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"What's Going to Happen?": Internal Medicine Resident Experiences of Uncertainty in the Care of Older Adults.
Loewenthal, Julia V; Beltran, Christine P; Atalay, Alev; Schwartz, Andrea Wershof; Ramani, Subha.
Afiliación
  • Loewenthal JV; Division of Aging, Brigham and Women's Hospital, Boston, USA. jloewenthal@bwh.harvard.edu.
  • Beltran CP; Harvard Medical School, Boston, USA. jloewenthal@bwh.harvard.edu.
  • Atalay A; Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, USA.
  • Schwartz AW; Harvard Medical School, Boston, USA.
  • Ramani S; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, USA.
J Gen Intern Med ; 2024 Mar 14.
Article en En | MEDLINE | ID: mdl-38485878
ABSTRACT

PURPOSE:

Internal medicine residents care for clinically complex older adults and may experience increased moral distress due to knowledge gaps, time constraints, and institutional barriers. We conducted a phenomenological study to explore residents' experiences and challenges through the lens of uncertainty.

METHODS:

Between January and March 2022, six focus groups were conducted comprising a total of 13 internal medicine residents in postgraduate years 2 and 3, who had completed a required 2-week geriatrics rotation. Applying the Beresford taxonomy of uncertainty as a conceptual model, data were analyzed using the framework method.

RESULTS:

All challenging experiences described by residents caring for older adults were linked to uncertainty. Sources of uncertainty were categorized and mapped to the Beresford taxonomy (1) lack of geriatrics knowledge or clinical guidelines (technical); (2) difficulty applying knowledge to complex older adults (conceptual); and (3) lack of longitudinal relationship with the older patient (personal). Residents identified capacity evaluation and discharge planning as two major geriatric knowledge areas linked with uncertainty. While the majority of residents reacted to uncertainty with some degree of distress, several reported positive coping strategies.

CONCLUSIONS:

Internal medicine residents face uncertainty when caring for older adults, particularly related to technical and conceptual factors. Strategies for mitigating uncertainty in the care of older adults are needed given links with moral distress and trainee well-being.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Gen Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Gen Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos