Ownership of Patient Care: Medical Students' Expectations, Experiences, and Evolutions Across the Core Clerkship Curriculum.

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.

Defining Research Funding Priorities: Emergency Nurses Association Foundation.

INTRODUCTION: Establishing research priorities provides focus and direction for limited resources among organizations and increasing impact in a focused area. The Emergency Nurses Association (ENA) Foundation sought to identify research priorities to guide funding decisions in its extramural grants program. METHODS: A modified Delphi research strategy was used to build consensus among ENA members and key leaders to determine research focus areas. Two Delphi rounds were conducted. In the first round, 81 emergency nurses participated in providing a list of potential research foci. In the second round, 221 emergency nurse leaders recommended which research topics should be prioritized. Descriptive statistics (frequencies, percentages) were calculated for each research topic. The topics were clustered together and rank ordered by frequency/percentage. RESULTS: Eight research priorities were identified: emergency department overcrowding, workplace violence, nurse well-being, appropriate use of the emergency department, new graduate training, mental health care, disaster training, and diversity, equity, and inclusion research. DISCUSSION: These identified research priorities offer direction for determining ENA Foundation funding priorities. In addition, the research priorities provide strategic direction to emergency nurse researchers to promote a rich depth of research that can make a meaningful impact to science and emergency nursing practice.

Stress and Coping in Emergency Nurses Following Trauma Patient Care: A Qualitative Grounded Theory Approach.

BACKGROUND: Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions. OBJECTIVE: This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care. METHODS: Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs. RESULTS: A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support. CONCLUSIONS: Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses.

Do All Roads Lead to Full Participation? Examining Trajectories of Clinical Educators in Graduate Medical Education through Situated Learning Theory.

Phenomenon: As new faculty members begin their careers in Graduate Medical Education, each begins a journey of Professional Identity Formation from the periphery of their educational communities. The trajectories traveled vary widely, and full participation in a given educational community is not assured. While some medical school and post-graduate training programs may nurture Professional Identity Formation, there is scant support for faculty. To date, the trajectories that Graduate Medical Education faculty travel, what may derail inbound trajectories, and what tools Graduate Medical Education faculty use to navigate these trajectories have not been explicitly described. We explore these three questions here. Approach: Communities of Practice, a component of Situated Learning Theory, serves as a helpful framework to explore trajectories of educator identity development among Graduate Medical Educators. We used a inductive and deductive approach to Thematic Analysis, with Situated Learning Theory as our interpretive frame. Semi-structured interviews of faculty members of GME programs matriculating into a Health Professions Education Program were conducted, focusing on participants' lived experiences in medical education and how these experiences shaped their Professional Identity Formation. Findings: Participants noted peripheral, inbound, boundary, and outbound trajectories, but not an insider trajectory. Trajectory derailment was attributed to competing demands, imposter syndrome and gendered marginality. Modes of belonging were critical tools participants used to shape PIF, not only engagement with educator roles but disengagement with other roles; imagination of future roles with the support of mentors; and fluid alignment with multiple mutually reinforcing identities. Participants identified boundary objects like resumes and formal roles that helped them negotiate across Community of Practice boundaries. Insights: Despite a desire for full participation, some clinical educators remain marginal, struggling along a peripheral trajectory. Further research exploring this struggle and potential interventions to strengthen modes of belonging and boundary objects is critical to create equitable access to the inbound trajectory for all of our colleagues, leaving the choice of trajectories up to them.

Teaching Medical Students How to Teach: A Scoping Review.

