Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Situational cues surrounding family physicians seeking external resources while self-monitoring in practice

Situational cues surrounding family physicians seeking external resources while self-monitoring... Many models of safe and effective clinical decision making in medical practice emphasize the importance of recognizing moments of uncertainty and seeking help accordingly. This is not always done effectively, but we know little about what cues prompt health professionals to call on resources beyond their own knowledge or skill set. Such information would offer guidance regarding how systems might be designed to offer better individual support. In this study, the authors explored the situational factors that are present during moments of uncertainty that lead primary care physicians to access external resources. To do so, a generic qualitative exploratory analysis was conducted on 72 narratives collected through audio recorder-based, self-observational, journaling completed by 12 purposively selected family physicians. Participants were asked to provide a detailed descriptive account of the circumstances surrounding their consultation of external resources immediately after 6 sequential patient encounters in which they felt compelled to seek such support. Thematic analysis of the transcripts was performed to better understand participants’ experiences of the social, contextual, and personal features surrounding decisions to seek support. When doing so we observed that specific features of patient encounters were routinely present when physicians decided to access external sources for help. These included medical aspects of the case (e.g., complex presentations), social aspects (e.g., the presence of another individual), and personal factors (e.g., feeling a need for reassurance). External resources were seen as an opportunity for verification, a mechanism to increase patient satisfaction, and a means through which to defend decision-making. Accessing such resources appeared to influence the physician–patient relationship for various reasons. Recognition and further study of the cues that prompt use of external information will further our understanding of physicians’ behavioural responses to challenging/uncertain situations, highlight mechanisms through which a culture of self-directed assessment seeking might be encouraged, and offer guidance regarding ways in which physicians can be encouraged to practice mindfully. Our results make it clear that reasons for which primary care physicians seek the support of external resources may be multifactorial and, therefore, one should be cautious when inferring reasons for the pursuit of such support. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Advances in Health Sciences Education Springer Journals

Situational cues surrounding family physicians seeking external resources while self-monitoring in practice

Download PDF
14 pages

Loading next page...
 
/lp/springer-journals/situational-cues-surrounding-family-physicians-seeking-external-THe8NhhMdO
Publisher
Springer Journals
Copyright
Copyright © 2019 by Springer Nature B.V.
Subject
Education; Medical Education
ISSN
1382-4996
eISSN
1573-1677
DOI
10.1007/s10459-019-09898-1
Publisher site
See Article on Publisher Site

Abstract

Many models of safe and effective clinical decision making in medical practice emphasize the importance of recognizing moments of uncertainty and seeking help accordingly. This is not always done effectively, but we know little about what cues prompt health professionals to call on resources beyond their own knowledge or skill set. Such information would offer guidance regarding how systems might be designed to offer better individual support. In this study, the authors explored the situational factors that are present during moments of uncertainty that lead primary care physicians to access external resources. To do so, a generic qualitative exploratory analysis was conducted on 72 narratives collected through audio recorder-based, self-observational, journaling completed by 12 purposively selected family physicians. Participants were asked to provide a detailed descriptive account of the circumstances surrounding their consultation of external resources immediately after 6 sequential patient encounters in which they felt compelled to seek such support. Thematic analysis of the transcripts was performed to better understand participants’ experiences of the social, contextual, and personal features surrounding decisions to seek support. When doing so we observed that specific features of patient encounters were routinely present when physicians decided to access external sources for help. These included medical aspects of the case (e.g., complex presentations), social aspects (e.g., the presence of another individual), and personal factors (e.g., feeling a need for reassurance). External resources were seen as an opportunity for verification, a mechanism to increase patient satisfaction, and a means through which to defend decision-making. Accessing such resources appeared to influence the physician–patient relationship for various reasons. Recognition and further study of the cues that prompt use of external information will further our understanding of physicians’ behavioural responses to challenging/uncertain situations, highlight mechanisms through which a culture of self-directed assessment seeking might be encouraged, and offer guidance regarding ways in which physicians can be encouraged to practice mindfully. Our results make it clear that reasons for which primary care physicians seek the support of external resources may be multifactorial and, therefore, one should be cautious when inferring reasons for the pursuit of such support.

Journal

Advances in Health Sciences Education – Springer Journals

Published: May 23, 2019

References

  • Resource utilization of patients with hypochondriacal health anxiety and somatization
    Barsky, AJ; Ettner, SL; Horsky, J; Bates, DW
  • Regret in decision making under uncertainty
    Bell, DE
  • Preventing errors in clinical practice: A call for self-awareness
    Borell-Carrio, F; Epstein, R
  • The theory and practice of clinical decision-making
    Croskerry, P
  • Physicians’ use of medical knowledge resources: Preliminary theoretical framework and findings
    Curley, SP; Connelly, DP; Rich, EC
  • The information-seeking behaviour of doctors: A review of the evidence
    Davies, K
  • Monitoring and regulation of learning in medical education: The need for predictive cues
    Bruin, ABH; Dunlosky, J; Cavalcanti, RB
  • Reasons for outpatient referrals from generalists to specialists
    Donohoe, MT; Kravitz, RL; Wheeler, DB; Chandra, R; Chen, A; Humphries, N
  • Obstacles to answering doctors’ questions about patient care with evidence: Qualitative study
    Ely, JW; Osheroff, JA; Ebell, MH; Chambliss, ML; Vinson, DC; Stevermer, JJ; Pifer, EA
  • Four models of the physician–patient relationship
    Emanuel, KJ; Emanuel, LL
  • Mindful practice
    Epstein, RM
  • Self-assessment in the health professions: A reformulation and research agenda
    Eva, KW; Regehr, G
  • Knowing when to look it up: A new conception of self-assessment ability
    Eva, KW; Regehr, G
  • “I’ll never play professional football” and other fallacies of self-assessment
    Eva, KW; Regehr, G
  • Exploring the divergence between self-assessment and self-monitoring
    Eva, KW; Regehr, G
  • The question of competence: Reconsidering medical education in the twenty-first century
    Eva, KW; Regehr, G; Gruppen, LD
  • The ‘chagrin factor’ and qualitative decision analysis
    Feinstein, AR
  • Family physicians’ referral decisions
    Forrest, CB; Nutting, PA; Starfield, B; Schrader, S
  • McWhinney’s textbook of family medicine
    Freeman, TR
  • Does physician uncertainty affect patient satisfaction?
    Johnson, CG; Levenkron, JC; Suchman, L; Manchester, R
  • Generic qualitative approaches: Pitfalls and benefits of methodological mixology
    Kahlke, RM
  • Judgments of learning depend on how learners interpret study effort
    Koriat, A; Nussinson, R; Ackerman, R
  • Physician self-awareness: The neglected insight
    Longhurst, M
  • What do we know about coaching in medical education? A literature review
    Lovell, B
  • Breaking down automaticity: Case ambiguity and the shift to reflective approaches in clinical reasoning
    Mamede, S; Schmidt, HG; Rikers, RMJP; Penaforte, JC; Coelho-Filho, JM
  • Influence of perceived difficulty of cases on physicians’ diagnostic reasoning
    Mamede, S; Schmidt, HG; Rikers, RMJP; Penaforte, JC; Coelho-Filho, JM
  • Self-monitoring and its relationship to medical knowledge
    McConnell, MM; Regehr, G; Wood, TJ; Eva, KW
  • Slowing down to stay out of trouble in the operating room: Remaining attentive in automaticity
    Moulton, C; Regehr, G; Lingard, L; Merritt, C; MacRae, H
  • Characteristics of clinical information-searching: Investigation using critical incident technique
    Northup, DE; Moore-West, M; Skipper, B; Teaf, SR
  • Version 8
  • Analysing qualitative data
    Pope, C; Ziebland, S; Mays, N
  • Accuracy of self-monitoring during learning of radiograph interpretation
    Pusic, MV; Chiaramonte, R; Gladding, S; Andrews, JS; Pecaric, MR; Boutis, K
  • What do general practice patients want when they present medically unexplained symptoms, and why do their doctors feel pressurized?
    Salmon, P; Ring, A; Dowric, KCF; Humphris, GM
  • The reflective practitioner: How professionals think in action
    Schön, D
  • What makes diagnosis hard?
    Wears, RL