| "I can do patient care on my own": autonomy and the manager role. | |
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MedLine Citation:
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PMID: 19858807 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Kevin T Hinchey; Isao Iwata; Michael Picchioni; Patricia J McArdle |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Academic medicine : journal of the Association of American Medical Colleges Volume: 84 ISSN: 1938-808X ISO Abbreviation: Acad Med Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-10-27 Completed Date: 2009-11-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8904605 Medline TA: Acad Med Country: United States |
Other Details:
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Languages: eng Pagination: 1516-21 Citation Subset: AIM; IM |
Affiliation:
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Internal Medicine Residency Program, Baystate Medical Center, Springfield, Massachusetts 01199, USA. Kevin.Hinchey@bhs.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Clinical Competence* Female Humans Internal Medicine / education* Internship and Residency / standards* Interviews as Topic Job Satisfaction Male Middle Aged Patient Care / methods* Professional Autonomy* Qualitative Research United States |
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