Bowen Judith L, Ilgen Jonathan S, Irby David M, Ten Cate Olle, O'Brien Bridget C
J.L. Bowen is professor, Department of Medicine, Oregon Health & Science University, Portland, Oregon. J.S. Ilgen is associate professor, Division of Emergency Medicine, Department of Medicine, and associate director, Center for Leadership & Innovation in Medical Education, University of Washington, School of Medicine, Seattle, Washington. D.M. Irby is professor, Department of Medicine, University of California, San Francisco, San Francisco, California. O. ten Cate is professor, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands, and adjunct professor, Department of Medicine, University of California, San Francisco, San Francisco, California. B.C. O'Brien is associate professor, Department of Medicine, University of California, San Francisco, San Francisco, California.
Acad Med. 2017 Nov;92(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions):S48-S54. doi: 10.1097/ACM.0000000000001919.
Physicians routinely transition responsibility for patient care to other physicians. When transitions of responsibility occur before the clinical outcome is known, physicians may lose opportunities to learn from the consequences of their decision making. Sometimes curiosity about patients does not end with the transition and physicians continue to follow them. This study explores physicians' motivations to follow up after transitioning responsibilities.
Using a constructivist grounded theory approach, the authors conducted 18 semistructured interviews in 2016 with internal medicine hospitalist and resident physicians at a single tertiary care academic medical center. Constant comparative methods guided the qualitative analysis, using motivation theories as sensitizing constructs.
The authors identified themes that characterized participants' motivations to follow up. Curiosity about patients' outcomes determined whether or not follow-up occurred. Insufficient curiosity about predictable clinical problems resulted in the choice to forgo follow-up. Sufficient curiosity due to clinical uncertainty, personal attachment to patients, and/or concern for patient vulnerability motivated follow-up to fulfill goals of knowledge building and professionalism. The authors interpret these findings through the lenses of expectancy-value (EVT) and self-determination (SDT) theories of motivation.
Participants' curiosity about what happened to their patients motivated them to follow up. EVT may explain how participants made choices in time-pressured work settings. SDT may help interpret how follow-up fulfills needs of relatedness. These findings add to a growing body of literature endorsing learning environments that consider task-value trade-offs and support basic psychological needs of autonomy, competency, and relatedness to motivate learning.
医生通常会将患者护理责任移交给其他医生。当在临床结果知晓之前就发生责任交接时，医生可能会失去从其决策后果中学习的机会。有时，医生对患者的好奇心并不会随着责任交接而结束，他们会继续关注这些患者。本研究探讨了医生在责任交接后进行随访的动机。
作者采用建构主义扎根理论方法，于2016年在一家三级医疗学术医学中心对内科住院医师和实习医师进行了18次半结构化访谈。恒定比较法指导定性分析，将动机理论用作敏感化建构。
作者确定了表征参与者随访动机的主题。对患者预后的好奇心决定了是否进行随访。对可预测临床问题的好奇心不足导致选择放弃随访。由于临床不确定性、对患者的个人情感依恋和/或对患者脆弱性的担忧而产生的足够好奇心促使进行随访，以实现知识积累和专业精神的目标。作者通过期望价值（EVT）和自我决定（SDT）动机理论来解释这些发现。
参与者对其患者情况的好奇心促使他们进行随访。EVT可以解释参与者在时间紧迫的工作环境中是如何做出选择的。SDT可能有助于解释随访如何满足关联性需求。这些发现为越来越多支持考虑任务价值权衡并支持自主性、能力和关联性等基本心理需求以促进学习的学习环境的文献增添了内容。
