What can tennis doubles teach us about medical dyads? Translating collaborative expertise into medical education

INTRODUCTION: Collaborative behaviours in acute care remain inconsistent despite substantial educational investment. Teamwork training often focuses on larger groups, overlooking dyads; the smallest collaborative unit. This study examines high-performing tennis doubles teams and expert medical dyads to identify collaborative behaviours that may inform medical education. METHODS: Using a limited realist perspective approach, we conducted 15 semi-structured interviews with 30 participants: 20 clinicians working in acute care dyads and 10 elite tennis doubles players. Participants were purposively sampled. Template analysis, guided by relational coordination and distributed cognition frameworks, was applied to explore how dyads coordinate and collaborate. RESULTS: Six collaborative dimensions were identified across both domains: trust, connectedness, shared goals, situation awareness, physical communication, and reflective practice with varying enactment strategies. Tennis dyads developed connectedness through repeated practice, psychological safety, co-regulation, error normalisation, and emotional trust. Medical dyads emphasised technical trust and task coordination, with limited opportunities for rehearsal, informal feedback, or relational engagement, often due to workload pressures and shifting schedules. DISCUSSION: While collaborative dimensions are shared, tennis dyads draw on a broader behavioural repertoire. These findings highlight opportunities to enhance medical education by integrating dyad-focused training that explicitly develops relational competence in simulation, debriefing, and workplace learning.