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Bearman M, Dracup M, Ajjawi R, Kirby C, Brown J. Feedback, learning and becoming: Narratives of feedback in complex performance challenges. MEDICAL EDUCATION 2024. [PMID: 38978135 DOI: 10.1111/medu.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Becoming a general practitioner (or family medicine specialist) is challenging, as trainees learn to manage complex and ambiguous situations. Feedback is a key component of this learning. Although research has tended to focus on feedback's momentary processes and impacts, there is value in seeking to understand the work it does over time and how trainees position themselves across multiple feedback encounters. We ask: how do newly qualified GPs narrate themselves and their experiences with complex performance challenges? Within these narratives, what is the role of feedback? METHODS The research adopts a holistic and sequential narrative analysis approach, with in-depth narrative interviews of 16 general practice trainees who had just completed their training requirements. The analysis involved restorying the participant narratives chronologically. Each narrative formed a unit of analysis where narrative commonalities across plots, characters, emotions and the role of feedback were interpreted. RESULTS Four plotlines within GP trainees' stories of complex performance challenges were identified: Journeyperson, Hero's Quest, Solo Journeyer and Endless Struggle. Trainees, supervisors and feedback are positioned differently within these plotlines. Narratives were saturated with emotions. DISCUSSION The plotlines bring together an alternative way of understanding how feedback, learning and becoming are woven together. They illustrate how multiple interactions with patients, supervisors, peers and systems thread together into an overall trajectory. How a trainee positions themselves as protagonists and who they characterise as their antagonists can help direct the focus of supervisors' feedback conversations.
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Affiliation(s)
- Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Burwood, Victoria, Australia
| | - Mary Dracup
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Burwood, Victoria, Australia
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Burwood, Victoria, Australia
| | | | - James Brown
- Sexual Health Victoria, Melbourne, Victoria, Australia
- Royal Australasian College of General Practitioners (RACGP), Melbourne, Victoria, Australia
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Winkel AF, Porter B, Scheer MR, Triola M, Pecoriello J, Cheloff AZ, Gillespie C. Evaluating the Impact of Coaching Through the Transition to Residency. J Gen Intern Med 2024:10.1007/s11606-024-08865-w. [PMID: 38926320 DOI: 10.1007/s11606-024-08865-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Coaching has been proposed to support the transition to residency. Clarifying its impact will help define its value and best use. OBJECTIVE To explore the experiences of residents working with coaches through the residency transition. DESIGN A cohort comparison survey compared experiences of a coached resident cohort with coaches to the prior, uncoached cohort. PARTICIPANTS Post-graduate year (PGY)-2 residents in internal medicine, obstetrics and gynecology, emergency medicine, and pathology at a single academic center. INTERVENTIONS Faculty trained as coaches had semi-structured meetings with graduating medical students and residents throughout the PGY-1 year. MAIN MEASURES An online anonymous survey assessed effects of coaching on measures of self-directed learning, professional development, program support and impact of coaching using existing scales (2-item Maslach Burnout Inventory, Brief Resilient Coping Scale, 2-item Connor-Davidson Resilience Scale, Stanford Professional Fulfillment Inventory), and novel measures adapted for this survey. Bivariate analyses (t-tests and chi-square tests) compared cohort responses. MANOVA assessed the effects of coaching, burnout and their interactions on the survey domains. KEY RESULTS Of 156 PGY2 residents, 86 (55%) completed the survey. More residents in the "un-coached" cohort reported burnout (69%) than the "coached" cohort (51%). Burnout was significantly and negatively associated (F = 3.97 (df 7, 75); p < .001) with the learning and professional development outcomes, while being coached was significantly and positively associated with those outcomes (F = 5.54 (df 9, 75); p < .001). Significant interaction effects were found for goal-setting attitudes, professional fulfillment, and perceived program career support such that the positive differences in these outcomes between coached and un-coached residents were greater among burned out residents. Coached residents reported a positive impact of coaching across many domains. CONCLUSIONS Residents experiencing coaching reported better professional fulfillment and development outcomes, with more pronounced differences in trainees experiencing burnout. Coaching is a promising tool to support a fraught professional transition.
