title: Medical Residents and Interprofessional Interactions in Discharge: An Ethnographic Exploration of Factors That Affect Negotiation.
abstract: BACKGROUND
  Interprofessional collaboration is an important aspect of patient discharge from a general internal medicine (GIM) unit. However, there has been minimal empirical or theoretical research that has examined interactions that occur between medical residents and other healthcare professionals in the discharge process. This study provides insight into the social processes that shape and characterize such interactions.
  
  
  OBJECTIVE
  To explore factors that shape interactions between medical residents and other healthcare professionals in relation to patient discharge, and to examine the opportunities for negotiations about discharge between these professional groups.
  
  
  METHODS
  A qualitative ethnographic approach using observations, interviews and documentary analysis.
  
  
  METHODS
  Healthcare professionals working in a GIM unit in Canada.
  
  
  METHODS
  Sixty-five hours of observations were undertaken in a range of settings (e.g. interprofessional rounds, medical and nursing rounds, nursing station) in the unit over a 17-month period. A maximum variation sampling approach was used to identify healthcare professionals working in the unit. Twenty-three interviews were completed, recorded and transcribed verbatim. A directed content approach using theories of medical dominance and negotiated order was used to analyze the data.
  
  
  RESULTS
  The organization of clinical work in combination with clinical teaching influenced interprofessional interactions and the quality of discharge in this GIM unit. While organizational activities (orientation and rounds) and individual activities (e.g. role modeling, teaching) supported negotiations between medical residents and other healthcare professionals around discharge, participants had varied perspectives about their effectiveness.
  
  
  CONCLUSIONS
  This study illuminates social factors and processes that require attention in order to address challenges with interprofessional collaboration and discharge in GIM. These findings have implications for medical education, workplace learning, patient safety and quality improvement.
authors: Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. joanne.goldman@utoronto.ca.|Wilson Centre, University Health Network, Toronto, ON, Canada. joanne.goldman@utoronto.ca.
authors: Joanne
authors: J
authors: Goldman
authors: Center for Health & Social Care Research, Faculty of Health, Social Care & Education, Kingston University & St George's, University of London, London, UK.
authors: Scott
authors: S
authors: Reeves
authors: Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors: Robert
authors: R
authors: Wu
authors: Centre for Addiction and Mental Health, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Ivan
authors: I
authors: Silver
authors: School of Nursing, Dalhousie University, Halifax, NS, Canada.
authors: Kathleen
authors: K
authors: MacMillan
authors: Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors: Simon
authors: S
authors: Kitto
mesh_terms: D000884:Anthropology, Cultural; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D007400:Interprofessional Relations; D008297:Male; D017008:Negotiating / Q000379:methods*; D010348:Patient Care Team / Q000592:standards; D010351:Patient Discharge / Q000592:standards
keywords: Health services research; Medical education-practice-based learning; Qualitative research; Quality improvement