title: Internal Medicine Residents' Perceptions of Team-Based Care and its Educational Value in the Continuity Clinic: A Qualitative Study.
abstract: BACKGROUND
  In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents' education in the ambulatory setting.
  
  
  OBJECTIVE
  To identify factors affecting residents' experience of team-based care within continuity clinics and the impact of these teams on residents' education.
  
  
  METHODS
  This was a qualitative study of focus groups with internal medicine residents.
  
  
  METHODS
  Seventy-seven internal medicine residents at the University of California San Francisco at three continuity clinic sites participated in the study.
  
  
  METHODS
  Qualitative interviews were audiotaped and transcribed. The authors used a general inductive approach with sensitizing concepts in four frames (structural, human resources, political and symbolic) to develop codes and identify themes.
  
  
  RESULTS
  Residents believed that team-based care improves continuity and quality of care. Factors in four frames affected their ability to achieve these goals. Structural factors included communication through the electronic medical record, consistent schedules and regular team meetings. Human resources factors included the presence of stable teams and clear roles. Political and symbolic factors negatively impacted team-based care, and included low staffing ratios and a culture of ultimate resident responsibility, respectively. Regardless of the presence of these factors or resident perceptions of their teams, residents did not see the practice of interprofessional team-based care as intrinsically educational.
  
  
  CONCLUSIONS
  Residents' experiences practicing team-based care are influenced by many principles described in the interprofessional teamwork literature, including understanding team members' roles, good communication and sufficient staffing. However, these attributes are not correlated with residents' perceptions of the educational value of team-based care. Including residents in interprofessional teams in their clinic may not be sufficient to teach residents how team-based care can enhance their overall learning and future practice.
authors.affiliation: Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA, tacara.soones@mssm.edu.
authors.forename: Tacara N
authors.initials: TN
authors.lastname: Soones
authors.forename: Bridget C
authors.initials: BC
authors.lastname: O'Brien
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Julian
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007400:Interprofessional Relations; D008297:Male; D017145:Models, Educational; D010348:Patient Care Team; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care; D036301:Qualitative Research; D012495:San Francisco; D000078329:Workforce