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Affiliation(s)
| | - Barbara Porter
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Marc Triola
- New York University Grossman School of Medicine, New York, NY, USA
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Griffith M, Zvonar I, Garrett A, Bayaa N. Making goals count: A theory-informed approach to on-shift learning goals. AEM EDUCATION AND TRAINING 2024; 8:e10993. [PMID: 38882241 PMCID: PMC11178521 DOI: 10.1002/aet2.10993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 06/18/2024]
Abstract
Supervisors often ask emergency medicine trainees for their learning goals at the start of a clinical shift, though they may do so without considering the reasons for this practice. Recognizing the underlying rationale for voicing on-shift learning goals and proactively considering solutions for some of the associated challenges can help learners and supervisors employ this practice to its full potential. Goal articulation is rooted in educational principles such as self-regulated learning, targeted performance feedback, and collaborative relationships between learner and supervisor. Despite the potential for on-shift learning goals to augment learning, there are numerous barriers that make it challenging for learners and supervisors alike to create or follow up on meaningful goals. Learner-related challenges include uncertainty about how to develop goals within an unpredictable clinical environment and creating goals too narrow or broad in scope. Supervisor-related challenges include difficulties integrating direct observation into the clinical workflow and a desire to avoid negative feedback. The learning environment also presents inherent challenges, such as lack of longitudinal supervisor-learner relationships, time constraints, space limitations, and incentives for learners to conceal their knowledge gaps. The authors discuss these challenges to effective on-shift learning goals and propose solutions that target the learner's approach, the supervisor's approach, and the learning environment itself.
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Affiliation(s)
- Max Griffith
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | - Ivan Zvonar
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | - Alexander Garrett
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | - Naeem Bayaa
- Department of Emergency Medicine University of Washington Seattle Washington USA
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Winters RC, Chan TM, Barth BE. Five hats of effective leaders: teacher, mentor, coach, supervisor and sponsor. BMJ LEADER 2024; 8:9-14. [PMID: 37344163 DOI: 10.1136/leader-2022-000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND/AIM Teaching, mentoring, coaching, supervising and sponsoring are often conflated in the literature. In this reflection, we clarify the distinctions, the benefits and the drawbacks of each approach. We describe a conceptual model for effective leadership conversations where leaders dynamically and deliberately 'wear the hats' of teacher, mentor, coach, supervisor and/or sponsor during a single conversation. METHODS As three experienced physician leaders and educators, we collaborated to write this reflection on how leaders may deliberately alter their approach during dynamic conversations with colleagues. Each of us brings our own perspective and lens. RESULTS We articulate how each of the 'five hats' of teacher, mentor, coach, supervisor and sponsor may help or hinder effectiveness. We discuss how a leader may 'switch' hats to engage, support and develop colleagues across an ever-expanding range of contexts and settings. We demonstrate how a leader might 'wear the five hats' during conversations about career advancement and burn-out. CONCLUSION Effective leaders teach, mentor, coach, supervise and sponsor during conversations with colleagues. These leaders employ a deliberate, dynamic and adaptive approach to better serve the needs of their colleagues at the moment.
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Affiliation(s)
- Richard C Winters
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Teresa M Chan
- Division of Education & Innovation, Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bradley E Barth
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Aguilar-Ferrándiz ME, Toledano-Moreno S, Casas-Barragán A, Albornoz-Cabello M, Tapia-Haro RM, Correa-Rodríguez M. Implementation of a coaching training for enhancing empathy and emotional intelligence skills in health science students: a prospective study. BMC MEDICAL EDUCATION 2024; 24:76. [PMID: 38254094 PMCID: PMC10801972 DOI: 10.1186/s12909-024-05076-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Empathy and emotional intelligence are core competencies in the educational curriculum of health science students, both play a significant role in teamwork relationships and in attention patient's cares; so innovative strategies to enhance these emotional skills are required. We prospectively tested an academic coaching program for improving empathy and emotional intelligence in students of health sciences degrees. METHODS A prospectively single arm intervention study was performed in undergraduate students of nursing, physiotherapy and occupational therapy of the Faculty of Health Sciences from the University of Granada (Spain). The three groups of students participated in nine sessions of coaching, which included a training program to manage patient's priorities and communication, adherence to treatment, motivation and satisfaction. Survey data included the Cognitive and Affective Empathy Test (TECA), the Trait Meta-Mood Scale (TMMS-24) and the Interpersonal Reactivity Index (IRI) which were assessed at baseline and post-intervention. RESULTS A total of 93 students of 259 (mean age of 21.6 ± 3.2 years) participated in the study and completed the sessions of coaching/surveys. After the intervention, we observed an improvement in the cognitive dimension of empathy among nursing students (p = 0.035) and in the affective dimension of empathy in physiotherapy students (p = 0.044). In addition, an increase on perceived emotional intelligence among students was achieved only in nursing/physiotherapy groups (p ≤ 0.048). Finally, slight improvements were founded in the dimensions "Perspective-Taking" and "Personal Distress" of the occupational therapy group (p ≤ 0.031). No significant differences were found for the rest of variables of TECA (p ≥ 0.052), TMMS-24 (p ≥ 0.06) and IRI (p ≥ 0.12). CONCLUSIONS This study shows that an academic coaching intervention with students from health sciences degrees improves their empathy skills and self-perceived emotional intelligence. The current findings can be used to determine more effective approaches to implementing academic coaching interventions based in better designs as clinical trial studies.