PHENOMENON: Teaching medical students how to teach is a growing and essential focus of medical education, which has given rise to student teaching programs. Educating medical students on how to teach can improve their own learning and lay the foundation for a professional identity rooted in teaching. Still, medical student-as-teacher (MSAT) programs face numerous obstacles including time constraints, prioritizing curriculum, and determining effective evaluation techniques. The purpose of this scoping review is to map the current landscape of the literature on medical school initiatives designed to train students to teach to describe why medical student teaching programs are started; the benefits and barriers; who teaches them; what content is taught; and how content is delivered. With this new map, the authors aimed to facilitate the growth of new programs and provide a shared knowledge of practices derived from existing programs. APPROACH: The authors conducted a scoping review, guided by Arksey and O'Malley's framework, to map the literature of MSAT training programs. Six databases were searched using combinations of keywords and controlled vocabulary terms. Data were charted in duplicate using a collaboratively designed data charting tool. This review builds on the Marton et al. review and includes articles published from 2014 to 2020. FINDINGS: Of the 1,644 manuscripts identified, the full-text of 57 were reviewed, and ultimately 27 were included. Articles included empirical research, synthetic reviews, opinion pieces, and a descriptive study. Analysis focused on modalities for teaching medical students how to teach; content to teach medical students about teaching; benefits and barriers to starting teaching programs; and the value of teaching programs for medical students. INSIGHTS: The rapid growth of MSAT programs suggests that this curricular offering is of great interest to the field. Literature shows an increase in evaluative efforts among programs, benefits for students beyond learning to teach, and evidence of effective engagement in medical students' designing and implementing programs.

The Isolated Surgeon: A Scoping Review.

BACKGROUND: Surgeons in resource-limited environments often provide care outside the expected scope of current general surgery training. Geographically isolated patients may be unwilling or unable to travel for specialty care. These same patients also present with life-threatening emergencies beyond the typical breadth of a general surgeon's practice, in hospitals with limited professional and material support. This review characterizes the unique role of isolated surgeons, so individual surgeons and health care organizations may focus professional development resources more efficiently, with the ultimate goal of improved patient care. METHODS: We performed a scoping review of the isolated surgeon, reviewing 25 years of literature regarding isolated US civilian and military surgeons. We examined emerging themes regarding the definition of an isolated surgeon, the scope of surgical practice beyond current training norms, and training gaps identified by surgeons in an isolated role. RESULTS: From 904 articles identified, we included 91 for final review. No prior definition exists for the isolated surgeon, although multiple definitions describe rural surgeons, patients, or hospitals; we propose an initial definition from consistent themes in the literature. Isolated surgeons across varied practice settings consistently performed relatively large volumes of cases of, and identified training gaps in, orthopedic, obstetric and gynecologic, urologic, and vascular surgery subspecialties. Life-threatening, "rare-but-real" cases in the above and neurosurgical disciplines are uncommon, but consistent across practice settings. CONCLUSIONS: This review represents the largest examination of the isolated surgeon in the current literature. Clarifying the identity, practice components, and training gaps of the isolated surgeon represent the first step in formalizing support for this small but critical group of surgeons and their patients.

Defragmenting the Day: The Effect of Full-Day Continuity Clinics on Continuity of Care and Perceptions of Clinic.

