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

Perspectives on Medical Education, Dec 2017

Introduction With 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. Methods The 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. Results 225 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. Discussion This 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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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 Deborah S. Cowley 0 1 2 3 Jesse D. Markman 0 1 2 3 Jennifer A. Best 0 1 2 3 Erica L. Greenberg 0 1 2 3 Michael J. Grodesky 0 1 2 3 Suzanne B. Murray 0 1 2 3 Kelli A. Corning 0 1 2 3 Mitchell R. Levy 0 1 2 3 William E. Greenberg 0 1 2 3 0 Department of Psychosocial and Community Health, University of Washington , Seattle, WA , USA 1 Department of Psychiatry, Harvard University, and Massachusetts General Hospital , Boston, MA , USA 2 Department of Medicine, University of Washington , Seattle, WA , USA 3 Department of Psychiatry, Harvard University and Beth Israel Deaconess Medical Center , Boston, MA , USA Introduction With 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. Methods The 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. Results 225 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. Discussion This 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. Ownership; Professionalism; Resident education - A preliminary version (before group meetings with the other two programs were held to refine and synthesize codes) of the University of Washington Medicine Residency data from this study was presented at the 2013 ACGME Annual Educational Conference in Orlando, Florida. Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, WA, USA In recent years, educators have expressed concern about erosion of ‘ownership’ among resident physicians. However, the definition of ownership is inconsistent and lacks systematic study. This qualitative study of residents and faculty in medicine and psychiatry at two institutions provides a rich understanding of meanings and components of ownership. The robust set of core elements identified across all groups in this study, as well as the differences between faculty and residents in perspectives on ‘shift work’ and the importance of resident decision-making, provide a framework for an enhanced conceptual understanding of and educational interventions to promote ownership of patient care. Introduction With changes in duty hours and supervision requirements, educators have expressed concerns about erosion in residents’ ‘ownership’ of patient care [ 1–6 ]. Though the term ownership is used in discussions of professionalism and medical education, systematic studies of the definition of this term are lacking and existing references lack consistency. For example, ownership has been described as ‘knowing everything about one’s patients and doing everything for them’ [3]; ‘the feeling of accountability’ for a patient and a care plan [ 4 ]; being assigned the care of a patient 24 h a day, 7 days a week; being responsible for the patient’s management and eventual disposition; and being the one person in charge of decision-making [ 6–8 ]. Ownership has also been conceptualized as resulting from time invested in the patient’s care and in a longitudinal treatment relationship [ 6–8 ] and has been linked with professional attributes of commitment (‘being obligated or emotionally impelled to act in the best interest of the patient’) and presence (‘to be fully present for a patient without distraction and to fully support and accompany the patient throughout care’) [ 9, 10 ]. Given the increasing use of the term ownership, it is important to better understand what meanings are ascrib (...truncated)


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Deborah S. Cowley, Jesse D. Markman, Jennifer A. Best, Erica L. Greenberg, Michael J. Grodesky, Suzanne B. Murray, Kelli A. Corning, Mitchell R. Levy, William E. Greenberg. Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry, Perspectives on Medical Education, 2017, pp. 1-8, DOI: 10.1007/s40037-017-0389-2