Richard Dunbar-Yaffe1, Peter E Wu2, Tatjana Kay3, Maria Mylopoulos4, Heather McDonald-Blumer5, Wayne L Gold6, Lynfa Stroud7. 1. , is a General Internist, Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario, Canada, and an Assistant Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. , is a General Internist and Clinical Pharmacologist/Toxicologist, Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario, Canada, and an Assistant Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. is a Research Assistant, University of Toronto, Toronto, Ontario, Canada. 4. is a Scientist & Associate Director of Training Programs, Wilson Centre, University of Toronto, Toronto, Ontario, Canada. 5. is a Rheumatologist, Division of Rheumatology, Sinai Health System, Toronto, Ontario, Canada, Associate Professor of Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 6. is a General Internist, Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario, Canada, and Infectious Disease Specialist, Division of Infectious Diseases, Sinai Health System and University Health Network, Toronto, Ontario, Canada, and a Professor of Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 7. is an Associate Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada, Researcher, Wilson Centre, University of Toronto, Toronto, Ontario, Canada, and General Internist, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
BACKGROUND: The Junior Attending (JA) role is an educational model, commonly implemented in the final years of training, wherein a very senior resident assumes the responsibilities of an attending physician under supervision. However, there is heterogeneity in the model's structure, and data are lacking on how it facilitates transition to independent practice. OBJECTIVE: The authors sought to determine the value of the JA role and factors that enabled a successful experience. METHODS: The authors performed a collective case study informed by a constructivist grounded theory analytical approach. Twenty semi-structured interviews from 2017 to 2020 were conducted across 2 cases: (1) Most Responsible Physician JA role (general internal medicine), and (2) Consultant JA role (infectious diseases and rheumatology). Participants included recent graduates who experienced the JA role, supervising attendings, and resident and faculty physicians who had not experienced or supervised the role. RESULTS: Experiencing the JA role builds resident confidence and may support the transition to independent practice, mainly in non-medical expert domains, as well as comfort in dealing with clinical uncertainty. The relationship between the supervising attending and the JA is an essential success factor, with more productive experiences reported when there is an establishment of clear goals and role definition that preserves the autonomy of the JA and legitimizes the JA's status as a team leader. CONCLUSIONS: The JA model offers promise in supporting the transition to independent practice when key success factors are present.
BACKGROUND: The Junior Attending (JA) role is an educational model, commonly implemented in the final years of training, wherein a very senior resident assumes the responsibilities of an attending physician under supervision. However, there is heterogeneity in the model's structure, and data are lacking on how it facilitates transition to independent practice. OBJECTIVE: The authors sought to determine the value of the JA role and factors that enabled a successful experience. METHODS: The authors performed a collective case study informed by a constructivist grounded theory analytical approach. Twenty semi-structured interviews from 2017 to 2020 were conducted across 2 cases: (1) Most Responsible Physician JA role (general internal medicine), and (2) Consultant JA role (infectious diseases and rheumatology). Participants included recent graduates who experienced the JA role, supervising attendings, and resident and faculty physicians who had not experienced or supervised the role. RESULTS: Experiencing the JA role builds resident confidence and may support the transition to independent practice, mainly in non-medical expert domains, as well as comfort in dealing with clinical uncertainty. The relationship between the supervising attending and the JA is an essential success factor, with more productive experiences reported when there is an establishment of clear goals and role definition that preserves the autonomy of the JA and legitimizes the JA's status as a team leader. CONCLUSIONS: The JA model offers promise in supporting the transition to independent practice when key success factors are present.
Authors: Michiel Westerman; Pim W Teunissen; Cees P M van der Vleuten; Albert J J A Scherpbier; Carl E H Siegert; Nadine van der Lee; Fedde Scheele Journal: Acad Med Date: 2010-12 Impact factor: 6.893
Authors: Michiel Westerman; Pim W Teunissen; Joanne P I Fokkema; Carl E H Siegert; Cees P M van der Vleuten; Albert J J A Scherpbier; Fedde Scheele Journal: Med Educ Date: 2013-04 Impact factor: 6.251