It's not just what you know: junior trainees' approach to follow-up and documentation

Abstract

ContextIn teaching hospitals, junior trainees (first‐year residents and third‐year medical students) are responsible for patient follow‐up and documentation under the supervision of senior team members. In order to support trainees in their role, supervisors need to understand how trainees approach these tasks and how they can be coached to develop best practices.ObjectivesThe purpose of our study was to explore the range of practices used by junior trainees in clinical settings.MethodsConstructivist grounded theory was used to guide the collection and analysis of data on follow‐up and documentation during 34 observation periods with 17 junior trainees. Data sources included field notes, field interviews and de‐identified copies of patient charts. We also held two focus groups with four attending physicians in each.ResultsWe were able to describe three interrelated characteristics that influenced a trainee's approach to and ability to perform the tasks of patient follow‐up and documentation: (i) diligence; (ii) relationship to the team (dependent, independent, collaborative), and (iii) level of performance (Data Gatherer, Sensemaker, Manager). Diligence and relationship to the team appeared to influence the quality and focus of a trainee's approach at all levels of performance. Level of performance was felt, by focus group attending physicians, to reflect a developmental progression of knowledge and skills.ConclusionsOur findings contribute to the existing literature in three ways. Firstly, they extend our understanding of how junior trainees approach the task of in‐patient follow‐up and clinical documentation and the value of those activities. Secondly, they provide new insights to support formative and summative assessment. Finally, they contribute to a growing body of literature exploring the factors that impact trainees' roles and interactions with the team. Future research should focus on validating our findings and exploring their utility in the development of novel assessment strategies.

What trainees grapple with: a study of threshold concepts on the medicine ward

“…Building on this notion, well‐designed EPAs should help identify and support trainees whose progress may be impeded by troublesome underlying TCs. Taking clinical documentation as an example EPA, if well designed it should hold a trainee back from performing documentation fully unsupervised until they have crossed the ‘Documentation as an Essential Practice’ threshold, a threshold that also has strong support from prior studies . We would also suggest that the collected data for defending an entrustment decision around a documentation‐based EPA should be selected to ensure that they can signal whether or not the TC had been crossed.…”

“…The methodology for both the prior study and this current one was constructivist grounded theory (CGT). CGT was chosen because of its well‐established and rigorous methodology for studying social and social‐psychological phenomena in medicine and other disciplines .…”

“…The study took place in two phases. The first phase used data collected as part of a prior study that has since been published . During this prior study, we noticed that the way junior trainees viewed the practice of medicine and their own role seemed to influence their actions.…”

“…In the clinical context, how trainees conceptualise their roles can greatly impact how they enact those roles . To date, with the exception of palliative care, TCs have not explicitly been studied in clinical contexts in medicine; in particular, what TCs trainees grapple with and the influence of these on both the performance of clinical tasks and who they are becoming as physicians.…”

Going from good to great: explicating norms through continuity in the clinical workplace

“…Making the implicit explicit . A strength of the study by Cadieux and Goldszmidt included in this issue of Medical Education is that it carefully examines two central tasks performed by trainees on in‐patient ward teams – follow‐up and documentation – and explores the range of trainee practices that can either enhance or detract from the team's work. The study contributes to the literature on workplace learning by explicitly describing how trainees can meaningfully contribute to patient care through these tasks.…”