title: Exclusion of Residents From Surgery-Intensive Care Team Communication: A Qualitative Study.
abstract: OBJECTIVE
  Communication competency is an important aspect of postgraduate training and patient care delivery in all specialties and clinical domains. This study explored staff surgeon and intensivist perceptions of and experiences with residents' communication with a view toward fostering high quality interspecialty team communication in the surgical intensive care unit.
  
  
  METHODS
  A qualitative study using semistructured interviews. Data were analyzed iteratively and inductively as per standard qualitative thematic approach.
  
  
  METHODS
  University of Toronto, Toronto, Canada.
  
  
  METHODS
  A total of 15 staff surgeons and intensivists who collaborate in patient care in the surgical intensive care unit.
  
  
  RESULTS
  The phenomenon of "resident bypass" emerged, resulting from staff surgeon and intensivist perceptions that residents threaten the quality of interspecialty team communication. Clear patterns and preferences for resident exclusion from this communication were present. A total of 5 interrelated drivers of resident bypass were discovered: lack of trust, lack of specialized knowledge, poor system design, need for timely communication, and residents' inadequate contribution to decision-making. Surgical and intensive care staff were dissatisfied with the structure of residents' roles in interspecialty team communication. Concerns about communication gaps, patient care continuity, and patient safety were expressed.
  
  
  CONCLUSIONS
  Surgical and intensive care staff exclude residents from interspecialty team communication for the benefit of patient safety and care continuity, but this limits opportunities for residents to develop communication skill and competence. Efforts are needed to effectively integrate surgery and intensive care residents in interspecialty attending-resident communication in ways that are meaningful for both patient care and postgraduate training. The implications for medical education are discussed.
authors.affiliation: Sunnybrook Research Institute, Toronto, Ontario, Canada. Electronic address: lesley.gotlibconn@sunnybrook.ca.
authors.forename: Lesley
authors.initials: L
authors.lastname: Gotlib Conn
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Haas
authors.affiliation: Sunnybrook Research Institute, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.affiliation: Sunnybrook Research Institute, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Damon C
authors.initials: DC
authors.lastname: Scales
authors.affiliation: Sunnybrook Research Institute, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andre C
authors.initials: AC
authors.lastname: Amaral
authors.affiliation: Critical Care Medicine, University Health Network, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.affiliation: Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
mesh_terms: D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D007400:Interprofessional Relations; D007407:Interviews as Topic; D009864:Ontario; D010348:Patient Care Team; D036301:Qualitative Research
keywords: Interpersonal and Communication Skills; Patient Care; Professionalism; communication; intensive care; surgery; teamwork