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Navigating complexity in team-based clinical settings.

Kori A LaDonna1,2, Emily Field3,4, Christopher Watling4,5

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Navigating clinical complexity requires health advocacy, which is often a team effort involving patients and families. Medical education should integrate advocacy training into complex patient care scenarios.

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Area of Science:

  • Medical Education
  • Clinical Practice
  • Healthcare Systems

Background:

  • Traditional medical training emphasizes biomedical and technical skills.
  • Socio-relational and systems issues contributing to clinical complexity are often overlooked.
  • Understanding clinician perspectives on complexity is crucial for transforming medical education.

Purpose of the Study:

  • To explore how clinicians perceive and respond to complex clinical situations.
  • To identify strategies for preparing medical learners to manage clinical complexity.
  • To investigate the role of health advocacy in navigating complex care.

Main Methods:

  • Constructivist grounded theory approach.
  • Semi-structured interviews with rich pictures used for data collection.
  • Constant comparative analysis to identify themes in neurology and intensive care units.

Main Results:

  • Clinical complexity arose with unknown prognoses, exhausted treatments, and patient-centered care challenging system capabilities or professional scope.
  • Care shifted from medical expertise to advocacy when facing complexity.
  • Some physicians did not recognize or perceived advocacy as outside their scope, leading to delegation.

Conclusions:

  • Expert clinicians navigate complexity by mastering health advocacy.
  • Advocacy is often a negotiated, collective effort involving patients and families.
  • Medical education should incorporate advocacy training within complex clinical encounters and involve diverse team members.