Abstract
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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.