHS 111 services may increase work for other health services. Our research used interviews and surveys to find out about the NHS 111 online service. We interviewed 80 people working in or with NHS services to find out about their experiences of NHS 111 online. There was low awareness of NHS 111 online, partly because there are so many other computer technologies and different services available. Interviewees often mixed-up NHS 111 online with the 111 telephone service. People are confused about where to get help. Interviewees also said that NHS 111 creates 'extra work', especially for emergency departments (accident and emergency). We interviewed 41 staff and stakeholders linked with a similar system used in Australia, called Healthdirect, and they had similar concerns. Our survey found that people who had used NHS 111 online were younger and had higher levels of education. People who had used NHS 111 online also had higher eHealth literacy (they were more able to access and understand online health services); however, they were also sicker, reported having more long-term conditions and used more health services. Our research suggests that we need to reduce confusion about what NHS 111 online does, get rid of unnecessary extra work and see whether or not it improves access to care for everyone.
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Medicina Estatal , Telemedicina , Humanos , Idoso , Inquéritos e Questionários , Autorrelato , TriagemRESUMO
BACKGROUND: NHS 111 is a phone and online urgent care triage and assessment system that aims to reduce UK ED demand. In 2020, 111 First was introduced to triage patients before entry to the ED and to offer direct booking for patients needing ED or urgent care into same-day arrival time slots. 111 First continues to be used post pandemic, but concerns about patient safety, delays or inequities in accessing care have been voiced. This paper examines ED and urgent care centre (UCC) staff experiences of NHS 111 First. METHOD: Semistructured telephone interviews were conducted with ED/UCC practitioners across England between October 2020 and July 2021 as part of a larger multimethod study examining the impact of NHS 111 online. We purposively recruited from areas with high need/demand likely to be using NHS 111 services. Interviews were transcribed verbatim and coded inductively by the primary researcher. We coded all items to capture experiences of 111 First within the full project coding tree and from this constructed two explanatory themes which were refined by the wider research team. RESULTS: We recruited 27 participants (10 nurses, 9 doctors and 8 administrator/managers) working in ED/UCCs serving areas with high deprivation and mixed sociodemographic profiles. Participants reported local triage/streaming systems predating 111 First continued to operate so that, despite prebooked arrival slots at the ED, all attendances were funnelled into a single queue. This was described by participants as a source of frustration for staff and patients. Interviewees perceived remote algorithm-based assessments as less robust than in-person assessments which drew on more nuanced clinical expertise. DISCUSSION: While remote preassessment of patients before they present at ED is attractive, existing triage and streaming systems based on acuity, and staff views about the superiority of clinical acumen, are likely to remain barriers to the effective use of 111 First as a demand management strategy.
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Serviço Hospitalar de Emergência , Medicina Estatal , Humanos , Inglaterra , Pesquisa Qualitativa , Medicina Estatal/organização & administração , Triagem/métodosRESUMO
INTRODUCTION: An admission to a mental health ward is an uncertain and unexpected part of a person's journey with dementia and consequently, families require information about what to expect and how to prepare. This study aimed to establish the information needs of people with dementia and their families at the point of admission to a mental health ward and to collate existing ward information leaflets to explore if they meet these information needs. METHODS: This research was conducted in two parts: (1) a qualitative study using focus groups, one with people with dementia and family carers with lived experience of such an admission (n = 6), and another with Admiral Nurses (n = 6) to explore information needs at the point of admission. (2) Each National Health Service (NHS) mental health trust (n = 67) was asked to provide a copy of their ward information shared at admission. A total of 30 leaflets were received from 15 NHS trusts; after removing duplicates, 22 were included. A content analysis was conducted to evaluate to what extent leaflets met the information needs identified by focus groups. RESULTS: Two main categories 'honest, accurate and up-to-date information' and 'who is the information for' and four subcategories were derived from focus group data. Participants felt that people with dementia and their families were likely to have different information needs. Material for people with dementia needed to be in an accessible format. Information should cover the aim of the admission, a timeline of what to expect and details about how families will be involved in care. Practical information about what to pack and ward facilities was valued. Participants spoke about the need to consider the tone of the information, given that people are likely to be distressed. The information leaflets reviewed did not meet the information needs identified by focus group participants. CONCLUSIONS: People with dementia and family carers have different information needs at the point of admission to a mental health ward. Information provided to people with dementia needs to be in an accessible format with content relevant to these needs. Wards should aim to co-create information to ensure that they meet people's information needs. PATIENT OR PUBLIC CONTRIBUTION: This research was supported by a patient and public involvement (PPI) group of people with dementia and carers who have experience in mental health wards. The idea for the study came from the group and was motivated by their experiences. The PPI group helped with the design of the study and took part in the focus groups. The information generated has been written up in this paper, and the knowledge generated has also been used to co-create a guide for wards on writing their information leaflets and to support the co-creation of a public information leaflet by Dementia UK about mental health admissions for people with dementia.
