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Fujikawa H, Hayashi M, Son D, Kondo K, Eto M. Translating, adapting, and validating the medical student version of the patient care ownership scale for use in Japan. BMC MEDICAL EDUCATION 2024; 24:706. [PMID: 38943114 PMCID: PMC11214203 DOI: 10.1186/s12909-024-05704-8] [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: 10/09/2023] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Patient care ownership (PCO) among medical students is a growing area in the field of medical education. While PCO has received increasing attention, there are no instruments to assess PCO in the context of Japanese undergraduate medical education. This study aimed to translate, culturally adapt, and validate the PCO Scale - Medical students (PCOS-S) in the Japanese context. METHODS We collected survey data from fifth- and sixth-grade medical students from five different universities varying in location and type. Structural validity, convergent validity, and internal consistency reliability were examined. RESULTS Data from 122 respondents were analyzed. Factor analysis of the Japanese PCOS-S revealed three factors with Cronbach's alpha values exceeding the satisfactory criterion (0.70). A positive correlation was observed between the total Japanese PCOS-S scores and the global rating scores for the clinical department as a learning environment (Pearson's correlation coefficient = 0.61). CONCLUSIONS We conducted the translation of the PCOS-S into Japanese and assessed its psychometric properties. The Japanese version has good reliability and validity. This instrument has potential value in assessing the development of medical students' PCO.
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Affiliation(s)
- Hirohisa Fujikawa
- Center for General Medicine Education, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Mikio Hayashi
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Center for Health Professions Education, Kansai Medical University, Hirakata, Osaka, Japan
- Master of Medical Sciences in Medical Education, Harvard Medical School, Boston, MA, USA
| | - Daisuke Son
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Kayo Kondo
- School of Modern Languages and Cultures, Durham University, Durham, UK
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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McKenzie CT, Cruz Walma DA. A cross-sectional study of academic success measures, grit, and resilience among US dental students. J Dent Educ 2024. [PMID: 38922895 DOI: 10.1002/jdd.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/15/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE This study explored themes previously identified as central to holistic professional school success, as related to traditional academic achievement, resilience, and grit measures. METHODS This cross-sectional study surveyed third- and fourth-year US dental students. Items addressed themes previously identified as central to professional school success, including need for cognition, patient ownership, collective orientation, grit, and resilience. Traditional academic metrics were also included. Statistical analyses comprised one-way analysis of variance (ANOVA), simple linear regression, and stepwise multiple regression procedures. RESULTS A total of 126 students participated (81% response rate). Collective orientation, need for cognition, patient ownership, and resilience did not significantly correlate with grade point average (GPA), whereas grit did, r = 0.29. Need for cognition and patient ownership combined significantly predicted grit with approximately 35% of variance explained. Approximately 25% of variance in resilience scores was accounted for by need for cognition, coupled with collective orientation. Grit and resilience significantly correlated, r = 0.59. CONCLUSIONS Grit significantly predicted both traditional and alternative metrics of success among dental students, particularly need for cognition and patient ownership. A high need for cognition is consistent among students who display both grit and resilience. Neither resilience nor the alternative measures of success predicted traditional academic metrics.
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Affiliation(s)
- Carly Timmons McKenzie
- Department of Clinical and Community Sciences, Behavioral and Population Sciences Division, School of Dentistry, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David Alexandre Cruz Walma
- University of Oxford, Oxford, UK
- National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
- School of Dentistry, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kiger ME, Meyer HS. Ownership of Patient Care: Medical Students' Expectations, Experiences, and Evolutions Across the Core Clerkship Curriculum. TEACHING AND LEARNING IN MEDICINE 2024:1-13. [PMID: 38857111 DOI: 10.1080/10401334.2024.2361913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 05/03/2024] [Indexed: 06/12/2024]
Abstract
Phenomenon: Ownership of patient care is a key element of professional growth and professional identity formation, but its development among medical students is incompletely understood. Specifically, how attitudes surrounding ownership of patient care develop, what experiences are most influential in shaping them, and how educators can best support this growth are not well known. Therefore, we studied the longitudinal progression of ownership definitions and experiences in medical students across their core clerkship curriculum. Approach: We conducted a series of four longitudinal focus groups with the same cohort of medical students across their core clerkship curriculum. Using workplace learning theory as a sensitizing concept, we conducted semi-structured interviews to explore how definitions, experiences, and influencers of ownership developed and evolved. Results were analyzed inductively using thematic analysis. Findings: Fifteen students participated in four focus groups spanning their core clerkship curriculum. We constructed four themes from responses: (1) students' definitions of ownership of patient care evolved to include more central roles for themselves and more defined limitations; (2) student conceptions of patient care ownership became more relational and reciprocal over time as they ascribed a more active role to patients; (3) student assessment fostered ownership as an external motivator when it explicitly addressed ownership, but detracted from ownership if it removed students from patient care; and (4) structural and logistical factors impacted students' ability to display patient care ownership. Insights: Student conceptions of ownership evolved over their core clerkship curriculum to include more patient care responsibility and more meaningful relational connections with patients, including recognizing patients' agency in this relationship. This progression was contingent on interactions with real patients and students being afforded opportunities to play a meaningful role in their care. Rotation structures and assessment processes are key influencers of care ownership that merit further study, as well as the voice of patients themselves in these relationships.
