gms | German Medical Science

Objective: The competencies to successfully practice as attending physicians in General Internal Medicine (GIM) are not sufficiently defined, and non-medical expert roles are often not addressed in this context [1], [2]. The objective of this study is to define the competencies of GIM attendings and to identify gaps in these competencies.

Methods: We explored the perceptions of 14 residents and 17 attendings in seven focus group discussions and of five department heads in GIM by means of semi-structured interviews. Participants were purposefully sampled from different GIM departments across Switzerland. The focus group discussions and interviews were recorded, transcribed verbatim and qualitatively analysed using a thematic analysis approach. Situated learning theory was used as a sensitizing concept.

Results: The transition from resident to attending physician in GIM is experienced as challenging, as the requirements and expectations of the new function as attending physician were neither explicitly stated nor clearly communicated. Participants described challenges and gaps in competencies in the medical expert role as well as in the non-medical expert roles. The following four themes were identified as particularly challenging:

1.

Decision making and taking ultimate responsibility in the context of uncertainty.

2.

Embracing a holistic, patient centered view by seeking different medical specialists opinions in case of complex patient problems and integrate them into a larger picture.

3.

Finding a balance between patient safety on the one hand and training needs for residents on the other.

4.

Adopting the role of a team leader orchestrating an interprofessional team of health care professionals.

It takes time and extensive practical experience to develop into the new role as attending. A regular and structured, professional coaching during the transition was reported to be often lacking, but was found to be very helpful when available.

Discussion: Making explicit the required competencies and challenges is a first step to tackle the stressful transition from resident to attending. In non-medical expert roles such as teacher and team leader short formalized training courses would be desirable. Support in the form of mentoring or gradual transfer of tasks and responsibilities could be helpful strategies to support attendings in their career start [3]. Extensive practical experience is building block to gain competence. If this process takes place in a guided environment, competence development is optimized.

Take home messages: Transition from resident to attending in GIM is stressful and burdensome. Defining the competencies that are deemed necessary to properly function as attending is a starting point for setting up supporting measures such as focused training courses and structured coaching/mentoring programs.