Navigating complexity in team‐based clinical settings.
Context: Educators must prepare learners to navigate the complexities of clinical care. Training programmes have, however, traditionally prioritised teaching around the biomedical and the technical, not the socio‐relational or systems issues that create complexity. If we are to transform medical edu...
| Publicado en: | Medical Education Vol. 52; no. 11; pp. 1125 - 1138 |
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| Autores principales: | , , , , , |
| Formato: | pictorial research Journal Article |
| Publicado: |
Wiley-Blackwell
Nov2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=132532666&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 132532666 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03080110 ESF jtl: Medical Education issn: 03080110 maglogo: Y pubinfo: dt: Nov2018 vid: 52 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 132532666 132532666 132532666 10.1111/medu.13671 132532666 ppf: 1125 ppct: 13 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Navigating complexity in team‐based clinical settings. aug: au: LaDonna, Kori A Field, Emily Watling, Christopher Lingard, Lorelei Haddara, Wael Cristancho, Sayra M affil: Department of Innovation in Medical Education, University of Ottawa, Ottawa Ontario, Canada sug: subj: Multidisciplinary Care Team Attitude of Health Personnel Grounded Theory Semi-Structured Interview Medical Care Physician Attitudes Expert Clinicians Human Negotiation ab: Context: Educators must prepare learners to navigate the complexities of clinical care. Training programmes have, however, traditionally prioritised teaching around the biomedical and the technical, not the socio‐relational or systems issues that create complexity. If we are to transform medical education to meet the demands of 21st century practice, we need to understand how clinicians perceive and respond to complex situations. Methods: Constructivist grounded theory informed data collection and analysis; during semi‐structured interviews, we used rich pictures to elicit team members' perspectives about clinical complexity in neurology and in the intensive care unit. We identified themes through constant comparative analysis. Results: Routine care became complex when the prognosis was unknown, when treatment was either non‐existent or had been exhausted or when being patient and family centred challenged a system's capabilities, or participants' training or professional scope of practice. When faced with complexity, participants reported that care shifted from relying on medical expertise to engaging in advocacy. Some physician participants, however, either did not recognise their care as advocacy or perceived it as outside their scope of practice. In turn, advocacy was often delegated to others. Conclusions: Our research illuminates how expert clinicians manoeuvre moments of complexity; specifically, navigating complexity may rely on mastering health advocacy. Our results suggest that advocacy is often negotiated or collectively enacted in team settings, often with input from patients and families. In order to prepare learners to navigate complexity, we suggest that programmes situate advocacy training in complex clinical encounters, encourage reflection and engage non‐physician team members in advocacy training. The authors demonstrate that navigating clinical complexity relies heavily on advocacy, and they discuss the challenges of both enacting and teaching this critical aspect of care. pubtype: Academic Journal doctype: pictorial research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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