Practical Interventions to Enhance Resident Ownership of Patient Care

Abstract

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.

“It is you, me on the team together, and my child”: Attending, resident, and patient family perspectives on patient ownership

“…Conversely, continuity of care, scheduling practices favoring continuity over access, and resident autonomy were facilitators in most circumstances (Box 1). While many of these factors also align with prior literature describing influencers of patient ownership [7][8][9][10][11][17][18][19][20][21][22], findings specific to the continuity clinic setting that have not been well described previously included protocols for calling back patients regarding laboratory or radiology results, the resident patient load during clinic, and the medical complexity of resident patient empanelments. The practice setting and medical care team can also be seen as integral parts of the local context; however, none of these contextual factors can guarantee or disallow patient ownership.…”

“…2 provides examples of such elements within our continuity clinic setting. The attitudes and behaviors articulated for physicians align well with prior descriptions of patient ownership that emphasize feelings of responsibility, personally carrying out patient care tasks, autonomy, and knowing patients well [5,8,12,13,15,29,36,37]. Within our continuity clinics, coordination of care The second premise of our theory is: The physician and patient engage in patient ownership within the constraints and affordances of their local context.…”

“…Degree of continuity of care Clinic scheduling practices (e.g., prioritizing access versus continuity) Resident rotation scheduling practices (e.g., full-day versus half-day continuity clinics, division of inpatient/outpatient rotations) Composition of medical care team Protocols for calling patients back regarding laboratory or radiology results Degree of resident autonomy Faculty role modeling Resident patient load during clinic Medical complexity of patient empanelment Handoff protocols/practices patients have full control of decisions), interpretive (physician helps patient elucidate and articulate their values), and deliberative (physician partners with patient to decide treatment plan based on patient values), with the conception of patient autonomy as one of the prime distinguishing features of each. Some have contended that the term patient ownership is inherently paternalistic [29] and suggested alternative phrasings such patient care ownership or decision ownership [2,8,36], and we respect those who chose to embrace different terminology. However, this model reframes patient ownership in a more inclusive sense by shifting the locus of control from the physician alone to a shared position between both parties-with the physician still having information and expertise, and with the patient/family empowered to negotiate and carry out treatment plans and to shape the nature of the relationship through their feelings toward the physician.…”

“…Several studies have suggested continuity of care facilitates patient ownership [17][18][19][20][21]. However, some characteristics of continuity clinics could poorly position residents to take ownership of their patients' care, including, for example, competing clinical demands, time constraints, and scheduling limitations [7][8][9][10][11]22]. Investigating the interplay between these and other factors that might be specific to continuity clinics could inform efforts to optimize clinic operations and structures in ways to promote patient ownership.…”

Creating a better learning environment: a qualitative study uncovering the experiences of Master Adaptive Learners in residency

“…Teaching •Build a culture of teaching (e.g. maximize teaching opportunities, celebrate excellent resident/faculty teachers) •Develop evidence-based teaching skills Create opportunities for collaborative learning The learning environment contains a deep reservoir of vertical and horizontal social learning opportunities •Prompt learners to identify trusted sources during formal evaluation or coaching sessions •Provide trainees with encouragement, time, and space to generate peer learning collaborations •Maximize learner autonomy commensurate with ability [ 26 ] …”