Abstract
Objective
In the modern training environment, some question whether trainees have the opportunity to develop ownership of patient care, which includes concepts such as advocacy, autonomy, commitment, communication, follow-through, knowledge about the patient, responsibility, and teamwork. Despite descriptions of what ownership is, there is little discussion of how to foster ownership during residency. The objective of this study was to solicit psychiatry resident and faculty perspectives on ways to enhance resident ownership in training.
Methods
Twenty-nine of 74 (39.2%) residents and 31 of 68 (45.6%) faculty members surveyed provided narrative responses to a voluntary, anonymous, electronic survey asking two structured, open-ended questions about what factors make it more or less likely that a resident will take “ownership” of patient care.
Results
The coding process produced four overarching categories of themes (attending, resident, educational program, and environment) that reflect domains for possible interventions to increase ownership, with conceptual guidance from the Theory of Planned Behavior. From these factors, the authors propose a number of practical yet theory-based interventions which include setting expectations, modeling, promoting autonomy, countertransference supervision, changing residency culture, and longer rotations.
Conclusions
These interventions address subjective norms, attitudes, perceived ability and control, environment, and actual resident abilities, all of which, according to the Theory of Planned Behavior, would be likely to influence patient care ownership. Future studies could develop curricula and examine the effectiveness of the interventions proposed here in reinforcing or developing ownership in physicians.
References
Van Eaton EG, Horvath KD, Pellegrini CA. Professionalism and the shift mentality: how to reconcile patient ownership with limited work hours. Arch Surg. 2005;140(3):230–5. doi:10.1001/archsurg.140.3.230.
McLaren K, Lord J, Murray SB, Levy M, Ciechanowski P, Markman J, et al. Ownership of patient care: a behavioural definition and stepwise approach to diagnosing problems in trainees. Perspect Med Educ. 2013; doi:10.1007/s40037-013-0058-z.
O’Sullivan H, van Mook W, Fewtrell R, Wass V. Integrating professionalism into the curriculum: AMEE Guide No. 61. Med Teach. 2012;34(2):e64–77. doi:10.3109/0142159X.2012.655610.
Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med. 2012;87(9):1185–90. doi:10.1097/ACM.0b013e3182604968.
Archer R, Elder W, Hustedde C, Milam A, Joyce J. The theory of planned behaviour in medical education: a model for integrating professionalism training. Med Educ. 2008;42(8):771–7. doi:10.1111/j.1365-2923.2008.03130.x.
ACGME and ABPN. The Psychiatry Milestone Project. ACGME.org. 2015 https://www.acgme.org/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf. Accessed 2 March 2017.
Madden T, Ellen P, Ajzen I. A comparison of the theory of planned behavior and the theory of reasoned action. Personal Soc Psychol Bull. 1992;18(1):3–9.
Ajzen I. Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. J Appl Soc Psychol. 2002;32(4):665–83.
Glazer BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. New York: Aldine De Gruyter; 1967.
Jha V, Brockbank S, Roberts T. A framework for understanding lapses in professionalism among medical students: applying the theory of planned behavior to fitness to practice cases. Acad Med. 2016; doi:10.1097/ACM.0000000000001287.
Grierson LE, Fowler N, Kwan MY. Family medicine residents’ practice intentions: theory of planned behaviour evaluation. Can Fam Physician. 2015;61(11):e524–31.
Fishbein M, von Haeften I, Appleyard J. The role of theory in developing effective interventions: implications from Project SAFER. Psychol Health Med. 2001;6(2):223–38.
Biondi EA, Varade WS, Garfunkel LC, Lynn JF, Craig MS, Cellini MM, et al. Discordance between resident and faculty perceptions of resident autonomy: can self-determination theory help interpret differences and guide strategies for bridging the divide? Acad Med. 2015;90(4):462–71. doi:10.1097/ACM.0000000000000522.
Ericsson KA. An expert-performance perspective of research on medical expertise: the study of clinical performance. Med Educ. 2007;41(12):1124–30. doi:10.1111/j.1365-2923.2007.02946.x.
Hirsh DA, Holmboe ES, ten Cate O. Time to trust: longitudinal integrated clerkships and entrustable professional activities. Acad Med. 2014;89(2):201–4. doi:10.1097/ACM.000000000000011.
Acknowledgements
This study was granted exempt status by the University of Washington Human Subjects Division (5/10/2012; HSD study #42964).
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The study protocol was reviewed by the Institutional Review Board of the University of Washington and was determined to have exempt status.
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On behalf of all authors, the corresponding author states that there is no conflict of interest.
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Soeprono, T., Markman, J., Grodesky, M. et al. Practical Interventions to Enhance Resident Ownership of Patient Care. Acad Psychiatry 42, 222–227 (2018). https://doi.org/10.1007/s40596-017-0731-3
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DOI: https://doi.org/10.1007/s40596-017-0731-3