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Affiliation(s)
- María Encarnación Aguilar-Ferrándiz
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Ave. de la Ilustración, 60, 18071, Granada, Spain
| | - Sonia Toledano-Moreno
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Ave. de la Ilustración, 60, 18071, Granada, Spain
| | - Antonio Casas-Barragán
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Ave. de la Ilustración, 60, 18071, Granada, Spain
| | - Manuel Albornoz-Cabello
- Department of Physical Therapy, Faculty of Nursing Physiotherapy and Podiatry, University of Sevilla (US), Sevilla, Spain
| | - Rosa María Tapia-Haro
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Ave. de la Ilustración, 60, 18071, Granada, Spain.
| | - María Correa-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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Sobel J, Hayden SR, Wardi G. The Knowledge Gap: Mentorship in Emergency Medicine Residency. Ann Emerg Med 2023; 82:47-54. [PMID: 36841659 PMCID: PMC10293097 DOI: 10.1016/j.annemergmed.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 01/14/2023] [Accepted: 01/24/2023] [Indexed: 02/26/2023]
Abstract
STUDY OBJECTIVE Studies of mentorship in emergency medicine show that mentored residents are twice as likely to describe their career preparation as excellent as compared to nonmentored peers. There has been significant interest in the mentor-mentee relationship in medicine; however, there is minimal guidance and published literature specific to emergency medicine residents. METHODS In this narrative review, we described the emergency medicine mentor-mentee relationship, discussed alternatives to the traditional dyadic model, and highlighted current barriers to effective mentorship. We conducted a structured literature review to identify relevant published articles regarding the mentoring of emergency medicine residents. Additional studies from general mentoring literature were included based on relevancy. RESULTS We identified 39 studies in emergency medicine literature based on our search criteria. Additional studies from general medicine literature were included based on relevancy to this review. Based on the limited available literature, we recommend maximizing the resident mentoring relationship by developing formal mentoring programs, supporting the advancement of women and underrepresented minority mentors, and moving toward team mentoring, including peer, near-peer, and collaborative mentorship. The development of a mentoring network is a logical strategy for residents to work with a diverse group of individuals to maximize benefits in multiple areas. CONCLUSION Alternative approaches to the traditional and hierarchal dyadic mentoring style (eg, team mentoring) are effective methods that residencies may promote to increase effective mentoring. Future efforts in mentoring emergency medicine residents emphasize these strategies, which are increasingly beneficial given the constraints and use of technology highlighted by the COVID-19 pandemic.
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Affiliation(s)
- Julia Sobel
- Department of Emergency Medicine, UC San Diego Health, San Diego, CA.