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Affiliation(s)
- Michelle E Kiger
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland, USA
| | - Holly S Meyer
- Department of Medicine, Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland, USA
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Wyatt TR, Wood EA, Waller JL, Egan SC, Stepleman LM. Patient care ownership in medical students: a validation study. BMC MEDICAL EDUCATION 2023; 23:127. [PMID: 36814275 PMCID: PMC9948326 DOI: 10.1186/s12909-023-04106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Psychological Ownership is the cognitive-affective state individuals experience when they come to feel they own something. The construct is context-dependent reliant on what is being owned and by whom. In medical education, this feeling translates to what has been described as "Patient Care Ownership," which includes the feelings of responsibility that physicians have for patient care. In this study, we adapted an instrument on Psychological Ownership that was originally developed for business employees for a medical student population. The aim of this study was to collect validity evidence for its fit with this population. METHODS A revised version of the Psychological Ownership survey was created and administered to 182 medical students rotating on their clerkships in 2018-2019, along with two other measures, the Teamwork Assessment Scale (TSA) and Maslach Burnout Inventory (MBI) Survey. A confirmatory factor analysis (CFA) was conducted, which indicated a poor fit between the original and revised version. As a result, an exploratory factor analysis (EFA) was conducted and validity evidence was gathered to assess the new instruments' fit with medical students. RESULTS The results show that the initial subscales proposed by Avey et al. (i.e. Territoriality, Accountability, Belongingness, Self-efficacy, and Self-identification) did not account for item responses in the revised instrument when administered to medical students. Instead, four subscales (Team Inclusion, Accountability, Territoriality, and Self-Confidence) better described patient care ownership for medical students, and the internal reliability of these subscales was found to be good. Using Cronbach's alpha, the internal consistency among items for each subscale, includes: Team Inclusion (0.91), Accountability (0.78), Territoriality (0.78), and Self-Confidence (0.82). The subscales of Territoriality, Team Inclusion, and Self-Confidence were negatively correlated with the 1-item Burnout measure (P = 0.01). The Team Inclusion subscale strongly correlated with the Teamwork Assessment Scale (TSA), while the subscales of Accountability correlated weakly, and Self-Confidence and Territoriality correlated moderately. CONCLUSION Our study provides preliminary validity evidence for an adapted version of Avey et al.'s Psychological Ownership survey, specifically designed to measure patient care ownership in a medical student population. We expect this revised instrument to be a valuable tool to medical educators evaluating and monitoring students as they learn how to engage in patient care ownership.
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Affiliation(s)
- Tasha R Wyatt
- Center for Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814-4712, USA.