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Demência , Saúde Mental , Humanos , Cuidadores/psicologia , Medicina Estatal , Hospitalização , Demência/psicologiaRESUMO
In 2017, the NHS 111 telephone service was augmented by an online service. This is an exemplar of 'digital-first', the push to enrol digital technologies to deliver services, and is viewed by policymakers as an important vehicle for managing demand for overburdened health services. This article reports the qualitative component of a larger multi-method study of NHS 111 online. Qualitative telephone interviews with 80 staff and stakeholders implicated in primary, urgent and emergency care service delivery explored the impact of NHS 111 online on health-care work. The analysis presented here draws on Susie Scott's work on the 'sociology of nothing' and theories of the marked and unmarked, which we reached for when confronted by the remarkable invisibility of this seemingly core NHS service in the wider landscape of health care. Despite the apparently high use by patients and the public (30 million visits over 6 months in the 2020 pandemic), we were surprised to find very low awareness among our interviewees. Confusion about nomenclature, an exceedingly crowded digital field (littered with alternative technologies and ways of accessing care) and constant change in service provision provide some cogent reasons for this invisibility, and sociology helps explain our data about this digital technology.
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Serviços Médicos de Emergência , Medicina Estatal , Humanos , Acessibilidade aos Serviços de Saúde , Satisfação do Paciente , TelefoneRESUMO
AIM: This paper is part of a larger doctoral study that investigated the impact of nationality on the job satisfaction of nurses and their intentions to leave Saudi Arabian government hospitals. The paper aims to gain an understanding of the impact of expatriate status on nurses' perceptions, by comparing the factors that influence job satisfaction among Saudi nurses to those that affect nurses recruited from other countries. BACKGROUND: Job satisfaction is a known predictor of nurse retention. Although there is a broad understanding of the factors that affect job satisfaction, little is known about how these vary between home and expatriate nurses working in countries which rely on a multicultural migrant workforce. METHODS: A descriptive qualitative approach was taken, in which 26 semi-structured interviews were conducted with nurses selected from different nationalities, all of whom were working in Saudi Arabian hospitals. Eight participants were Saudi Arabian, six Filipino, four Indian, four South African, two Jordanian and two Malaysian. FINDINGS: Five themes were identified that differentiated the perceptions of expatriates regarding their job satisfaction from those of the home nurses: separation from family, language and communication, fairness of remuneration, moving into the future and professionalism. CONCLUSION: Focusing on the enhancement of job satisfaction experienced by expatriate nurses can result in a healthier work environment and greater retention of these nurses. IMPLICATIONS FOR NURSING AND NURSING POLICY: To enhance nurse retention, policy makers in countries with migrant nurses should address their socio-economic needs. This includes providing both greater access to their dependent family members, and language lessons and cultural orientation to reduce linguistic and cultural challenges.
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Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem Hospitalar , Estudos Transversais , Humanos , Satisfação no Emprego , Arábia Saudita , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Theoretical models have sought to comprehend and conceptualise how people seek help from health professionals but it is unclear if such models apply to urgent care. Much previous research does not explain the complex interactions that influence how people make sense of urgent care and how this shapes service use. This paper aims to conceptualise the complexity of sense-making and help-seeking behaviour in peoples' everyday evaluations of when and how to access modern urgent care provision. METHODS: This study comprised longitudinal semi-structured interviews undertaken in the South of England. We purposively sampled participants 75+, 18-26 years, and from East/Central Europe (sub-sample of 41 received a second interview at + 6-12 months). Framework analysis was thematic and comparative. RESULTS: The amount and nature of the effort (work) undertaken to make sense of urgent care was an overarching theme of the analysis. We distinguished three distinct types of work: illness work, moral work and navigation work. These take place at an individual level but are also shared or delegated across social networks and shaped by social context and time. We have developed a conceptual model that shows how people make sense of urgent care through work which then influences help-seeking decisions and action. CONCLUSIONS: There are important intersections between individual work and their social networks, further shaped by social context and time, to influence help-seeking. Recognising different, hidden or additional work for some groups may help design and configure services to support patient work in understanding and navigating urgent care.
