Mia Djulbegovic1,2,3, Shradha A Kulkarni4, Katherine L Chen5,6,7, Maureen Canavan8,9, Marney A White8,10,11, W Cameron McGuire12, Savan Shan13, Revati Reddy14, Shannon Kay15, Liana Fraenkel16,17. 1. National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA. mia.djulbeg@gmail.com. 2. Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA. mia.djulbeg@gmail.com. 3. Department of Medicine, Division of Hematology & Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. mia.djulbeg@gmail.com. 4. Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. 5. National Clinician Scholars Program at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA. 6. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 7. Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA. 8. National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA. 9. Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA. 10. Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA. 11. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. 12. Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego School of Medicine, La Jolla, CA, USA. 13. Department of Internal Medicine, University of South Florida College of Medicine, Tampa, FL, USA. 14. Department of Internal Medicine, Tampa General Hospital, Tampa, FL, USA. 15. Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA. 16. Patient Centered Population Health Research, Berkshire Health Systems, Pittsfield, MA, USA. 17. Yale University School of Medicine, New Haven, CT, USA.
Abstract
BACKGROUND: Patient care ownership improves accountability, clinical skills, and quality of patient care among resident physicians, but appears to be gradually eroding. Research is limited by the lack of a reliable, objective measure of ownership. OBJECTIVE: To validate the Patient Care Ownership Scale, an instrument that measures decision ownership among internal medicine residents. DESIGN: Multi-institutional, cross-sectional study using a 66-item, online survey that queried residents on ownership's key constructs (advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, self-efficacy, and perceived ownership) as well as mood and burnout. PARTICIPANTS: Internal medicine residents in five geographically diverse residency programs completing an inpatient rotation. MAIN MEASURES: We performed exploratory and confirmatory factor analysis in two randomly split groups to evaluate for subscales and inform item reduction. We conducted reliability testing with Cronbach's α. We performed bivariate analyses to examine construct validity and identify correlates of ownership. KEY RESULTS: Of the 785 eligible residents, 625 completed the survey (80% response rate); we included responses from 563 in the analysis. We identified three factors corresponding to assertiveness, conscientiousness, and confidence or perceived competence. After iterative item reduction, the 13-item ownership scale demonstrated good reliability (Cronbach's α = 0.82). Convergent validity was supported by a significant association with perceived ownership (eliminated from the final scale) (r = 0.67, p < 0.001). There was a positive association between ownership and training level (p < 0.01) and prior experience in the intensive care unit (p < 0.001). There were significant, inverse relationships between ownership and self-defined burnout (r = - 0.24, p < 0.001), depression (r = - 0.22, p < 0.001), detachment (r = - 0.26, p < 0.001), and frustration (r = - 0.15, p = 0.02), and significant positive associations between ownership and feeling energetic (r = 0.29, p < 0.001), happy (r = 0.33, p < 0.001), and fulfilled (r = 0.34, p < 0.001). CONCLUSIONS: The Patient Care Ownership Scale is valid in diverse residency program settings. Medical educators and investigators can use our scale to assess interventions aimed at fostering ownership.
BACKGROUND: Patient care ownership improves accountability, clinical skills, and quality of patient care among resident physicians, but appears to be gradually eroding. Research is limited by the lack of a reliable, objective measure of ownership. OBJECTIVE: To validate the Patient Care Ownership Scale, an instrument that measures decision ownership among internal medicine residents. DESIGN: Multi-institutional, cross-sectional study using a 66-item, online survey that queried residents on ownership's key constructs (advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, self-efficacy, and perceived ownership) as well as mood and burnout. PARTICIPANTS: Internal medicine residents in five geographically diverse residency programs completing an inpatient rotation. MAIN MEASURES: We performed exploratory and confirmatory factor analysis in two randomly split groups to evaluate for subscales and inform item reduction. We conducted reliability testing with Cronbach's α. We performed bivariate analyses to examine construct validity and identify correlates of ownership. KEY RESULTS: Of the 785 eligible residents, 625 completed the survey (80% response rate); we included responses from 563 in the analysis. We identified three factors corresponding to assertiveness, conscientiousness, and confidence or perceived competence. After iterative item reduction, the 13-item ownership scale demonstrated good reliability (Cronbach's α = 0.82). Convergent validity was supported by a significant association with perceived ownership (eliminated from the final scale) (r = 0.67, p < 0.001). There was a positive association between ownership and training level (p < 0.01) and prior experience in the intensive care unit (p < 0.001). There were significant, inverse relationships between ownership and self-defined burnout (r = - 0.24, p < 0.001), depression (r = - 0.22, p < 0.001), detachment (r = - 0.26, p < 0.001), and frustration (r = - 0.15, p = 0.02), and significant positive associations between ownership and feeling energetic (r = 0.29, p < 0.001), happy (r = 0.33, p < 0.001), and fulfilled (r = 0.34, p < 0.001). CONCLUSIONS: The Patient Care Ownership Scale is valid in diverse residency program settings. Medical educators and investigators can use our scale to assess interventions aimed at fostering ownership.
Authors: Tait D Shanafelt; Michelle Mungo; Jaime Schmitgen; Kristin A Storz; David Reeves; Sharonne N Hayes; Jeff A Sloan; Stephen J Swensen; Steven J Buskirk Journal: Mayo Clin Proc Date: 2016-04 Impact factor: 7.616
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