| | - Elena A Wood
- Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Jennifer L Waller
- Department of Population Health Science, Division of Biostatistics & Data Science, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Sarah C Egan
- Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Lara M Stepleman
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Fujikawa H, Son D, Aoki T, Eto M. Association between patient care ownership and personal or environmental factors among medical trainees: a multicenter cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:666. [PMID: 36076223 PMCID: PMC9461127 DOI: 10.1186/s12909-022-03730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patient care ownership (PCO) is crucial to enhancing accountability, clinical skills, and medical care quality among medical trainees. Despite its relevance, there is limited information on the association of personal or environmental factors with PCO, and thus, authors aimed to explore this association. METHODS In 2021, the authors conducted a multicentered cross-sectional study in 25 hospitals across Japan. PCO was assessed by using the Japanese version of the PCO Scale (J-PCOS). To examine the association between personal (level of training, gender, and department) or environmental factors (hospital size, hospital type, medical care system, number of team members, number of patients receiving care, mean working hours per week, number of off-hour calls per month, and perceived level of the workplace as a learning environment) and PCO after adjusting for clustering within hospitals, the authors employed a linear mixed-effects model. RESULTS The analysis included 401 trainees. After adjusting for clustering within hospitals, it was confirmed that the senior residents had significantly better J-PCOS total scores (adjusted mean difference: 8.64, 95% confidence interval [CI]: 6.18-11.09) than the junior residents and the perceived level of the workplace as a learning environment had a positive association with J-PCOS total scores (adjusted mean difference per point on a global rating of 0-10 points: 1.39, 95% CI: 0.88-1.90). Trainees who received calls after duty hours had significantly higher J-PCOS total scores than those who did not (adjusted mean difference: 2.51, 95% CI: 0.17-4.85). There was no clear trend in the association between working hours and PCO. CONCLUSIONS Seniority and the perceived level of the workplace as a learning environment are associated with PCO. An approach that establishes a supportive learning environment and offers trainees a reasonable amount of autonomy may be beneficial in fostering PCO among trainees. The study findings will serve as a useful reference for designing an effective postgraduate clinical training program for PCO development.
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Affiliation(s)
- Hirohisa Fujikawa
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Daisuke Son
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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The Patient Care Ownership Scale: External Validation of an Instrument that Measures Patient Care Ownership Among Internal Medicine Trainees-a Multi-Institutional Study. J Gen Intern Med 2021; 36:3680-3688. [PMID: 33782886 PMCID: PMC8642535 DOI: 10.1007/s11606-021-06703-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient care ownership improves accountability, clinical skills, and quality of patient care among resident physicians, but appears to be gradually eroding. Research is limited by the lack of a reliable, objective measure of ownership. OBJECTIVE To validate the Patient Care Ownership Scale, an instrument that measures decision ownership among internal medicine residents. DESIGN Multi-institutional, cross-sectional study using a 66-item, online survey that queried residents on ownership's key constructs (advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, self-efficacy, and perceived ownership) as well as mood and burnout. PARTICIPANTS Internal medicine residents in five geographically diverse residency programs completing an inpatient rotation. MAIN MEASURES We performed exploratory and confirmatory factor analysis in two randomly split groups to evaluate for subscales and inform item reduction. We conducted reliability testing with Cronbach's α. We performed bivariate analyses to examine construct validity and identify correlates of ownership. KEY RESULTS Of the 785 eligible residents, 625 completed the survey (80% response rate); we included responses from 563 in the analysis. We identified three factors corresponding to assertiveness, conscientiousness, and confidence or perceived competence. After iterative item reduction, the 13-item ownership scale demonstrated good reliability (Cronbach's α = 0.82). Convergent validity was supported by a significant association with perceived ownership (eliminated from the final scale) (r = 0.67, p < 0.001). There was a positive association between ownership and training level (p < 0.01) and prior experience in the intensive care unit (p < 0.001). There were significant, inverse relationships between ownership and self-defined burnout (r = - 0.24, p < 0.001), depression (r = - 0.22, p < 0.001), detachment (r = - 0.26, p < 0.001), and frustration (r = - 0.15, p = 0.02), and significant positive associations between ownership and feeling energetic (r = 0.29, p < 0.001), happy (r = 0.33, p < 0.001), and fulfilled (r = 0.34, p < 0.001). CONCLUSIONS The Patient Care Ownership Scale is valid in diverse residency program settings. Medical educators and investigators can use our scale to assess interventions aimed at fostering ownership.
