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01-04-2013 | Original Paper | Uitgave 2/2013 Open Access

Perspectives on Medical Education 2/2013

Ownership of patient care: a behavioural definition and stepwise approach to diagnosing problems in trainees

Perspectives on Medical Education > Uitgave 2/2013
Kimberly McLaren, Julie Lord, Suzanne B. Murray, Mitchell Levy, Paul Ciechanowski, Jesse Markman, Anna Ratzliff, Michael Grodesky, Deborah S. Cowley


In medical education, behavioural definitions allow for more effective evaluation and supervision. Ownership of patient care is a complex area of trainee development that crosses multiple areas of evaluation and may lack clear behavioural definitions. In an effort to define ownership for educational purposes, the authors surveyed psychiatry teaching faculty and trainees about behaviours that would indicate that a physician is demonstrating ownership of patient care. Emerging themes were identified through analysis of narrative responses in this qualitative descriptive study. Forty-one faculty (54 %) and 29 trainees (52 %) responded. Both faculty and trainees identified seven core elements of ownership: advocacy, autonomy, commitment, communication, follow-through, knowledge and teamwork. These seven elements provide a consensus-derived behavioural definition that can be used to determine competency or identify deficits. The proposed two-step process enables supervisors to identify problematic ownership behaviours and determine whether there is a deficit of knowledge, skill or attitude. Further, the theory of planned behaviour is applied to better understand the relationship between attitudes, intentions and subsequent behaviour. By structuring the diagnosis of problems with ownership of patient care, supervisors are able to provide actionable feedback and intervention in a naturalistic setting. Three examples are presented to illustrate this stepwise process.
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