A Qualitative Study of Drivers for Use of the Primary Care Exception Among Internal Medicine Teaching Faculty.
J Gen Intern Med
; 39(2): 255-262, 2024 Feb.
Article
em En
| MEDLINE
| ID: mdl-37698722
ABSTRACT
BACKGROUND:
The Primary Care Exception (PCE) is a billing rule from the Centers for Medicare and Medicaid Services (CMS) that allows supervising physicians to bill for ambulatory care provided by a resident without their direct supervision. There has been increased focus on entrustment as a method to assess readiness for unsupervised practice.OBJECTIVE:
To understand the factors influencing attending physicians' use of the PCE in ambulatory settings and identify common themes defining what motivates faculty preceptors to use the PCE.APPROACH:
This was a qualitative exploratory study. Participants were interviewed one-on-one using a semi-structured template informed by the entrustment literature. Analysis was conducted using a thematically framed, grounded theory-based approach to identify major themes and subthemes.PARTICIPANTS:
Twenty-seven internal medicine teaching faculty took part in a multi-institutional study representing four residency training programs across two academic medical centers in Connecticut. KEYRESULTS:
Four predominant categories of themes influencing PCE use were identified (1) clinical environment factors, (2) attending attitudes, (3) resident characteristics, and (4) patient attributes. An attending's "internal rules" drawn from prior experiences served as a significant driver of PCE non-use regardless of the trainee, patient, or clinical context. A common conflict existed between using the PCE to promote resident autonomy versus waiving the PCE to promote safety.CONCLUSIONS:
The PCE can serve as a tool to support resident autonomy, confidence, and overall clinical efficiency. Choice of PCE use by attendings involved complex internal decision-making schema balancing internal, patient, resident, and environmental-related factors. The lack of standardized processes in competency evaluation may increase susceptibility to biases, which could be mitigated by applying standardized modes of assessment that encompass shared principles.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Temas RHS:
Educacion
Base de dados:
MEDLINE
Assunto principal:
Internato e Residência
Tipo de estudo:
Prognostic_studies
/
Qualitative_research
Limite:
Aged
/
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Gen Intern Med
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos