Just be Respectful of the Primary Doc

In conversations that took place during clinical work rounds, pediatric residents spoke condescendingly about community-based physicians; in many, but not all cases, attending physicians countered negative attitudes by insisting on respect for their community-based counterparts.

This article presents a focused inquiry into the nature of discussions between pediatric residents and academic general pediatric attending physicians. Conversations during clinical rounds are an example of implicit training (explicit training, also discussed here, is delivered through a formal curriculum).

The inquiry followed a larger investigation of teamwork training in general pediatrics at a large urban children’s hospital. From January to August 2006, a researcher observed clinical work rounds in the hospital’s general pediatric ward. She conducted in-depth interviews with residents and attending physicians to gain a clear understanding of their attitudes toward community physicians.

The observations and interviews generated approximately 1,000 pages of notes and transcripts. The researcher derived codes from the data and applied them to the transcripts. When applied to the transcripts, the code “boundary crossing,” indicated a mention of specialists or community-based physicians. This report also focused on data tagged with related codes, such as “teamwork.”

Key Findings:

  • Pediatric residents had a tendency to regard themselves as superior to community-based physicians.
  • Attending physicians who were primarily assigned to community-based settings, asserted that they brought a “beyond the hospital walls” approach to teaching.

Teamwork between community-based and hospital-based physicians can improve the quality of care. Teamwork, however, requires mutual respect. The findings reported here suggest that implicit and explicit teamwork training needs to emphasize positive, respectful attitudes toward community-based physicians.

[This research was not funded by the Robert Wood Johnson Foundation.]