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05-12-2017 | Original Article | Uitgave 6/2017 Open Access

Perspectives on Medical Education 6/2017

Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry

Tijdschrift:
Perspectives on Medical Education > Uitgave 6/2017
Auteurs:
Deborah S. Cowley, Jesse D. Markman, Jennifer A. Best, Erica L. Greenberg, Michael J. Grodesky, Suzanne B. Murray, Kelli A. Corning, Mitchell R. Levy, William E. Greenberg
Belangrijke opmerkingen
A preliminary version (before group meetings with the other two programs were held to refine and synthesize codes) of the University of Washington Medicine Residency data from this study was presented at the 2013 ACGME Annual Educational Conference in Orlando, Florida.

Abstract

Introduction

With changes in duty hours and supervision requirements, educators have raised concerns about erosion of patient care ownership by resident physicians. However, the definition of ownership is unclear. This qualitative study investigated definitions of ownership in medicine and psychiatry faculty and residents.

Methods

The authors distributed an anonymous online survey regarding definitions of ownership to faculty and residents at the psychiatry and internal medicine residency programs at the University of Washington and the Harvard Longwood psychiatry residency and conducted a qualitative analysis of free-text responses to identify emergent themes.

Results

225 faculty (48.6%) and 131 residents (43.8%) across the three programs responded. Responses yielded themes in five domains: Physician Actions, Physician Attitudes, Physician Identity, Physician Qualities, and Quality of Patient Care. All groups identified themes of advocacy, communication and care coordination, decision-making, follow through, knowledge, leadership, attitudes of going ‘above and beyond’ and ‘the buck stops here’, responsibility, serving as primary provider, demonstrating initiative, and providing the best care as central to ownership. Residents and faculty had differing perspectives on ‘shift work’ and transitions of care and on resident decision-making as elements of ownership.

Discussion

This study expanded and enriched the definition of patient care ownership. There were more similarities than differences across groups, a reassuring finding for those concerned about a decreasing understanding of ownership in trainees. Findings regarding shared values, shift work, and the decision-making role can inform educators in setting clear expectations and fostering ownership despite changing educational and care models.
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