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Fujikawa H, Son D, Kondo K, Djulbegovic M, Takemura Y, Eto M. Translating and validating a Japanese version of the Patient Care Ownership Scale: a multicenter cross-sectional study. BMC MEDICAL EDUCATION 2021; 21:415. [PMID: 34344354 PMCID: PMC8329902 DOI: 10.1186/s12909-021-02853-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/26/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND Patient care ownership (PCO) is an essential component in medical professionalism and is crucial for delivering high-quality care. The 15-item PCO Scale (PCOS) is a validated questionnaire for quantifying PCO in residents; however, no corresponding tool for assessing PCO in Japan exists. This study aimed to develop a Japanese version of the PCOS (J-PCOS) and validate it among Japanese medical trainees. METHODS We performed a multicenter cross-sectional survey to test the validity and reliability of the J-PCOS. The study sample was trainees of postgraduate years 1-5 in Japan. The participants completed the J-PCOS questionnaire. Construct validity was assessed through exploratory and confirmatory factor analyses. Internal consistency reliability was examined by calculating Cronbach's alpha coefficients and inter-item correlations. RESULTS During the survey period, 437 trainees at 48 hospitals completed the questionnaire. Exploratory factor analysis of the J-PCOS extracted four factors: assertiveness, sense of ownership, diligence, and being the "go-to" person. The second factor had not been identified in the original PCOS, which may be related to a unique cultural feature of Japan, namely, a historical code of personal conduct. Confirmatory factor analysis supported this four-factor model, revealing good model fit indices. The analysis results of Cronbach's alpha coefficients and inter-item correlations indicated adequate internal consistency reliability. CONCLUSIONS We developed the J-PCOS and examined its validity and reliability. This tool can be used in studies on postgraduate medical education. Further studies should confirm its robustness and usefulness for improving PCO.
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Affiliation(s)
- Hirohisa Fujikawa
- Department of Medical Education Studies, Graduate School of Medicine, International Research Center for Medical Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan.
| | - Daisuke Son
- Department of Medical Education Studies, Graduate School of Medicine, International Research Center for Medical Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan
- Department of Community-based Family Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Kayo Kondo
- School of East Asian Studies, The University of Sheffield, Sheffield, UK
| | - Mia Djulbegovic
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yousuke Takemura
- Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, Graduate School of Medicine, International Research Center for Medical Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan
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Letter Regarding: The Multifaceted Concept of Patient Ownership in the Era of Duty Hour Restrictions. J Surg Res 2021; 263:285-286. [DOI: 10.1016/j.jss.2021.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
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Wyatt TR, Kleinheksel AJ, Tews M. Linking Patient Care Ownership and Professional Identity Formation through Simulation. TEACHING AND LEARNING IN MEDICINE 2021; 33:164-172. [PMID: 33840311 DOI: 10.1080/10401334.2020.1813583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The link between ownership of patient care and professional identity formation (PIF) has not been formally established, yet PIF researchers frequently cite clinical experiences as powerful contributions to PIF. Hypothesis: Using clinical simulation, this study aimed to explore the relationship between patient care ownership and the cognitive processes involved in the creation of a professional identity. Methods: In 2018-2019, 189 third-year students participated in a simulation in which they were placed in the role of a physician treating a patient in respiratory distress. Data were collected from 12 focus groups (n = 84; 44% of the third-year class), each lasting 15-25 minute. Students were asked four questions designed to identify moments when they felt like a physician and experienced feelings of ownership. Each focus group was transcribed and analyzed for the presence of known elements that contribute to feelings of psychological ownership, and then inductively for how students related their feelings of ownership to their professional identity. Results: When students were asked to take ownership of their patient's care, they underwent a three-step process: (1) experiencing disorientation, (2) reconceptualizing roles and responsibilities, and (3) reorientation to professional goals. Patient care ownership was disorienting because it marked a departure from the clinical roles the students had previously experienced. While disoriented, students engaged in a process of reflection during which they asked themselves who they were, who they were becoming, and who they needed to become to effectively serve in the role of a physician. This process prompted students to realize the limitations of their clinical reasoning abilities and that the role of a physician requires new ways of thinking. Conclusions: This study advances a conceptual model of PIF that identifies patient care ownership as a catalyst in developing a professional identity. Assuming responsibility for patients places students into an unfamiliar role, which opens a channel for students to access new perspectives in their development as physicians.