PROBLEM: Traditional half-day continuity clinics within primary care residency programs require residents to split time between their assigned clinical rotation and continuity clinic, which can have detrimental effects on resident experiences and patient care within continuity clinics. Most previous efforts to separate inpatient and outpatient obligations have employed block scheduling models, which entail significant rearrangements to clinical rotations, team structures, and didactic education and have yielded mixed effects on continuity of care. A full-day continuity clinic schedule within a traditional, non-block rotation framework holds potential to de-conflict resident schedules without the logistical rearrangements required to adopt block scheduling models, but no literature has described the effect of such full-day continuity clinics on continuity of care or resident experiences within continuity clinic. INTERVENTION: A pediatric residency program implemented full-day continuity clinics within a traditional rotation framework. We examined the change in continuity for physician (PHY) measure in the six months prior to versus the six months following the switch, as well as changes in how often residents saw clinic patients in follow-up and personally followed up clinic laboratory and radiology results, which we term episodic follow-up. Resident and attending perceptions of full-day continuity clinics were measured using a survey administered 5-7 months after the switch. CONTEXT: The switch to full-day continuity clinics occurred in January 2018 within the Wright State University/Wright-Patterson Medical Center Pediatric Residency Program. The program has 46 residents who are assigned to one of two continuity clinic sites, each of which implemented the full-day continuity clinics simultaneously. OUTCOME: The PHY for residents at one clinic decreased slightly from 18.0% to 13.6% (p<.001) with full-day continuity clinics but was unchanged at another clinic [60.6% vs 59.5%, p=.86]. Measures of episodic follow-up were unchanged. Residents (32/46 = 77% responding) and attendings (6/8 = 75% responding) indicated full-day continuity clinics improved residents' balance of inpatient and outpatient obligations, preparation for clinic, continuity relationships with patients, and clinic satisfaction. LESSONS LEARNED: Full-day continuity clinics within a traditional rotation framework had mixed effects on continuity of care but improved residents' experiences within clinic. This model offers a viable alternative to block scheduling models for primary care residency programs wishing to defragment resident schedules.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1879652.

Getting Better Together: A Website Review of Peer Coaching Initiatives for Medical Educators.

Phenomenon: Peer coaching is a form of faculty development in which medical educators collegially work together to improve their teaching. Benefits include use of evidence-based teaching practices, promotion of collegial discussions, and reflection within the workplace teaching context. Some faculty developers have expertise in designing and offering peer coaching initiatives for medical educators. However, because of a paucity of reporting on these initiatives in the literature, this specialized knowledge is not readily accessible to the health professions education community. This gap hinders practice advancement and creates barriers for new initiative implementation. Approach: The authors conducted a website review to identify, examine, and conceptually map characteristics of peer coaching initiatives at Association of American Medical Colleges-accredited medical schools. Forty-five initiatives were included that maintained publicly accessible websites, performed direct observation of teaching with feedback, and had a stated purpose of improving teaching. Data collection included details related to initiative purpose, structure, participation, observation of teaching, feedback, and support of learning. Findings: Most initiatives were voluntary and provided formative feedback with the sole purpose of improving teaching. Nearly all used a three-phase process with a preobservation meeting for goal setting, direct observation of teaching, and a postobservation meeting with feedback. Many initiatives required peer coach training and expertise. Reflection, collaboration, confidentiality, and use of an observation instrument were frequently mentioned. Insights: This website review provides faculty developers with a knowledge synthesis of how present-day peer coaching initiatives are structured and enacted-laying a foundation to collaborate, build best practices, and identify areas for future research. These findings enable faculty developers to learn from and build upon others' examples. Future research should explore whether there is an ideal coaching model and location for peer coaching within the higher level organization. In addition, researchers should seek to build consensus on initiative characteristics that enhance participation and foster teaching effectiveness.

Factors influencing midwives' intentions to facilitate normal physiological birth: A qualitative study.

BACKGROUND: Whilst most women desire to birth vaginally, research highlights reducing rates of normal physiological birth worldwide. Previous studies have focussed largely on clinical practices associated with vaginal birth however health care professionals' intentions are also known to effect behaviour; a factor not well understood within the context of midwifery and normal physiological birth. QUESTION/AIM: To explore factors influencing midwives' intentions to facilitate normal physiological birth. METHODS: A qualitative study using individual interviews was conducted. The Theory of Planned Behaviour was used to develop a semi-structured interview guide to gather perceptions, thoughts, knowledge, and experience of normal physiological birth from participants. Data were analysed thematically within the theoretical constructs: attitudes, subjective norms, and perceived behavioural control. FINDINGS: Fourteen midwives from various practice settings, models, and locations in Australia were interviewed. Major factors influencing midwives' intentions to facilitate normal physiological birth were influenced by workplace culture, values and influence of leaders, the need to prioritise collaborative interdisciplinary relationships and support autonomy in midwifery. DISCUSSION: Factors influencing the midwives' intentions of facilitating normal physiological birth were multifaceted. Some influences are more obvious and observable through practice, while others were rooted in underlying beliefs and attitudes that were hidden in the subconscious of those involved. However, all contributing influences ultimately shape midwives' intentions and the way in which they facilitate normal physiological birth. CONCLUSIONS: Midwives intend to support normal physiological birth; however multiple factors influence their intentions over time. Prioritising collaborative interdisciplinary relationships and supporting autonomy in midwifery could address known barriers.

