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Approaches and Barriers to Building Collaborative Practice Competencies of Anesthesiology and Obstetrics Residents
Abstract Number: T-11
Abstract Type: Original Research
Graduate medical education is highly successful at producing physicians who are excellent individual performers and masters of independent learning. Unfortunately the mastery of solo strategies is insufficient preparation for the increasingly team-oriented and multidisciplinary demands of perinatal care. To develop physicians capable of meeting these demands, it is important to examine how residency programs can both encourage and obstruct the development of collaborative practice competencies.
Methods: To promote collaborative learning and communication among obstetrics and anesthesiology residents, we introduced an interdisciplinary case-based learning program into the obstetrics service curriculum at a large teaching hospital. Each month we sent a new case to the residents on this service and advised them to review the case in collaboration with a resident from the other discipline. Small interdisciplinary case discussions were then facilitated by attendings from both disciplines. In the first 7 months, 60 residents (33 Anesthesia, 27 OB/GYN) participated in one or more sessions and submitted a total of 97 anonymous post-session questionnaires.
Results: In 92% of the questionnaires, the participant indicated that the new program was “moderately” or “very” valuable to their overall development as a physician. Responses to other feedback items reinforced this overall evaluation. However, 83 of the 97 responses also indicated that the participant had failed to consult a colleague from the other discipline when preparing to discuss the case. Of those who had not collaborated, 41 believed that it would have been “moderately” or “very” helpful to have done so. A brief explanation for the lack of collaboration was provided in 33 of these 41 responses. Four themes emerged: busyness or overall lack of time, a lack of overlapping available time, social or physical barriers separating the disciplines, and misunderstanding of the instructions.
Discussion: The very positive response to the overall program suggests that both the obstetrics and anesthesiology residents benefited from the new interdisciplinary curriculum. However, the explanations for failing to collaborate suggest critical questions about underlying organizational and cultural issues: Does the program culture teach residents that interdisciplinary learning is a low priority on their busy schedules? What organizational practices create the lack of overlapping availability between the disciplines, and is this obstructing residents’ ability to practice in a collaborative context? Do social norms and physical structures that separate the disciplines prevent collaboration and impede patient care?
Conclusion: Improving residents’ collaborative practice competencies requires new approaches to graduate medical education; however, adding new curriculum may not be enough. Underlying factors embedded in an institution’s organizational structures, culture, and history may also need to be addressed.