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Affiliation(s)
- Tasha R Wyatt
- Educational Innovation Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - A J Kleinheksel
- Educational Innovation Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matthew Tews
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Randle RW, Hildreth AN. Response Regarding: The Multifaceted Concept of Patient Ownership in the Era of Duty Hour Restrictions. J Surg Res 2021; 263:287-288. [PMID: 33678415 DOI: 10.1016/j.jss.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Reese W Randle
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
| | - Amy N Hildreth
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Kiger ME, Meyer HS, Varpio L. "It is you, me on the team together, and my child": Attending, resident, and patient family perspectives on patient ownership. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:101-109. [PMID: 33263864 PMCID: PMC7952476 DOI: 10.1007/s40037-020-00635-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/27/2020] [Accepted: 11/05/2020] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Patient ownership is an important element of physicians' professional responsibility, but important gaps remain in our understanding of this concept. We sought to develop a theory of patient ownership by studying it in continuity clinics from the perspective of residents, attending physicians, and patients. METHODS Using constructivist grounded theory, we conducted 27 semi-structured interviews of attending physicians, residents, and patient families within two pediatric continuity clinics to examine definitions, expectations, and experiences of patient ownership from March-August 2019. We constructed themes using constant comparative analysis and developed a theory describing patient ownership that takes into account a diversity of perspectives. RESULTS Patient ownership was described as a bi-directional, relational commitment between patient/family and physician that includes affective and behavioral components. The experience of patient ownership was promoted by continuity of care and constrained by logistical and other systems-based factors. The physician was seen as part of a medical care team that included clinic staff and patient families. Physicians adjusted expectations surrounding patient ownership for residents based on scheduling limitations. DISCUSSION Our theory of patient ownership portrays the patient/family as an active participant in the patient-physician relationship, rather than a passive recipient of care. While specific expectations and tasks will vary based on the practice setting, our findings reframe the way in which patient ownership can be viewed and studied in the future by attending to a diversity of perspectives.
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Affiliation(s)
- Michelle E Kiger
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- Department of Pediatrics, Wright-Patterson Medical Center, Dayton, OH, USA.
| | - Holly S Meyer
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Boyle SM, Subedi K, Pivert KA, Harhay MN, Baynes-Fields J, Goldman J, Warburton KM. Nephrology Fellows' and Program Directors' Perceptions of Hospital Rounds in the United States. Clin J Am Soc Nephrol 2020; 15:474-483. [PMID: 32184295 PMCID: PMC7133138 DOI: 10.2215/cjn.10190819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/18/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Hospital rounds are a traditional vehicle for patient-care delivery and experiential learning for trainees. We aimed to characterize practices and perceptions of rounds in United States nephrology training programs. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a national survey of United States nephrology fellows and program directors. Fellows received the survey after completing the 2019 National Board of Medical Examiners Nephrology In-Training Exam. Program directors received the survey at the American Society of Nephrology's 2019 Nephrology Training Program Directors' Retreat. Surveys assessed the structure and perceptions of rounds, focusing on workload, workflow, value for patient care, and fellows' clinical skill-building. Directors were queried about their expectations for fellow prerounds and efficiency of rounds. Responses were quantified by proportions. RESULTS Fellow and program director response rates were 73% (n=621) and 70% (n=55). Most fellows (74%) report a patient census of >15, arrive at the hospital before 7:00 am (59%), and complete progress notes after 5:00 pm (46%). Among several rounding activities, fellows most valued bedside discussions for building their clinical skills (34%), but only 30% examine all patients with the attending at the bedside. Most directors (71%) expect fellows to both examine patients and collect data before attending-rounds. A majority (78%) of directors commonly complete their documentation after 5:00 pm, and for 36%, after 8:00 pm. Like fellows, directors most value bedside discussion for development of fellows' clinical skills (44%). Lack of preparedness for the rigors of nephrology fellowship was the most-cited barrier to efficient rounds (31%). CONCLUSIONS Hospital rounds in United States nephrology training programs are characterized by high patient volumes, early-morning starts, and late-evening clinical documentation. Fellows use a variety of prerounding styles and examine patients at the beside with their attendings at different frequencies. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_17_CJN.10190819.mp3.
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Affiliation(s)
- Suzanne M Boyle
- Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania;
| | - Keshab Subedi
- Value Institute, Christiana Care Health System, Newark, Delaware
| | - Kurtis A Pivert
- Department of Workforce, Training, and Career Advancement, American Society of Nephrology, Alliance for Kidney Health, Washington, DC
| | - Meera Nair Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Tower Health Transplant Institute, Tower Health System, West Reading, Pennsylvania.,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Jaime Baynes-Fields
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jesse Goldman
- Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Karen M Warburton
- Division of Nephrology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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