Striking up a Conversation: Exploring Advising in Graduate Programs in Health Professions Education.

INTRODUCTION: Advising is happening across the medical education continuum, within non-medical graduate education programs, and is central to the advancement of said learners. This suggests that advising should play a role in graduate health progressions education (HPE) programs. MATERIALS AND METHODS: To explore advising curricula among HPE programs, we conducted a website review of all published HPE programs on the Foundation for Advancement of International Medical Education and Research's website. RESULTS: We recognized the lack of information published on advisory roles in graduate HPE programs. This prompted a literature review, which revealed a similar gap. CONCLUSIONS: Advising serves to benefit a student, advisor, and program thus carrying importance and need for discussion. This article is intended to kick-start a scholarly discussion about advising within graduate HPE programs.

Development of Ventral Hernia Repair Curriculum Using the AWSSOM-a Synthetic Abdominal Wall Surgical Skills Operational Model.

INTRODUCTION: Ventral hernia repair cost the U.S. healthcare system nearly 3 billion dollars annually. Surgical repair is a critical competency for residents yet hernia recurrence rates following mesh-based repair range from 0.8% to 24%. Improving surgical techniques using cadavers is often cost-prohibited for many education programs and limited research exists using simulation models with a corresponding hernia repair curriculum in the graduate medical education setting. This pilot project aimed to develop a low cost, easily reproducible novel abdominal wall reconstruction model and pilot-test the ventral hernia repair curriculum to inform further refinement prior to formal evaluation. MATERIAL AND METHODS: This descriptive study pilot-tested the newly refined Abdominal Wall Surgical Skills Operative Model (AWSSOM) simulator for ventral hernia repair with mesh and its corresponding 2-h training curriculum for use at all levels of general surgery graduate medical education. The AWSSOM is a 3D printed synthetic anatomically realistic abdominal wall model consisting of silicone cured layers of skin, fat, rectus abdominis and a posterior rectus sheath fascia, and silicone tubules to simulate lateral neurovascular bundles. The curriculum incorporated didactic content reflecting surgical practice guidelines, hands-on practice, and faculty guidance promoting interactive critical thinking development during task performance. A pre-/post-assessment included a 10-item knowledge test, a 19-item psychomotor assessment, and 4-items confidence survey to examine changes in performance, knowledge, and confidence in competently completing the ventral hernia repair technique. Descriptive statistics were used to report the limited results of six military surgical resident participants and inform further model and curriculum refinement prior to formal evaluation. RESULTS: The five-layer AWSSOM model was manufactured in 65 h at a material cost of $87 per model frame, is reusable model, and secure base. Six surgical residents were recruited; only four completed both pre- and post-tests due to resident schedule conflicts. The average increase in knowledge was 25%, although variable changes in confidence were observed over the four program year participants. A larger sample size and a control group are needed to demonstrate curriculum effectiveness at improving knowledge, performance, and confidence in ventral hernia repair with mesh and better delineate if high scores translate to better operative skills. A key improvement requested by residents was a more secure model base for dissection and performance of the hernia repair. CONCLUSIONS: The novel abdominal wall surgical skills operative model fills an important proof of concept gap in simulation training. It is low cost with the potential to improve cognitive and psychomotor skills, as well as confidence to competently complete ventral hernia repair with mesh in the graduate medical education setting. Prior to formal effectiveness testing, our lessons learned should be addressed in both the model and curriculum. Future studies must include an adequately powered statistical evaluation with a larger sample across all levels of training.

