Discordance Between Resident and Faculty Perceptions of Resident Autonomy

Biondi, Eric; Varade, William S.; Garfunkel, Lynn C.; Lynn, Justin; Craig, Mark S.; Cellini, Melissa M.; Shone, Laura P.; Harris, J. Peter; Baldwin, Constance D.

doi:10.1097/acm.0000000000000522

Cited by 69 publications

(27 citation statements)

References 34 publications

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“…Several studies and opinion papers have highlighted the loss of autonomy in current clinical educational settings and have discussed its educational impact [ 13 – 17 ]. Some suggest that increased faculty oversight has led to a decline in resident understanding of ownership [ 6 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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IntroductionWith 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.MethodsThe 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.Results225 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.DiscussionThis 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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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…The finding that there is only a minimal curriculum implemented in SDT constructs is, to some degree, remarkable since: a) in the practice of health care practitioners, several examples can be found of interventions that actually utilize (elements of) SDT in several (psycho)pathologically and/or lifestyle related issues [ 7 ]. Obviously, practitioners are more proactive than curriculum developers; b) several curricula do use SDT constructs for motivating their own students [ 20 ] as commented by Hoffman (2015) [ 21 ] for promoting techniques like scaffolding. From this, it can be concluded that, in the field of education and training of medical practitioners, there is sufficient familiarity with SDT constructs per se; what is needed, however, is a renewed perspective of the classical communication model using Huber’s “to adapt and to self-manage” [ 5 ] as a starting point for defining learning outcomes in curricula on the training and education of these practitioners.…”

Section: Discussionmentioning

confidence: 99%

A dynamic approach to communication in health literacy education

Veenker

Paans

2016

BMC Med Educ

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BackgroundResearch within the framework of Self-Determination Theory (SDT) indicates that patients' autonomy is to be considered a critical health care outcome in its own right since it promotes improved mental and physical health.This paper presents an analysis of studies addressing communication and interaction interventions in health literacy curricula for medical and health care practitioners, focusing on patient-oriented skills in “making sense” and “to adapt and self-manage”. For evaluating interventions, underlying communication models were traced. The criteria for good practice are “making sense” and “supporting autonomy in making choices”. For the search of interventions, keywords from both the framework of the EU-project, Intervention Research on Health Literacy among Ageing population (IROHLA (The IROHLA project received financial support from the European Union through FP7 Grant 305831)), as well as the SDT (Self Determination Theory) were applied.The research question of this paper is to what degree is autonomy supporting communication skills part of the curricula of health literacy (HL) for medical and health care practitioners and providers? A Pubmed search revealed: a) that “making sense” is clearly represented in HL interventions in curricula; however, b) very few interventions teach medical and health care practitioners how to give autonomy support in the interaction with their (future) patients.Four promising, beneficial practices were identified. Several recommendations were presented encouraging curriculum developers to adapt skills of supporting autonomy into their programs.MethodsA qualitative content analysis of interventions in the curricula of communication and interaction skills for medical students and practitioners.ResultsA review of literature indicates: a) most interventions in curricula for medical students and practitioners are focusing on skills in adequately providing information to patients by using an underlying (advanced) Sender-Message-Receiver Model; and b) only a few interventions in curricula are available for providing the acquisition of interaction skills in supporting autonomy.ConclusionsThe proposal of Huber and others to change the emphasis in the definition of the WHO definition on health towards “to adapt and self manage” has impact on the training of medical students and practioners in dealing with patients with low levels of health literacy. From the present study it can be concluded that a dynamic approach to communication can be linked to theoretical constructs on self-management. In such an approach interaction techniques like scaffolding can increase the level of HL of the patient.

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“…In spite of description of the best principles for doing this [13], few initiatives consider and measure the effect of interventions catered to enhance student motivation in medical education [14], especially so in undergraduate medical curricula. The theoretical framework for this study is based on the Self-determination Theory (SDT).…”

Section: Introductionmentioning

confidence: 99%

Motivation and competence of participants in a learner-centered student-run clinic: an exploratory pilot study

et al. 2017

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BackgroundThe Learner-Centered Student-run Clinic (LC-SRC) was designed to teach and train prescribing skills grounded in a real-life context, to provide students with early clinical experience and responsibility. The current studies’ theoretical framework was based on the Self-determination Theory. According to the Self-determination Theory, early involvement in clinical practice combined with a high level of responsibility makes the LC-SRC an environment that can stimulate intrinsic motivation. We investigated the different types of motivation and the proficiency in CanMEDS competencies of the participating students.MethodType of motivation was measured using the Academic Motivation Scale and Intrinsic Motivation Inventory. CanMEDS competencies were evaluated by faculty using a mini-clinical examination and by the students themselves using a post-participation questionnaire.ResultsThe 29 participating students were highly intrinsic motivated for this project on all subscales of the Intrinsic Motivation Inventory. Motivation for medical school on the Academic Motivation Scale was high before and was not significantly changed after participation. Students considered that their CanMEDS competencies “Collaborator”, “Communicator”, “Academic”, and “Medical expert” had improved. Their actual clinical team competence was judged by faculty to be at a junior doctor level.ConclusionStudents showed a high level of intrinsic motivation to participate in the LC-SRC and perceived an improvement in competence. Furthermore their actual clinical competence was at junior doctor level in all CanMEDS competencies. The stimulating characteristics of the LC-SRC, the high levels of intrinsic motivation and the qualitative comments of the students in this study makes the LC-SRC an attractive place for learning.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0856-9) contains supplementary material, which is available to authorized users.

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Discordance Between Resident and Faculty Perceptions of Resident Autonomy

Cited by 69 publications

References 34 publications

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

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

A dynamic approach to communication in health literacy education

Motivation and competence of participants in a learner-centered student-run clinic: an exploratory pilot study

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Discordance Between Resident and Faculty Perceptions of Resident Autonomy

Cited by 69 publications

References 34 publications

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

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

A dynamic approach to communication in health literacy education

Motivation and competence of participants in a learner-centered student-run clinic: an exploratory pilot study

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Product

Resources

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

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