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Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Comportamento de Busca de Ajuda , Adolescente , Adulto , Inglaterra , Feminino , Humanos , Masculino , Modelos Teóricos , Pesquisa Qualitativa , Adulto JovemRESUMO
BACKGROUND: Whilst many health systems offer a range of urgent and emergency care services to deal with the need for unscheduled care, these can be problematic to navigate. OBJECTIVE: To explore how lay people make sense of urgent care provision and processes. DESIGN: Qualitative study, incorporating citizen panels and longitudinal semi-structured qualitative interviews. SETTING AND PARTICIPANTS: Two citizens' panels, comprising purposively selected public populations-a group of regular users and a group of potentially marginalized users of urgent and emergency care. Semi-structured interviews were conducted with 100 people, purposively sampled to include those over 75, aged 18-26 years, and from East/Central Europe. A sub-sample of 41 people received a second interview at +6-12 months. Framework analysis was thematic and comparative, moving through coding to narrative and interpretive summaries. FINDINGS AND DISCUSSION: Participants narratives illuminated considerable uncertainty and confusion regarding urgent and emergency care provision which in part could be traced to the contingent nature of urgent and emergency care need. Accounts of emergency care provision were underpinned by strong moral positioning of appropriate help-seeking, demarcating legitimate service use that echoed policy rhetoric, but did not necessarily translate into individual behaviour. People struggled to make sense of urgent care provision making navigating "appropriate" use problematic. CONCLUSIONS: The focus on help-seeking behaviour, rather than sense-making, makes it difficult to move beyond the polarization of "appropriate" and "inappropriate" service use. A deeper analysis of sense-making might shift the focus of attention and allow us to intervene to reshape understandings before this point.
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Serviços Médicos de Emergência , Avaliação de Processos em Cuidados de Saúde , Opinião Pública , Adolescente , Adulto , Idoso , Europa (Continente) , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pesquisa QualitativaRESUMO
OBJECTIVES: To explore the success of the introduction of the National Health Service (NHS) 111 urgent care service and describe service activity in the period 2014-2016. DESIGN: Comparative mixed method case study of five NHS 111 service providers and analysis of national level routine data on activity and service use. SETTINGS AND DATA: Our primary research involved five NHS 111 sites in England. We conducted 356 hours of non-participant observation in NHS 111 call centres and the urgent care centres and, linked to these observations, held 6 focus group interviews with 47 call advisors, clinical and managerial staff. This primary research is augmented by a secondary analysis of routine data about the 44 NHS 111 sites in England contained in the NHS 111 Minimum Data Set made available by NHS England. RESULTS: Opinions vary depending on the criteria used to judge the success of NHS 111. The service has been rolled out across 44 sites. The 111 phone number is operational and the service has replaced its predecessor NHS Direct. This new service has led to changes in who does the work of managing urgent care demand, achieving significant labour substitution. Judged against internal performance criteria, the service appears not to meet some targets such as call answering times, but it has seen a steady increase in use over time. Patients appear largely satisfied with NHS 111, but the view from some stakeholders is more mixed. The impact of NHS 111 on other health services is difficult to assess and cost-effectiveness has not been established. CONCLUSION: The new urgent care service NHS 111 has been brought into use but its success against some key criteria has not been comprehensively proven.
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Assistência Ambulatorial/métodos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Linhas Diretas/economia , Satisfação do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/normas , Plantão Médico/estatística & dados numéricos , Análise Custo-Benefício , Inglaterra , Grupos Focais , Linhas Diretas/organização & administração , Humanos , Entrevistas como Assunto , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa , Medicina EstatalRESUMO
This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.