Priority Competencies for Designated Education Officers in the Veterans Health Administration.

INTRODUCTION: Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance. MATERIALS AND METHODS: Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that operationalizes competencies for more than 200 federal jobs. RESULTS: The research identified 25 primary competencies within 6 leadership domains. Five of the primary competencies cut across all leadership domains. CONCLUSIONS: Veteran Health Administration subject-matter experts in educational leadership say the identified competencies are urgently needed, critical for effective leadership, and valuable for distinguishing superior DEO performance. The competencies are relevant to VHA and perhaps other senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. In military training facilities, attending to these competencies can help Designated Institutional Officials responsible for graduate medical education become more credible partners to other hospital leaders and contribute to becoming a high reliability organization. Executives identifying, recruiting, and appointing VHA DEOs and Designated Institutional Officials at military training facilities should consider these competencies when assessing candidates.

Perceptions of Key Responsibilities and Professional Development Interests of Senior Educational Leaders: A Needs Assessment.

PURPOSE: High-ranking educational leaders in academic medicine oversee multiple clinical programs. This requires them to prioritize dozens of emergent tasks and responsibilities daily, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Identifying their key responsibilities and frequently used skills and competencies may clarify the educational needs of senior educational leaders and facilitate targeted professional development to promote effective and efficient performance. METHOD: In August 2022 researchers interviewed 12 designated education officers (DEOs) from U.S. Department of Veterans Affairs (VA) Veterans Health Administration medical centers about their daily work and most challenging responsibilities. Content analysis of interview transcripts identified key responsibilities and activities identified by participants and prioritization of the perceived skills needed to complete them. RESULTS: Participants emphasized 4 key areas of responsibility: fiscal, administrative, affiliate partnership, and educational duties. They identified 12 skills as baseline requirements for effective performance for which additional professional development would be useful and suggested that both new and more established educational leaders receive targeted professional development and mentoring to foster these capacities. CONCLUSIONS: The key skills participants identified by area of perceived responsibility are relevant to VA DEOs, designated institutional officers, and senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. Structured orientation programs and ongoing professional development for senior educational leaders could emphasize these areas of responsibility, potentially enriching DEOs' performance and reducing burnout.

The Making of an Educator: Professional Identity Formation Among Graduate Medical Education Faculty Through Situated Learning Theory.

INTRODUCTION: Professional identity formation (PIF) is a foundational element to professional medical education and training. Given the impact of faculty role models and mentors to student and trainee learning, mapping the landscape of PIF among faculty takes on increased importance. We conducted a scoping review of PIF through the lens of situated learning theory. Our scoping review question was: How is situated learning theory used to understand the process of PIF among graduate medical educators? METHODS: The scoping review methodology described by Levac et al served as the architecture for this review. Medline, Embase, PubMed, ERIC, CINAHL, PsycINFO, and Web of Science Core Collection were searched (from inception) using a combination of terms that describe PIF among graduate medical educators. RESULTS: Of the 1434 unique abstracts screened, 129 articles underwent full-text review, with 14 meeting criteria for inclusion and full coding. Significant results organized into three main themes: importance of using common definitions; evolution of theory over time with untapped explanatory power; identity as a dynamic construct. DISCUSSION: The current body of knowledge leaves many gaps. These include lack of common definitions, need to apply ongoing theoretical insights to research, and exploration of professional identity as an evolving construct. As we come to understand PIF among medical faculty more fully, twin benefits accrue: (1) Community of practices can be designed deliberately to encourage full participation of all graduate medical education faculty who desire it, and (2) Faculty can more effectively lead trainees in negotiating the ongoing process of PIF across the landscape of professional identities.

Masters in health professions education programs as they choose to represent themselves: A website review.

