title: Developing and validating a conceptual model of recurring problems in teaching clinic.
abstract: Recurrent problems in medical teaching clinic are common and difficult to address because of complex interpersonal dynamics. To minimize this difficulty, we developed a conceptual model that simplifies problems and identifies the root cause of tension between groups in clinic. We used recursive analysis and modeling of the data from a larger multi-site, multi-method study of problems in teaching clinic. The first dataset from this study consisted of problem lists generated and prioritized by knowledgeable insiders from each site. The second dataset was a cultural consensus analysis independently performed at each site. The final model was checked for face validity and construct validity (using model predictions versus prior data and convergent/discriminant analysis). The study was performed in five Veterans Affairs teaching clinics in the U.S. Our final model, the Perception of Care Map, is a pentagram with five critical perspectives of the clinic visit. These five perspectives are structured care, educational care, relationship-based care, algorithmic care and efficient care. Each group emphasizes one or more of these perspectives, and group locations on the conceptual map explain the observed tensions between groups. Validity of the model is high. The Perception of Care Map may be a useful adjunct for understanding and addressing recurrent problems in teaching clinic.
authors.affiliation: Medicine (111), VAMC, 500 W. Fort St., Boise, ID 83702, USA. scott.smith2@med.va.gov
authors.forename: C Scott
authors.initials: CS
authors.lastname: Smith
authors.forename: Magdalena
authors.initials: M
authors.lastname: Morris
authors.forename: William
authors.initials: W
authors.lastname: Hill
authors.forename: Chris
authors.initials: C
authors.lastname: Francovich
authors.forename: Jennifer
authors.initials: J
authors.lastname: Christiano
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D000884:Anthropology, Cultural; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards*; D005180:Faculty, Medical; D006801:Humans; D008960:Models, Psychological; D015203:Reproducibility of Results; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards