Chances for learning intraprofessional collaboration between residents in hospitals

Abstract

Context: Intraprofessional collaboration (intraPC) between primary care (PC) doctors and medical specialists (MSs) is becoming increasingly important. Patient safety issues are often related to intraPC. In order to equip doctors well for their task of providing good quality and continuity of care, intraPC needs explicit attention, starting in postgraduate training. Worldwide, PC residents undertake a hospital placement during their postgraduate training, where they work in proximity with MS residents. This placement offers the opportunity to learn intraPC. It is yet unknown whether and how residents learn intraPC and what barriers to and opportunities for exist in learning intraPC during hospital placements. Methods: We performed an ethnographic non-participatory observational study in three emergency departments and three geriatric departments of five hospitals in the Netherlands. This was followed by 42 in-depth interviews with the observed residents and supervisors. The observations were used to feed the questions for the in-depth interviews. We analysed the interviews iteratively following the data collection using template analysis. Results: Hospital wards are rich in opportunities for learning intraPC. These opportunities, however, are seldom exploited for various reasons: intraPC receives limited attention when formulating placement goals, so purposeful learning of intraPC hardly takes place; residents lack awareness of the learning of intraPC; MS residents are not accustomed to searching for expertise from PC residents; PC residents adapt to the MS role and they contribute very little of their PC knowledge, and power dynamics in the hospital department negatively influence the learning of intraPC. Therefore, improvements in mindset, professional identity and power dynamics are crucial to facilitate and promote intraPC. Conclusions: Intraprofessional collaboration is not learned spontaneously during hospital placements. To benefit from the abundant opportunities to learn intraPC, adjustments to the setup of these placements are necessary. Learning intraPC is promoted when there is a collaborative culture, hierarchy is limited, and there is dedicated time for intraPC and support from the supervisor. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Teaching and Learning Core Values in General Practice/Family Medicine: A Narrative Review

“…This proved to be a rich learning opportunity ( 52 ). Also, the moments that primary care trainees have their hospital placement, can be used to learn to collaborate intraprofessionally ( 53 ).…”

Exploring power dynamics and their impact on intraprofessional learning

“…Worldwide, during postgraduate training, PC residents undertake hospital placements in the same departments where MS residents are in training. 15,[19][20][21][22][23] In the Netherlands, this means that PC residents work four days a week on the hospital ward together with MS residents; the fifth day is spent with other PC residents at the PC specialty training institute. This current study expands on previously published research by Looman et al (2020), which investigated opportunities and barriers to intraPC learning between PC and MS residents during hospital placements.…”

The troublesome nature of intraprofessional collaboration: A threshold concept perspective

“…It is with great pleasure that we write this commentary to the paper by Looman et al which focused on intraprofessional collaboration (IntraPC) amongst health care providers (HCPs). 1 As we read the paper, we thought about our own clinical experiences as an emergency medicine resident (author CB) working on off-service rotations and an internal medicine attending physician (author MG) who has worked with off-service residents on the wards for over two decades. As we discussed and reflected on our experiences, we could not help but agree with the study findings that, on the one hand, it is easy to acknowledge the importance of IntraPC, but on the other that it can be difficult to enact in practice.…”

“…Identifying and responding appropriately to doctors who are underperforming, whether they are in training or in clinical practice, is vital in a profession where high standards are a pre-requisite for ensuring high-quality care that is safe and effective and provides patients with a good experience. 1 Identifying and responding appropriately to doctors who are underperforming,…”

“…It is with great pleasure that we write this commentary to the paper by Looman et al which focused on intraprofessional collaboration (IntraPC) amongst health care providers (HCPs) 1 . As we read the paper, we thought about our own clinical experiences as an emergency medicine resident (author CB) working on off‐service rotations and an internal medicine attending physician (author MG) who has worked with off‐service residents on the wards for over two decades.…”