Introduction: In an age of increasingly face-to-face, blended, and online Health Professions Education, students have more choices of institutions at which to study their degree. For an applicant, oftentimes, the first step is to learn more about a program through its website. Websites allow programs to convey their unique voice and to share their mission and values with others such as applicants, researchers, and academics. Additionally, as the number of master in health professions education (MHPE), or equivalent, programs rapidly grows, websites can share the priorities of these programs. Methods: In this study, we conducted a website review of 158 MHPE websites to explore their geographical distributions, missions, educational concentrations, and various programmatic components. Results: We compiled this information and synthesized pertinent aspects, such as program similarities and differences, or highlighted the omission of critical data. Conclusions: Given that websites are often the first point of contact for prospective applicants, curious collaborators, and potential faculty, the digital image of MHPE programs matters. We believe our findings demonstrate opportunities for growth within institutions and assist the field in identifying the priorities of MHPE programs. As programs begin to shape their websites with more intentionality, they can reflect their relative divergence/convergence compared to other programs as they see fit and, therefore, attract individuals to best match this identity. Periodic reviews of the breadth of programs, such as those undergone here, are necessary to capture diversifying goals, and serves to help advance the field of MHPE as a whole.

Development and Implementation of Urologic Care Army/Air Force/Navy Provider Education, a Urologic Emergency Simulation Curriculum.

BACKGROUND: Military general surgeons commonly perform urologic procedures, yet, there are no required urologic procedural minimums during general surgery residency training. Additionally, urologists are not included in the composition of forward operating surgical units. Urologic Care Army/Air Force/Navy Provider Education was created to provide military general surgeons with training to diagnose and treat frequently encountered urologic emergencies when practicing in environments without a urologist present. STUDY DESIGN: A literature review and needs assessment were conducted to identify diagnoses and procedures to feature in the course. The course included a 1-hour didactic session and then a 2-hour hands-on simulated skills session using small, lightweight, cost-effective simulators. Using a pretest-posttest design, participants completed confidence and knowledge assessments before and after the course. The program was granted educational exemption by the institutional review board. RESULTS: Twenty-seven learners participated. They demonstrated statistically significant improvement on the knowledge assessment (45.4% [SD 0.15] to 83.6% [SD 0.10], P < .01). On the confidence assessment, there were statistically significant (P ≤ .001) improvements for identifying phimosis, paraphimosis, and testicular torsion, as well as identifying indications for suprapubic catheterization, retrograde urethrogram, and cystogram. There were also statistically significant (P < .001) improvements for performing: suprapubic catheterization, dorsal penile block, dorsal slit, scrotal exploration, orchiopexy, orchiectomy, retrograde urethrogram, and cystogram. CONCLUSION: We created the first-ever urologic emergencies simulation curriculum for military general surgeons that has demonstrated efficacy in improving the diagnostic confidence, procedural confidence, and topic knowledge for the urologic emergencies commonly encountered by military general surgeons.

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

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.

The burden they bear: A scoping review of physician empathy in the intensive care unit.

PURPOSE: Research shows that physician empathy can improve patients' reporting of symptoms, participation in care, compliance, and satisfaction; however, success in harnessing these advantages in the ICU hinges on a myriad of contextual factors. This study describes the current state of knowledge about intensivists' empathy. METHODS: A scoping review was conducted across six databases and grey literature to clarify intensivists' experiences of empathy and identify directions of future inquiries. The search had no date limits and was specific to empathy, intensivists, and ICU environments. Results were blindly and independently reviewed by authors. RESULTS: The search yielded 628 manuscripts; 45 met inclusion criteria. Three overarching themes connected the manuscripts: (1) the risks and benefits of empathy, (2) the spectrum of connection and distance of intensivists from patients/families, and (3) the facilitators and barriers to empathy's development. CONCLUSION: Empathy among intensivists is not a dichotomous phenomenon. It instead exists on continua. Four steps are recommended for optimizing empathy in the ICU: clearly defining empathy, addressing risks and benefits transparently, providing education regarding reflective practice, and developing supportive environments. Overall, this review revealed that the state of knowledge about empathy as experienced by intensivists still has room to grow and be further explored.

