Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
McMaster FHS program for Education Research, Innovation & Theory (MERIT), McMaster University, Hamilton, Ontario, Canada.
Med Educ. 2022 Dec;56(12):1214-1222. doi: 10.1111/medu.14921. Epub 2022 Aug 29.
Indirect patient care activities (IPCA) such as documentation, reviewing investigations and filling out forms require an increasing amount of physician time. While an essential part of patient care, rising rates of IPCA work correspond with increases in physician burnout and job dissatisfaction. It is not known how best to prepare residents in IPCA-heavy specialties (e.g. family medicine) for this aspect of their career. This study investigates how educators and residency programmes can optimise IPCA work during residency to best prepare residents for future practice.
Using Constructivist Grounded Theory, we conducted focus groups and individual interviews with 42 clinicians (19 family medicine residents, 16 family physicians in the first 5 years of practice and 7 family physician educators). All participants were connected to one family medicine residency programme. We analysed interview data iteratively, using a staged approach to constant comparative analysis.
While residents, early career physicians and educators perceived the educational value of IPCAs differently, they all reported IPCAs as a necessary weight that family physicians carry throughout their career. Some residents described IPCAs as a burden, creating inequities in workload and interfering with other learning and personal opportunities. In contrast, educators conceptualised IPCAs as an opportunity to build and develop the skills required to carry the weight of IPCAs throughout their career. We make specific recommendations for helping residents recognise this educational opportunity, such as clarifying expectations, navigating equity, understanding purpose and maintaining consistency when teaching IPCAs.
IPCAs are a key competency for many medical residents but require explicit pedagogical attention. If the educational opportunities are not made explicit, residents may miss the opportunity to develop strategies for practice management, professional boundaries, and administrative efficiencies.
间接患者护理活动（IPCAs），如文件记录、审查检查和填写表格，需要占用医生越来越多的时间。虽然这些活动是患者护理的重要组成部分，但随着 IPCA 工作的增加，医生的倦怠和工作不满也随之增加。目前尚不清楚如何最好地为从事 IPCA 工作量大的专业（如家庭医学）的住院医师做好这方面的职业准备。本研究探讨了教育者和住院医师培训计划如何在住院医师培训期间优化 IPCA 工作，以使住院医师为未来的实践做好最佳准备。
使用建构主义扎根理论，我们对 42 名临床医生（19 名家庭医学住院医师、16 名从业 5 年内的家庭医生和 7 名家庭医生教育者）进行了焦点小组和个人访谈。所有参与者都与一个家庭医学住院医师培训计划有关。我们使用分阶段的恒比分析方法对访谈数据进行了迭代分析。
尽管住院医师、早期职业医生和教育者对 IPCAs 的教育价值有不同的看法，但他们都报告说 IPCAs 是家庭医生在整个职业生涯中必须承担的必要负担。一些住院医师将 IPCAs 描述为一种负担，造成工作量的不平等，并干扰了其他学习和个人机会。相比之下，教育者将 IPCAs 视为一个机会，可以建立和发展在整个职业生涯中承担 IPCAs 所需的技能。我们为帮助住院医师认识到这一教育机会提出了具体建议，例如明确期望、公平处理、理解目的以及在教授 IPCAs 时保持一致性。
IPCAs 是许多住院医师的一项关键能力，但需要明确的教学关注。如果不明确教育机会，住院医师可能会错过发展实践管理、专业界限和行政效率策略的机会。