| | - Stephen R Hayden
- Department of Emergency Medicine, UC San Diego Health, San Diego, CA; Department of Emergency Medicine, UHS SoCal MEC - Temecula Valley Hospital, Temecula, CA
| | - Gabriel Wardi
- Department of Emergency Medicine, UC San Diego Health, San Diego, CA; Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Health, La Jolla, CA
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Marcus CH, Michelson CD, Luff D, Newman LR. Participation in a Resident-as-Teacher Rotation: Motivations of and Impacts on Faculty Coaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1832-1840. [PMID: 35703138 DOI: 10.1097/acm.0000000000004778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Coaching in medical education is increasingly used for trainee development for a variety of skills, including improving trainee teaching skills through resident-as-teacher programs. Faculty who serve as coaches commit significant effort to the coaching role, often without protected time or support. Little is known about faculty motivations to participate in coaching programs or how the coaching experience affects the faculty. This study explored faculty coaches' motivations to participate as coaches in a resident-as-teacher rotation and the impacts they experienced as a result of their participation. METHOD In this qualitative study, authors conducted 14 semistructured interviews in 2019 with faculty coaches from a single resident-as-teacher program in Boston, Massachusetts. Authors analyzed the transcripts using thematic analysis to develop a conceptual framework. RESULTS Faculty coaches' motivations for initial participation included a sense of honor; a sense of duty; perception of competence; interest in promoting medical education; and desire for increased connectedness. These motivations all related to a larger theme of educator identity. Coaches identified 3 main impacts from participation: improvement in their own teaching, personal satisfaction from helping others and seeing improvement in their learners, and increased connectedness. These impacts affirmed the coaches' educator identity and led to ongoing motivation to participate. They also contributed to the coaches' well-being at work. CONCLUSIONS Faculty were initially motivated to participate as coaches in a resident-as-teacher rotation based on their identity as educators. The benefits achieved-improvement in own teaching, personal satisfaction, and increased connectedness-affirmed their educator identity and led to ongoing participation and increased well-being at work. These motivations and impacts are important to consider as future programs are developed and coaches are recruited for programs across undergraduate, graduate, and continuing medical education settings.
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Affiliation(s)
- Carolyn H Marcus
- C.H. Marcus is an instructor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Catherine D Michelson
- C.D. Michelson is assistant professor, Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Donna Luff
- D. Luff is assistant professor, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lori R Newman
- L.R. Newman is assistant professor, Department of Pediatrics and Department of Education, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Pandit K, Coates WC, Diercks D, Gupta S, Siegelman J. Faculty Development for Academic Emergency Physicians: A Focus Group Analysis. Cureus 2022; 14:e27596. [PMID: 36059367 PMCID: PMC9436480 DOI: 10.7759/cureus.27596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: The objective is to explore academic emergency medicine physicians’ exposure to and needs regarding faculty development. Methods: We conducted a prospective qualitative study of Society for Academic Emergency Medicine members in 2018 using focus groups selected by convenience and snowball sampling. One facilitator ensured representative engagement and responses were transcribed in real-time by an assistant after obtaining verbal consent. Results were analyzed using a grounded theory approach with a constructivist perspective. Thematic analysis was refined using the constant comparative method. Results: Sixteen physicians participated in the focus groups, representing a diverse group of perspectives. Six themes emerged about unmet needs in faculty development: knowledge and skills, relationships, specific programs or resources, and professional benefits. Conclusions: Members of a national academic society identified three areas of focus important to developing academicians in emergency medicine: content for faculty developers, relationship-building among members, and support from the organization as a “professional home.” Academic societies can use this to guide future programming.
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The disruptive radiologist. Clin Imaging 2022; 87:5-10. [DOI: 10.1016/j.clinimag.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022]
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Kamhawy R, Chan TM, Mondoux S. Enabling positive practice improvement through data-driven feedback: A model for understanding how data and self-perception lead to practice change. J Eval Clin Pract 2021; 27:917-925. [PMID: 33124754 DOI: 10.1111/jep.13504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This article aims to identify the factors that affect physicians' experiences of receiving practice data and to use these data to develop a model describing how individuals interact with the data. METHODS We designed an interview guide to study physicians' perspectives on audit and feedback. By intentional sampling, we recruited 15 physicians amongst gender groups, types of practice (academic vs community), and durations of practice. The interviews were conducted by a single author and transcribed without identifiers. We then began with an open coding analysis for all of the transcripts, and thereafter conducted axial coding to group the data into larger themes. RESULTS Several attributes were identified as either enabling or counterproductive attributes for participant improvement. The final proposed model identifies different zones of engagement on the basis of both the individual practitioner's growth mindset and the quality of the existing data system. In the highest engagement zone, the mindset of the collective leadership is one of growth. Systemic supports are in place, which potentiates learning that may come from an individual motivated to use their own data. CONCLUSION Our novel model depicts the relationship between data feedback systems and individuals' mindsets interact to augment or hinder clinical practice improvement. This model may provide leaders with a framework to examine their academic and administrative structures and how they might interface with performance feedback systems with clinicians.
