#KeyLIMEPodcast 97: “Who is looking after me?” What patients think.

Well, it’s Friday the 13th… If you’re hiding out at home scared to venture into the world because of impending mishaps, yet bored with nothing to do, check out the Key Literature in Medical Education podcast.  The KeyLIME podcast takes the patient perspective this week, determining, who is the most responsible physician for my care?  Concerning punchline… 29% stated, “I don’t know.”

For all of the details, download the podcast here.   For a quick synopsis the abstract is below.
Jonathan

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KeyLIME Session 97 – Article under review:

Fri post_Ken Harris

Listen to the podcast

View/download the abstract here.

Arora M3, Prochaska MT, Farnan JM, Meltzer DO. Patient Perceptions of Whom is Most Involved in Their Care with Successive Duty Hour Limits. Journal of General Internal Medicine. 2015 Sept;30(9):1275-8.

Reviewer: Linda Snell

Background
With current changes in policy, residents and education systems face two opposing paradigms:  the need to decrease duty hours for PG trainees’ wellness (with a likelihood of seeing fewer patients) and their need to learn via patient care. Reduced resident work hours have led to concerns over decreased professional responsibility towards patients, and less time in direct patient care. At the same time, attendings report a greater role in direct patient care, which could lead to burnout, fatigue, and less time for teaching.

Purpose
“To look at patients’ perceptions of who is most involved in their care changed with residency duty hours. Aims to characterize whom hospitalized patients perceive as most involved in their care, and to determine how this perception has changed with successive duty hour limitations in 2003 and 2011.”

Type of Paper
Research: Prospective observational study

Key Points on the Method
Survey over 12 years at a single institution, of recently admitted patients via phone interview 30 days after discharge. Patients were asked, ‘During your inpatient hospital stay, who was most involved in your medical care?’ Response options included, Attending, Resident, Intern, Medical Student, Nurse, I don’t know, Other.

Outcome: Percentage of inpatients who reported an attending, resident, or intern as most involved in their care by duty hour period (pre-2003, post-2003-pre-2011, post-2011)

Descriptive stats, Chi-squared and multivariate analysis.

Key Conclusions
The authors conclude…Successive resident duty hour restrictions were associated with a doubling of the percentage of patients reporting the attending physician as most involved in their Care and patients identifying a housestaff as most involved in their care decreased. One-third of patients did not know who was most involved in their care.

These changes could be due to reduced resident hours, greater attending involvement in patient care, or less resident time with patients because of electronic health records.

Given the importance of experiential learning to residents’ progression to clinical independence, it is critical to examine the implications of these findings on resident education.

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