"Learning by doing"--resident perspectives on developing competency in high-quality discharge care.

Journal of General Internal Medicine
S Ryan GreysenLeora I Horwitz

Abstract

Reducing readmissions and post-discharge adverse events by improving the quality of discharge care has become a national priority, yet we have limited understanding about how physicians learn to provide high-quality discharge care. We conducted in-depth, in-person interviews with housestaff physicians with qualitative analysis by a multi-disciplinary team using the constant comparative method to explore learning about high-quality discharge care as a systems-based practice and to identify opportunities to improve training around these concepts. We analyzed interview transcripts from 29 internal medicine residents: 17 (59 %) were interns (PGY-2 or PGY-3), 12 (41 %) seniors, and 17 (59 %) were female. We identified a recurrent theme of lack of formal training about the discharge process, substantial peer-to-peer instruction, and "learning by doing" on the wards. Within this theme, we identified five specific concepts related to systems-based practice and high-quality discharge care which residents learned during residency: (1) teamwork and the interdisciplinary nature of discharge planning; (2) advanced planning strategies to anticipate challenges in the discharge process; (3) patient safety and the concept of a "safe discharge;"...Continue Reading

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Citations

Sep 28, 2013·Academic Medicine : Journal of the Association of American Medical Colleges·Jennifer I LeeKaren A Scott
Aug 19, 2014·Academic Pediatrics·Jori F BogetzAllison Ballantine
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