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“Learning by Doing”—Resident Perspectives on Developing Competency in High-Quality Discharge Care

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Abstract

Background

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.

Methods

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.

Results

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;” (4) patient continuity of care and learning from post-discharge outcomes and; (5) documentation of discharge plans as a valuable skill.

Conclusions

Discharge care is an overlooked opportunity to teach concepts of systems-based practice explicitly as learning about discharge care is unstructured and individual experiences may vary considerably. Educational interventions to standardize learning about discharge care may improve the development of systems-based practice during residency and help improve the overall quality of discharge care at teaching hospitals.

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Acknowledgements

The authors would like to thank the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program and US Department of Veterans Affairs (VA) for funding support. Dr. Horwitz is supported by the National Institute on Aging (K08 AG038336) and by the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program. Dr. Horwitz is also a Pepper Scholar with support from the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#P30AG021342 NIH/NIA).

No funding source had any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of RWJF, VA, the National Institute on Aging, the National Institutes of Health, or the American Federation for Aging Research.

Material from this manuscript was presented as a poster at the 2011 Annual Meeting of the Society for General Internal Medicine.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Author notes

  1. S. Ryan Greysen MD, MHS, MA

    Present address: Division of Hospital Medicine, University of California, San Francisco, 533 Parnassus Avenue, Box 0131, San Francisco, CA, 94113, USA

Authors and Affiliations

  1. Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA

    S. Ryan Greysen MD, MHS, MA

  2. Department of Internal Medicine, New York University School of Medicine, New Haven, CT, USA

    Danise Schiliro MD

  3. Department of Health Policy and Administration, Yale University School of Public Health, New Haven, CT, USA

    Leslie Curry PhD, MPH & Elizabeth H. Bradley PhD

  4. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Leora I. Horwitz MD, MHS

Authors
  1. S. Ryan Greysen MD, MHS, MA
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  2. Danise Schiliro MD
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  3. Leslie Curry PhD, MPH
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  4. Elizabeth H. Bradley PhD
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  5. Leora I. Horwitz MD, MHS
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Correspondence to S. Ryan Greysen MD, MHS, MA.

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Greysen, S.R., Schiliro, D., Curry, L. et al. “Learning by Doing”—Resident Perspectives on Developing Competency in High-Quality Discharge Care. J GEN INTERN MED 27, 1188–1194 (2012). https://doi.org/10.1007/s11606-012-2094-5

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  • DOI: https://doi.org/10.1007/s11606-012-2094-5

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