Ethical Bearing Is About Our Conduct: Ethics as an Essential Component of Military Interprofessional Healthcare Teams.

INTRODUCTION: The need to maintain medical ethical standards during conflict and peace has been the source of considerable academic discourse. Although still an unsolved challenge, scholars have made significant contributions to the literature, constructing categorizations that can help military providers contend with ethical conflicts. However, insights into the ethical comportment of military interprofessional healthcare teams (MIHTs) have yet to be reported. MATERIALS AND METHODS: This interview-based study collected insights from 30 military healthcare providers who participated in and/or led MIHTs. Altogether, participants represented 11 health professions, both officers and enlisted military members, and the U.S. Army, Navy, and Air Force. Following Grounded Theory methodology, data were collected and analyzed in iterative cycles until theme saturation was reached. RESULTS: The research team identified two themes of ethical bearing that enable MIHT success in and across care contexts. One theme of successful ethical bearing is "raising concerns," referring to speaking up when something needs to be addressed. The other is "making compromises," where individuals have to make sacrifices (e.g., lack of equipment, non-sterile environment, etc.) to give patient care. CONCLUSIONS: These data suggest that effective MIHTs have a collective moral compass. This moral compass is the team's ability to judge what is ethically right and wrong, as well as the team's willingness and ability to act accordingly-to consistently "do the right thing." There is a collective moral compass, and while the team may not all agree on what exactly is true north-they are all bending that way.

Leadership and Followership in Military Interprofessional Health Care Teams.

INTRODUCTION: The U.S. Military has long been aware of the vital role effective leaders play in high-functioning teams. Recently, attention has also been paid to the role of followers in team success. However, despite these investigations, the leader-follower dynamic in military interprofessional health care teams (MIHTs) has yet to be studied. Although interprofessional health care teams have become a topic of increasing importance in the civilian literature, investigations of MIHTs have yet to inform that body of work. To address this gap, our research team set out to study MIHTs, specifically focusing on the ways in which team leaders and followers collaborate in MIHTs. We asked what qualities of leadership and followership support MIHT collaboration? MATERIALS AND METHODS: This study was conducted using semi-structured interviews within a grounded theory methodology. Participants were purposefully sampled, representing military health care professionals who had experience working within or leading one or many MIHTs. Thirty interviews were conducted with participants representing a broad range of military health care providers and health care specialties (i.e., 11 different health professions), ranks (i.e., officers and enlisted military members), and branches of the U.S. Military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until thematic saturation was achieved. The subsets of data for leadership and followership were further analyzed separately, and the overlap and alignment across these two datasets were analyzed. RESULTS: The insights and themes developed for leadership and followership had significant overlap. Therefore, we present the study's key findings following the two central themes that participants expressed, and we include the perspectives from both leader and follower viewpoints to illustrate each premise. These themes are as follows: (1) a unique collaborative dynamic emerges when team members commit to a shared mission and a shared sense of responsibility to achieve that mission; and (2) embracing and encouraging both leader and follower roles can benefit MIHT collaboration. CONCLUSIONS: This study focused on ways in which team leaders and followers on MIHTs collaborate. Findings focused on qualities of leadership and followership that support MIHT's collaboration and found that MIHTs have a commitment to a shared mission and a shared sense of responsibility to achieve that mission. From this foundational position of collective responsibility to achieve a common goal, MIHTs develop ways of collaborating that enable leaders and followers to excel to include (1) understanding your role and the roles of others; (2) mutual respect; (3) flexibility; and (4) emotional safety. The study data suggest that MIHT members work along a continuum of leadership and followership, which may shift at any moment. Military interprofessional health care teams members are advised to be adaptive to these shared roles and contextual changes. We recommend that all members of MIHTs acquire leadership and followership training to enhance team performance.