Patient care is a collective responsibility: perceptions of professional responsibility in surgery.
BACKGROUND
Changes in training are likely to affect the professionalization process, but such complex social phenomena are poorly studied by quantitative research methodologies. In contrast, qualitative research designs are more effective in exploring complex social processes. The objective of this study was to use a qualitative methodology to explore how professional responsibilities are perceived by surgical trainees and faculty in the current academic environment.


METHODS
Semi-structured individual interviews of 43 surgical residents and faculty (ranging from second year residents to senior faculty) were conducted at 2 academic institutions. The interviews consisted of open-ended questions, followed by discussion of 4 written, case-based scenarios on specific issues related to professional responsibilities. All interviews were audio-recorded and transcribed, and then analyzed for emergent themes by 3 researchers using a grounded theory approach.


RESULTS
In discussing professional responsibilities, the motivations that shaped participants' responses reflected a balance between 4 major factors: (1) patient care, (2) education, (3) self, and (4) collegial relationships. Patient care was described as being at the center of professional responsibility, but it did not necessarily supersede other factors. Rather, patient care was described as a collective responsibility, operationalized through teamwork, communication, and trust.


CONCLUSIONS
Traditional medical ethics have largely focused on professional responsibility from the standpoint of individual healthcare providers. Our findings suggest it is a much more complex construct characterized by competing responsibilities and an evolving perception of patient care as a collective responsibility. Explicit acknowledgment of this framework sets the stage for educational interventions to support residents' professional development and enhance cooperative behavior among participants.
Park
Jason
J
Department of Surgery, University of Toronto, Toronto, Ontario, Canada. j.park@utoronto.ca
Woodrow
Sarah I
SI
Reznick
Richard K
RK
Beales
Jennifer
J
MacRae
Helen M
HM
D001291:Attitude of Health Personnel; D003142:Communication; D004501:Education, Medical; D004992:Ethics, Medical; D005178:Faculty; D013502:General Surgery / Q000193:education* / Q000941:ethics*; D006801:Humans; D007407:Interviews as Topic; D005791:Patient Care; D010348:Patient Care Team; D012941:Social Responsibility; D013337:Students, Medical / Q000523:psychology*; D035502:Trust