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“Just be Respectful of the Primary Doc”: Teaching Mutual Respect as a Dimension of Teamwork in General Pediatrics

  • Dorene F. Balmer
    Correspondence
    Address correspondence to Dorene Balmer, PhD, Center for Education Research and Evaluation, Columbia University Medical Center, 701 W 168th St, Room LL-10A, New York, New York 10032.
    Affiliations
    Center for Education Research and Evaluation, Columbia University Medical Center, New York, NY (Drs Balmer and Richards); and Department of General Pediatrics, Baylor College of Medicine, Texas Children’s Health Plan, Houston, Tex (Dr Giardino)
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  • Boyd F. Richards
    Affiliations
    Center for Education Research and Evaluation, Columbia University Medical Center, New York, NY (Drs Balmer and Richards); and Department of General Pediatrics, Baylor College of Medicine, Texas Children’s Health Plan, Houston, Tex (Dr Giardino)
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  • Angelo P. Giardino
    Affiliations
    Center for Education Research and Evaluation, Columbia University Medical Center, New York, NY (Drs Balmer and Richards); and Department of General Pediatrics, Baylor College of Medicine, Texas Children’s Health Plan, Houston, Tex (Dr Giardino)
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      Abstract

      Objective

      Although others have reported on teamwork training, little is known about what pediatric residents in inpatient settings learn implicitly about respectful working relationships with community-based general pediatricians. The purpose of this brief report is to examine how pediatric residents on an inpatient general pediatric rotation regard “the other” (community-based general pediatricians), and how academic, hospital-based general pediatric attending physicians respond.

      Methods

      We conducted a case study on one general pediatrics floor, which entailed 143 hours of observation over 8 months (January to August 2006), as well as in-depth interviews with 25 residents and 14 general pediatric attending physicians whom we observed as they worked on the floor. Data were derived from >1000 pages of field notes and interview transcripts. We systematically reviewed the data and inductively derived codes related to explicit and implicit education. In this brief report, we focused our analysis on data relevant to the concept of boundary crossing: when members of the group talk about members of another group in the process of inquiring about or negotiating patient care.

      Results

      Residents’ comments tended to reveal a neutral or somewhat negative regard for their general pediatric community counterparts, whom they typically referred to as PMDs (primary medical doctors). Attending physicians’ responses to these comments varied, but often explicitly taught residents about dimensions of teamwork, including mutual respect.

      Conclusions

      Explicit teamwork training in pediatric education should not be limited to partnering with other disciplines or other specialties, but expanded to enhance positive regard and mutual respect for general pediatricians in hospital- and community-based settings alike. Attending physicians in general pediatrics are ideally positioned to implicitly teach respectful working relationships within the specialty.

      Keywords

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      References

        • Committee on Quality of Health Care in America, Institution of Medicine
        Crossing the Quality Chasm: A New Health System for the 21st Century.
        National Academy Press, Washington, DC2001
        • Frohna J.G.
        • Cox M.
        • Kalet A.
        • et al.
        Assessing residents’ competency in care management: report of a consensus conference.
        Teach Learn Med. 2004; 16: 77-84
        • Kripalani S.
        • LeFevre F.
        • Phillips C.O.
        • et al.
        Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care.
        JAMA. 2007; 297: 831-841
        • Snow V.
        • Beck D.
        • Budnitz T.
        • et al.
        Transitions of care consensus policy statement American College of Physicians; Society of General Internal Medicine; Society of Hospital Medicine; American Geriatrics Society; American College of Emergency Physicians; Society of Academic Emergency Medicine.
        J Gen Intern Med. 2009; 24: 971-976
        • Bodenheimer T.
        Coordinating care—a perilous journey through the health care system.
        N Engl J Med. 2008; 358: 1064-1071
        • Stille C.J.
        • McLaughlin T.J.
        • Primack W.A.
        • et al.
        Determinants and impact of generalist-specialist communication about pediatric outpatient referrals.
        Pediatrics. 2006; 118: 1341-1349
        • Forrest C.B.
        • Glade G.B.
        • Baker A.E.
        • et al.
        Coordination of specialty referrals and physician satisfaction with referral care.
        Arch Pediatr Adolesc Med. 2000; 154: 499-506
        • Chakraborti C.
        • Boonyasai R.T.
        • Wright S.M.
        • Kern D.E.
        A systematic review of teamwork training interventions in medical student and resident education.
        J Gen Intern Med. 2008; 23: 846-853
        • Balmer D.F.
        • Master C.L.
        • Richards B.F.
        • et al.
        An ethnographic study of attending rounds in general pediatrics: understanding the ritual.
        Med Educ. 2010; 44: 1105-1116
        • Balmer D.F.
        • Master C.L.
        • Richards B.F.
        • Giardino A.P.
        Implicit versus explicit curricula in general pediatrics education: is there a convergence?.
        Pediatrics. 2009; 124: e347-e354
        • Zenni E.A.
        • Sectish T.C.
        • Martin B.N.
        • Prober C.G.
        Pediatric resident training in a school environment.
        Arch Pediatr Adolesc Med. 1996; 150: 632-637
        • Wadhwa A.
        • Lingard L.
        A qualitative study examining tensions in interdoctor telephone consultations.
        Med Educ. 2006; 40: 759-767
        • Meyer E.C.
        • Sellers D.E.
        • Browning D.M.
        • et al.
        Difficult conversations: improving communication skills and relational abilities in health care.
        Pediatr Crit Care Med. 2009; 10: 352-359
        • Merriam S.B.
        Qualitative Research and Case Study Applications in Education.
        Jossey-Bass, San Francisco, Calif1998
        • Safran D.G.
        Organizational dimensions of relationship-centered care: theory, evidence and practice.
        J Gen Intern Med. 2006; 21: S9-S16
        • Balmer D.F.
        • Serwint J.R.
        • Ruzek S.
        • et al.
        Learning behind the scenes: perceptions and observations of role modeling in pediatric residents’ continuity clinic.
        Ambul Pediatr. 2007; 7: 176-181