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Affiliation(s)
- Rana Kamhawy
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Teresa M Chan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shawn Mondoux
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Kandasamy S, Vanstone M, Colvin E, Chan T, Sherbino J, Monteiro S. "I made a mistake!": A narrative analysis of experienced physicians' stories of preventable error. J Eval Clin Pract 2021; 27:236-245. [PMID: 33399266 DOI: 10.1111/jep.13531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The complexity of healthcare systems makes errors unavoidable. To strengthen the dialogue around how physicians experience and share medical errors, the objective of this study was to understand how generalist physicians make meaning of and grow from their medical errors. METHODS This study used a narrative inquiry approach to conduct and analyse in-depth interviews from 26 physicians from the generalist specialties of emergency, internal, and family medicine. We gathered stories via individual interview, analysed them for key components, and rewrote a "meta-story" in a chronological sequence. We conceptualized the findings into a metaphor to draw similarities, learn from, and apply new principles from other fields of practice. RESULTS Through analysis we interpreted the story of a physician who is required to make numerous decisions in a short period of time in different clinical environments among the patient's family and whilst abiding by existing rules and regulations. Through sharing stories of success and failure, the clinical supervisor can help optimize the physician's emotional growth and professional development. Similarly, through sharing and learning from stories, colleagues and trainees can also contribute to the growth of the protagonist's character and the development of clinic, hospital, and healthcare system. CONCLUSION We draw parallels between the clinical setting and a generalist physician's experiences of a medical error with the environment and practices within professional sports. Using this comparison, we discuss the potential for meaningful coaching in medical education.
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Affiliation(s)
- Sujane Kandasamy
- Department of Health Research Methods, Evidence & Impact, Health Research Methodology PhD Program, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.,McMaster Education Research, Innovation & Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada
| | - Eamon Colvin
- School of Psychology, Clinical Psychology PhD Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Teresa Chan
- McMaster Education Research, Innovation & Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.,Program for Faculty Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Sherbino
- McMaster Education Research, Innovation & Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Monteiro
- Department of Health Research Methods, Evidence & Impact, Health Research Methodology PhD Program, McMaster University, Hamilton, Ontario, Canada.,McMaster Education Research, Innovation & Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada
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Li S, Acai A, Sherbino J, Chan TM. The Teacher, the Assessor, and the Patient Protector: A Conceptual Model Describing How Context Interfaces With the Supervisory Roles of Academic Emergency Physicians. AEM EDUCATION AND TRAINING 2021; 5:52-62. [PMID: 33521491 PMCID: PMC7821073 DOI: 10.1002/aet2.10431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Emergency medicine is a fast-paced specialty that demands emergency physicians to respond to rapidly evolving patient presentations, while engaging in clinical supervision. Most research on supervisory roles has focused on the behaviors of attending physicians, including their individual preferences of supervision and level of entrustment of clinical tasks to trainees. However, less research has investigated how the clinical context (patient case complexity, workflow) influences clinical supervision. In this study, we examined how the context of the emergency department (ED) shapes the ways in which emergency physicians reconcile their competing roles in patient care and clinical supervision to optimize learning and ensure patient safety. METHODS Emergency physicians who regularly participated in clinical supervision in several academic teaching hospitals were individually interviewed using a semi-structured format. The interviews were transcribed and analyzed using a constructivist grounded theory approach. RESULTS Sixteen emergency physicians were asked to reflect on their clinical supervisory roles in the ED. We conceptualized a model that describes three prominent roles: teacher, assessor, and patient protector. Contextual features such as trainee competence, pace of the ED, patient complexity, and the culture of academic medicine influenced the extent to which certain roles were considered salient at any given time. CONCLUSIONS This conceptual model can inform researchers and medical educators about the role of context in accentuating or minimizing various roles of emergency physicians. Identifying how context interfaces with these roles may help design faculty development initiatives aimed to navigate the tension between urgent patient care and medical education for emergency physicians.
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Affiliation(s)
- Shelly‐Anne Li
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
| | - Anita Acai
- Department of PsychologyNeuroscience & Behaviour and Office of Education ScienceDepartment of SurgeryMcMaster UniversityHamiltonOntarioCanada
| | - Jonathan Sherbino
- Division of Emergency MedicineDepartment of Medicine, and McMaster Education Research, Innovation and Theory (MERIT) ProgramMcMaster UniversityHamiltonOntarioCanada
| | - Teresa M. Chan
- Division of Emergency MedicineDepartment of Medicine, and McMaster Education Research, Innovation and Theory (MERIT) ProgramMcMaster UniversityHamiltonOntarioCanada
- Program for Faculty DevelopmentMcMaster UniversityHamiltonOntarioCanada
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