Medicine and Health Sciences Commons^™

'It's A Cultural Expectation...' The Pressure On Medical Trainees To Work Independently In Clinical Practice, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

CONTEXT: Medical trainees demonstrate a reluctance to ask for help unless they believe it is absolutely necessary, a situation which could impact on the safety of patients. This study aimed to develop a theoretical exploration of the pressure on medical trainees to be independent and to generate theory-based approaches to the implications for patient safety of this pressure towards independent working.

METHODS: In Phase 1, 88 teaching team members from internal and emergency medicine were observed during clinical activities (216 hours), and 65 participants completed brief interviews. In Phase 2, 36 in-depth interviews were conducted using video vignettes. Data collection …

Routine And Adaptive Expert Strategies For Resolving Ict Mediated Communication Problems In The Team Setting, Lara Varpio, Catherine F Schryer, Lorelei Lingard

Lorelei Lingard

CONTEXT: The use of information and communication technologies (ICTs) for supporting interprofessional communication is becoming increasingly common in health care. However, little research has explored how ICTs affect interprofessional communication, or how novices are trained to be effective interprofessional ICT users. This study explores the interprofessional communication strategies of nurses and doctors (trainees and experts) when their communications were mediated by a specific ICT: an electronic patient record (EPR).

METHODS: A total of 72 doctors and nurses participated in this 8-month study on a paediatric in-patient ward. Eighty hours of non-participant observations and 20 semi-structured interviews were conducted. All data …

Priority Setting: What Constitutes Success? A Conceptual Framework For Successful Priority Setting, Shannon Sibbald, Peter Singer, Ross Upshur, Douglas Martin

Shannon L. Sibbald

BACKGROUND: The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. METHODS: Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation …

Preserving Professional Credibility: Grounded Theory Study Of Medical Trainees' Requests For Clinical Support, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: To develop a conceptual framework of the influences on medical trainees' decisions regarding requests for clinical support from a supervisor.

DESIGN: Phase 1: members of teaching teams in internal and emergency medicine were observed during regular clinical activities (216 hours) and subsequently completed brief interviews. Phase 2: 36 in depth interviews were conducted using videotaped vignettes to probe tacit influences on decisions to request support. Data collection and analysis used grounded theory methods.

SETTING: Three teaching hospitals in an urban setting in Canada.

PARTICIPANTS: 124 members of teaching teams on general internal medicine wards and in the emergency department, …