title: Residents' Perspectives on Rewards and Challenges of Caring for Ambulatory Care Patients Living With Chronic Illness: Findings From Three Academic Health Centers.
abstract: OBJECTIVE
  To elicit residents' perspectives on rewards and challenges of caring for ambulatory patients with chronic illness and ways to improve their education in caring for these patients.
  
  
  METHODS
  The authors conducted a qualitative study with internal medicine residents during ambulatory medicine block rotations at three academic health centers from October 2011 through February 2012. Focus group questions covered rewards and challenges of caring for patients with chronic illness and strengths and weaknesses of residency education therein, and the Chronic Care Model provided a framework for interpretation. Qualitative analysis was used to identify themes.
  
  
  RESULTS
  Five focus groups were conducted with 28 residents. Discussions yielded 224 comments, which were categorized into 5 domains and 36 themes. Twelve themes related to perceptions of challenges in providing care, and 3 themes related to perceptions of rewards in providing care. Eight themes focused on strategies to improve the patient experience. Strengths of the residency program were identified in 7 themes. Six themes related to ways for improving learning about caring for patients with chronic disease in the ambulatory setting.
  
  
  CONCLUSIONS
  Residents perceived rewards, challenges, and barriers in caring for patients with chronic illness in the ambulatory setting, from providers' and patients' perspectives. They have developed strategies to provide effective patient care. Residents identified best practices in their residency for resident education and patient care and also made suggestions for improvement. Findings have significant implications for residency education and practice redesign in the 21st century for care of patients with chronic illness.
authors.affiliation: D.C. Thomas is vice chair for education and professor of medicine, medical education, and rehabilitation medicine, Departments of Medicine, Medical Education, and Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. C. Kessler is deputy chief of staff, Durham VA Medical Center, and associate professor of medicine and emergency medicine, Duke University School of Medicine, Durham, North Carolina. N. Sachdev is associate program director, Internal Medicine-Pediatrics Program, and assistant professor of medicine and pediatrics, Departments of Medicine and Pediatrics, University of Michigan Health System, Ann Arbor, Michigan. H.B. Fromme is associate program director, Pediatric Residency Program, and associate professor of pediatrics, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. A. Schwartz is professor, associate head, and director of research, Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois. I. Harris is professor, head, and director of graduate studies, Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois.
authors.forename: David C
authors.initials: DC
authors.lastname: Thomas
authors.forename: Chad
authors.initials: C
authors.lastname: Kessler
authors.forename: Namita
authors.initials: N
authors.lastname: Sachdev
authors.forename: H Barrett
authors.initials: HB
authors.lastname: Fromme
authors.forename: Alan
authors.initials: A
authors.lastname: Schwartz
authors.forename: Ilene
authors.initials: I
authors.lastname: Harris
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D015397:Program Evaluation; D036301:Qualitative Research; D012201:Reward; D014481:United States; D000078329:Workforce