'I Can Do Patient Care on My Own': Autonomy and the Manager Role
| Autor: | Isao Iwata, Michael Picchioni, Patricia Mcardle, Kevin Hinchey |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male media_common.quotation_subject education MEDLINE Job Satisfaction Education Skills management Interviews as Topic Nursing Internal Medicine Humans Medicine Professional Autonomy Competence (human resources) Qualitative Research media_common business.industry Internship and Residency General Medicine Middle Aged United States Accountability Female Job satisfaction Clinical Competence Patient Care Clinical competence business Autonomy Qualitative research |
| Zdroj: | Academic Medicine. 84:1516-1521 |
| ISSN: | 1040-2446 2005-2006 |
| Popis: | Purpose An internal medicine (IM) residency program redesigned its second year, the Manager Year, to restore balance among autonomy, supervision, and clinical competence. This study examined the response of residents and some supervising attendings to this innovation. Method In this qualitative study-part of a total program evaluation-two authors gathered data from 36 second-year resident-managers, 3 third-year residents, and 8 attendings through semistructured interviews between spring 2005 and spring 2007. All resident-managers in 2005-2006 and all but one in 2006-2007 were interviewed. From verbatim transcripts, two of the authors coded the responses into themes; then all four reviewed and revised these themes. Results Coding revealed that second-year residents associated four qualities with their experience as managers: ownership of patients, accountability to others, competence in patient management skills, and personal satisfaction. They described the manager role as being as being "on your own." They were accountable to fellow managers, attendings, and nursing staff at a different level from that of an intern. Without an intern to teach, they learned critical management skills to complete their work. They became adult learners around their own patient cases. Conclusions Successful preparation of physicians for independent practice requires a careful balance between autonomy and supervision, increasing the former during the training program sequence. For resident-managers, the assignment as principle caregiver occurs at the interface between the two. Managers identify themselves as a great deal more autonomous while still valuing attending supervision and input from co-managers to meet responsibilities. |
| Databáze: | OpenAIRE |
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