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Plantão Médico/organização & administração , Sistemas de Apoio a Decisões Clínicas/organização & administração , Serviços Médicos de Emergência/organização & administração , Linhas Diretas/organização & administração , Algoritmos , Sistemas Inteligentes , HumanosRESUMO
BACKGROUND: Information and communication technologies (ICTs) are often proposed as 'technological fixes' for problems facing healthcare. They promise to deliver services more quickly and cheaply. Yet research on the implementation of ICTs reveals a litany of delays, compromises and failures. Case studies have established that these technologies are difficult to embed in everyday healthcare. METHODS: We undertook an ethnographic comparative analysis of a single computer decision support system in three different settings to understand the implementation and everyday use of this technology which is designed to deal with calls to emergency and urgent care services. We examined the deployment of this technology in an established 999 ambulance call-handling service, a new single point of access for urgent care and an established general practice out-of-hours service. We used Normalization Process Theory as a framework to enable systematic cross-case analysis. RESULTS: Our data comprise nearly 500 hours of observation, interviews with 64 call-handlers, and stakeholders and documents about the technology and settings. The technology has been implemented and is used distinctively in each setting reflecting important differences between work and contexts. Using Normalisation Process Theory we show how the work (collective action) of implementing the system and maintaining its routine use was enabled by a range of actors who established coherence for the technology, secured buy-in (cognitive participation) and engaged in on-going appraisal and adjustment (reflexive monitoring). CONCLUSIONS: Huge effort was expended and continues to be required to implement and keep this technology in use. This innovation must be understood both as a computer technology and as a set of practices related to that technology, kept in place by a network of actors in particular contexts. While technologies can be 'made to work' in different settings, successful implementation has been achieved, and will only be maintained, through the efforts of those involved in the specific settings and if the wider context continues to support the coherence, cognitive participation, and reflective monitoring processes that surround this collective action. Implementation is more than simply putting technologies in place - it requires new resources and considerable effort, perhaps on an on-going basis.
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Sistemas de Apoio a Decisões Clínicas , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Medicina Estatal , Plantão Médico , Antropologia Cultural , Inglaterra , Linhas Diretas , Humanos , Pesquisa QualitativaRESUMO
OBJECTIVES: To examine the skills and expertise required and used by non-clinical call-handlers doing telephone triage and assessment, supported by a computer decision support system (CDSS) in urgent and emergency care services. METHODS: Comparative case study of three different English emergency and urgent care services. Data consisted of nearly 500 hours of non-participant observation, 61 semi-structured interviews with health service staff, documentary analysis, and a survey of 106 call-handlers. RESULTS: Communication skills and 'allowing the CDSS to drive the assessment' are viewed by the CDSS developers and staff as key competencies for call-handling. Call-handlers demonstrated high levels of experience, skills and expertise in using the CDSS. These workers are often portrayed simply as 'trained users' of technology, but they used a broader set of skills including team work, flexibility and 'translation'. Call-handlers develop a 'pseudo-clinical' expertise and draw upon their experiential knowledge to bring the CDSS into everyday use. CONCLUSIONS: Clinical assessment and triage by non-clinical staff supported by a CDSS represents a major change in urgent and emergency care delivery, warranting a detailed examination of call-handlers' skills and expertise. We found that this work appears to have more in common with clinical work and expertise than with other call-centre work that it superficially resembles. Recognizing the range of skills call-handlers demonstrate and developing a better understanding of this should be incorporated into the training for, and management of, emergency and urgent care call-handling.
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Assistência Ambulatorial/organização & administração , Competência Clínica/estatística & dados numéricos , Serviços Médicos de Emergência/organização & administração , Linhas Diretas , Triagem , Adolescente , Adulto , Tomada de Decisões Assistida por Computador , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Medicina Estatal , Triagem/métodos , Reino Unido , Recursos Humanos , Adulto JovemRESUMO
BACKGROUND: Despite a vast literature on collaborative learning (CL), there is little research on preparing students to work collaboratively. AIMS: This two-phase evaluation investigated whether team-skills training could enhance the performance of collaborative groups through the introduction of a team development programme to a group-based undergraduate key-skills unit. SAMPLE: Phase 1 compared two consecutive cohorts of second-year students, Cohort 1 (N = 94) who received no preparation, and Cohort 2 (N = 113) who received team-skills training. Phase 2 added Cohort 3 (N = 88), who also received team-skills training, to extend the analysis. METHOD: In Phase 1, students in both Cohorts 1 and 2 worked on a series of curriculum based key-skill tasks across two semesters. Students worked in one group in Semester 1 and were then formed into new groups for Semester 2. Effects of the training were measured by student group marks and key-skill ratings. RESULTS: Marks and key-skill ratings were significantly higher for the trained cohort in Semester 1 (p < .01). However, in Semester 2 performance reduced for the trained cohort in comparison to Semester 1. To explore this further, Phase 2 of the study evaluated Cohort 3, where after training, collaborative groups remained intact throughout the academic year. Results for Cohort 3 showed no attenuation of performance effects in Semester 2. CONCLUSIONS: Phase 1 results support the use of team-skills training to enhance CL group performance. The findings for Phase 2 suggest that these benefits may be lost if training groups are disrupted.