Developing and Validating a Conceptual Model of Recurring Problems in Teaching Clinic

Abstract

Recurrent problems in medical teaching clinic are common and difficult to address because of complex interpersonal dynamics. To minimize this difficulty, we developed a conceptual model that simplifies problems and identifies the root cause of tension between groups in clinic. We used recursive analysis and modeling of the data from a larger multi-site, multi-method study of problems in teaching clinic. The first dataset from this study consisted of problem lists generated and prioritized by knowledgeable insiders from each site. The second dataset was a cultural consensus analysis independently performed at each site. The final model was checked for face validity and construct validity (using model predictions versus prior data and convergent/discriminant analysis). The study was performed in five Veterans Affairs teaching clinics in the U.S. Our final model, the Perception of Care Map, is a pentagram with five critical perspectives of the clinic visit. These five perspectives are structured care, educational care, relationship-based care, algorithmic care and efficient care. Each group emphasizes one or more of these perspectives, and group locations on the conceptual map explain the observed tensions between groups. Validity of the model is high. The Perception of Care Map may be a useful adjunct for understanding and addressing recurrent problems in teaching clinic.

A pilot study using Cultural Consensus Analysis to measure Systems-Based Practice performance

“…The assumption that the two CCA statements 'goals' and 'changes' reflect interpersonal relationships in the same way as the ABIM-PSQ and ABIM NEMH may be erroneous, especially for residents and nursing staff, since they are written from the doctor-patient perspective. 10 It is often difficult to make meaningful improvements in teaching clinic. This has to do with the complexity of clinic systems, resistance because many top down interventions have a perceived lack of relevance to people on the 'front lines', and the difficulty in having open, honest conversations.…”

“…We studied the relationship between the two CCA statements representing the 'relationship-based pole' in our conceptual model 10 and standard patient and staff satisfaction with medical housestaff measures using a crosssectional correlation study. The Human Subjects Division from the University of Washington (Seattle, Washington, USA) performed an ethical review and approved this project.…”

“…9 Data from these studies have also been used to verify a coherent and complete model of clinic operations that includes all stakeholders perspectives ( Figure 1). 10 Our pilot study was designed to further validate this CCA tool as a 360° measure of resident performance. In particular, we wanted to examine the association between the two CCA statements representing the 'relationshipbased care' pole of the conceptual model mentioned above and standard measures of patient and staff satisfaction with medical housestaff commonly used for 360° performance evaluation.…”

Conceptual Models of Early and Involuntary Retirement among Canadian Registered Nurses and Allied Health Professionals

“…To refine and validate the proposed conceptual models of retirement among health professionals (seen in Figures 2 and 3), we conducted in-depth individual interviews with 14 current and former health professionals between the ages of 45 and 85. Specifically, we sought to achieve face validity; Smith, Morris, Hill, Francovich, and Christiano (2006) employed a similar methodology when validating their conceptual model of recurring problems in a teaching clinic (Smith et al, 2006).

Figure 2:Conceptual model of early retirement among registered nurses and allied health professionals (pre- and post-validation)

Figure 3:Conceptual model of involuntary retirement among registered nurses and allied health professionals (pre-validation)

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“…To refine and validate the proposed conceptual models of retirement among health professionals (seen in Figures 2 and 3), we conducted in-depth individual interviews with 14 current and former health professionals between the ages of 45 and 85. Specifically, we sought to achieve face validity; Smith, Morris, Hill, Francovich, and Christiano (2006) employed a similar methodology when validating their conceptual model of recurring problems in a teaching clinic (Smith et al, 2006).…”