Abstract Manager

Oral

OA3-2-2

Accept

I declare I have no actual or potential conflict of interest in relation to this program.

Building competence in the ambulatory setting is a key element to Canadian Internal Medicine (IM) residency training. A key sub-competency is how to appropriately discharge patients from IM clinics to their primary care providers. We sought to understand how practicing physicians engage in discharge decision-making in the outpatient setting so as to inform development of teaching framework. Through purposive sampling, twenty-three general internists who practice in the ambulatory clinics in six academic hospitals in Toronto were identified. Semi-structured interviewers were conducted from October 2019 to January 2020. Data collection and analysis were iterative with constant comparison according to constructivist grounded theory. The themes identified are centred around the value added to patients' care and included: 1) Stability of the medical condition, 2) Accessibility of appropriate care, 3) Individual physician factors including risk tolerance and experience, 4) Models of care including clinic structures, and 5) Individual patient factors including frailty, comorbidity burden, and vulnerability. Trainee education around these decisions is informal and often relies on role modelling and supporting trainee independent decision-making under guidance. We propose that these elements can be synthesized into a framework for educating trainees regarding transitions of care decisions in ambulatory Internal medicine.

no

General Call (Workshop, Oral Presentation, Poster Presentation)

Oral

Education Research

Resident

yes

Elements Leading to Discharge Decisions in Ambulatory Internal Medicine Clinics

Building competence in the ambulatory setting is a key element to Canadian Internal Medicine (IM) residency training. An existing gap in the medical education literature is how to teach learners on appropriately discharging patients from clinic to their primary care providers. To define this competency of discharge from IM clinics, we sought to understand how practicing physicians engage in discharge decision-making in the outpatient setting so as to inform development of teaching frameworks.

We purposively sampled staff general internists who practice in the ambulatory clinic from six academic hospitals in Toronto. Twenty-three semi-structured interviews were conducted from October 2019 to January 2020. Data collection and analysis were iterative with constant comparison according to constructivist grounded theory.

The themes identified include: 1) Stability of the medical condition, 2) Accessibility of appropriate care, 3) Individual physician factors including risk tolerance and experience, 4) Models of care including clinic structures, and 5) Individual patient factors including frailty, comorbidity burden, and vulnerability. Discharge from clinic involved a discussion between the internist and the patient with an "open-door" policy at the time of discharge. Trainee education around these decisions is informal and often relies on role modelling and supporting trainee independent decision-making under guidance.

The critical elements that influence general internists' discharge practices from ambulatory clinic are centred around the value added to a patients' care. We propose that these elements can be synthesized into a framework for educating trainees regarding transitions of care decisions in ambulatory Internal medicine.

Ambulatory medicine

Internal Medicine

Discharge Practices

Post Graduate

Teaching and learning

Postgraduate

Yes

Yes

Yes

Yes

Yes