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

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 of patient care: a behavioural definition and stepwise approach to diagnosing problems in trainees.

In medical education, behavioural definitions allow for more effective evaluation and supervision. Ownership of patient care is a complex area of trainee development that crosses multiple areas of evaluation and may lack clear behavioural definitions. In an effort to define ownership for educational purposes, the authors surveyed psychiatry teaching faculty and trainees about behaviours that would indicate that a physician is demonstrating ownership of patient care. Emerging themes were identified through analysis of narrative responses in this qualitative descriptive study. Forty-one faculty (54 %) and 29 trainees (52 %) responded. Both faculty and trainees identified seven core elements of ownership: advocacy, autonomy, commitment, communication, follow-through, knowledge and teamwork. These seven elements provide a consensus-derived behavioural definition that can be used to determine competency or identify deficits. The proposed two-step process enables supervisors to identify problematic ownership behaviours and determine whether there is a deficit of knowledge, skill or attitude. Further, the theory of planned behaviour is applied to better understand the relationship between attitudes, intentions and subsequent behaviour. By structuring the diagnosis of problems with ownership of patient care, supervisors are able to provide actionable feedback and intervention in a naturalistic setting. Three examples are presented to illustrate this stepwise process.

A peer mentoring group for junior clinician educators: four years' experience.

PURPOSE: To study the effect of a peer mentoring group (PMG). METHOD: Six junior clinician educator faculty and one senior faculty at the University of Washington Medical Center's Department of Psychiatry formed a PMG in 2006. The PMG had 30 meetings during 2006-2010. Group format, goals, and meeting agendas were determined solely by participants. Feedback about positive and negative outcomes of participation in the PMG was determined by open-ended response to three sets of questions; qualitative analysis was performed by an outside research consultant. RESULTS: Program evaluation revealed benefits and undesirable or unintended outcomes. Reported benefits were increased workplace satisfaction; improved social connection; increased professional productivity and personal growth/development through accountability, collaboration, mutual learning, support, and information sharing; synergy, collaboration, and diversity of thought; increased involvement in professional activities; opportunity for peer discussions in a safe environment; and increased accountability and motivation. Undesirable or unintentional outcomes were exclusivity, lack of hierarchy, scheduling of meetings, absence of an intentional curriculum, diverse and competing interests, personal-professional enmeshment, and occasional loss of focus due to overemphasis on personal matters. Every member of the PMG was retained, and scholarly productivity increased, as did collaboration with other group members. CONCLUSIONS: Participants in this PMG experienced qualitative benefits and perceived advantages in career advancement and scholarly productivity. Negative consequences did not deter participation in the PMG or outweigh benefits. The self-sufficient and low-cost structure makes it particularly portable.

Mothball induced encephalopathy presenting as depression: it's all in the history.

Case reports of mothball ingestion have shown that paradichlorobenzene, the organic compound found in mothballs, can induce multiple organ effects, including encephalopathy. Psychiatrists are often involved in these cases due to presumed depression. Diagnosis is frequently delayed and/or inaccurate due to the inability to obtain a full history. A delay in diagnosis may result in an inappropriate treatment plan. We present a case involving a woman who ingested mothballs due to Pica emphasizing the importance and challenges of getting a thorough history. Barriers include cultural differences, shame and obtaining collateral information.