Resident assessment facilitation team: collaborative support for activated learning

Because healthcare knowledge, practices and systems change so rapidly, physicians-in-training need to develop skills related to lifelong learning. The adult learning paradigm defines the effective professional learner as autonomous and activated. A part of the residency’s p4 (Preparing the Personal Physician for Practice) redesign, the RAFT (Resident Assessment Facilitation Team) process was designed to encourage residents’ adoption of activated learning behaviors by incorporating their participation in team-based educational planning and assessment of competence. This study examined interaction within the RAFT meetings to guage residents’ adoption of activated learning behaviors over time. In this study, transcripts of RAFT meetings from a single cohort of residents during the first and third years of training were analyzed using a grounded theory approach. Teams of at least two analysts per transcript engaged in two rounds of descriptive coding and three levels of axial coding to examine interaction during the RAFT meetings and identify how that interaction was related to residents’ activated learning. Four categories of interaction were identified: advising, managing the process of the meeting, expressing and managing emotion, and demonstrating reflective practice and mindfulness. Across those categories, 36 sub-types of messages indicated both similarities and differences between first- and third-year residents. Specifically, third-year residents took a more active leadership role in meetings; faculty team members were more likely to hand over responsibility for problem solving to thirdyear residents. Integrating residents into the RAFT advising and assessment process provides a context for residents to practice and exhibit activated learning behaviors.

Between change and reproduction

Purpose The purpose of this paper is to examine the role of organizational space in attempts at practice redesign and innovation that involve a break with the traditional professional boundaries in a recently established Danish hospital department. Design/methodology/approach Organizational ethnography combined with Bourdieusian theorization. The data used for this paper are derived from 13 months of ethnographic fieldwork. The author performed participant and meeting observations combined with interviews and the reading of internal and external documents. Findings Despite the department’s attempts at pursuing practice redesign and innovation by breaking with the institutionalized professional boundaries as well as role hierarchies, and emphasizing collaboration between nurses and doctors, the paper demonstrates how the attempts at change meet invisible impediments in practice and how organizational space plays an important yet, overlooked part in reproducing field tradition. Originality/value By virtue of Bourdieusian theorization in combination with organizational ethnography, the paper contributes with unique insights into a seldom studied part of hospital organization, which is how organizational space, rather than being a backdrop for organizational life, is constructed and used by professionals whose habitus renders this space an active component in delimiting professional work as well as the scope of change.

The Oncology Care Model: Perspectives From the Centers for Medicare & Medicaid Services and Participating Oncology Practices in Academia and the Community

Cancer care delivery in the United States is often fragmented and inefficient, imposing substantial burdens on patients. Costs of cancer care are rising more rapidly than other specialties, with substantial regional differences in quality and cost. The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMIS) recently launched the Oncology Care Model (OCM), which uses payment incentives and practice redesign requirements toward the goal of improving quality while controlling costs. As of March 2017, 190 practices were participating, with approximately 3,200 oncologists providing care for approximately 150,000 unique beneficiaries per year (approximately 20% of the Medicare Fee-for-Service population receiving chemotherapy for cancer). This article provides an overview of the program from the CMS perspective, as well as perspectives from two practices implementing OCM: an academic health system (Yale Cancer Center) and a community practice (Hematology Oncology Associates of Central New York). Requirements of OCM, as well as implementation successes, challenges, financial implications, impact on quality, and future visions, are provided from each perspective.