Ítem
Acceso Abierto
Administración y Medicina, los estudiantes de postgrado entre dos mundos
Título de la revista
Autores
Delgadillo Sánchez, Vivian Paola
Aluja Jaramillo, Felipe
Archivos
Fecha
2022-12-13
Directores
Olmos-Vega, Francisco
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Título del volumen
Editor
Universidad del Rosario
Pontificia Universidad Javeriana. Facultad de Medicina
Pontificia Universidad Javeriana. Facultad de Medicina
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Resumen
Contexto: es limitada la información disponible en la literatura respecto a la forma en que los estudiantes de postgrados médicos adquieren competencias en Gestión Administrativa (GA) en los lugares de práctica y rara vez sus experiencias son contempladas en el diseño de estrategias de transformación educativa en el área, a pesar de ocupar un rol protagónico en la ejecución del día a día de las labores administrativas en las instituciones sanitarias. Objetivo: diseñamos una investigación que exploró los Mundos Figurados de los médicos residentes y cómo sus experiencias en el lugar de trabajo incidieron en la adquisición de competencias en GA. Metodología: desarrollamos una investigación cualitativa de Teoría Fundamentada Constructivista, con grupos focales y entrevistas semiestructuradas en 22 residentes médicos de la Pontificia Universidad Javeriana, de diferentes niveles formativos y disciplinas, rotantes en el Hospital Universitario San Ignacio, en la ciudad de Bogotá, Colombia. Resultados: La adquisición de competencias en GA en residentes médicos se enmarca en dos mundos figurados opuestos. Uno de ellos constituido por vivencias negativas y poco formativas, y, en contraposición, un mundo enriquecido por estrategias de transformación cultural y apropiación de la GA como parte del acto médico. Conclusiones: Los médicos, sin duda, debemos adquirir competencias administrativas en beneficio de una mejor calidad, seguridad en la atención y un uso eficiente de los recursos sanitarios; para lograrlo, se requiere una profunda transformación cultural de la comunidad educativa, partiendo de los profesores quienes deben afianzar sus conocimientos en GA y mejorar su integración a la práctica clínica.
Abstract
Introduction: Administrative tasks have historically been part of the care burden of medical residents, who are forced to assume them often without prior preparation (Myers & Provonost, 2017). However, healthcare management (HCM) competencies are relevant to provide efficient and high-quality patient care (Souza, Ros & Zeferino, 2012). Limited information in the literature explains how postgraduate medical students acquire competencies in HCM in the workplace. Their experiences are rarely considered in designing educational transformation strategies in this area despite occupying a leading role in the day-to-day execution of administrative tasks in health organizations. In this study, we explore how residents’ experiences in the workplace influenced the acquisition of HCM competencies using the Figured World theory as the theoretical framework. Methods: We designed a constructivist grounded theory study. We conducted focal groups and semi-structured interviews with 22 medical residents of the Pontificia Universidad Javeriana from different learning levels and disciplines, rotating at the San Ignacio University Hospital in Bogotá, Colombia. We constructed the final results using iterative data collection and analysis, constant comparison methods, and theoretical sampling. Results: We constructed two opposite figured worlds that represent residents' experience with the acquisition of HCM competencies: The non-managing physician and the physician-as-administrator. The former is characterized by a discourse that deliberately underscores the role of the HCM tasks as part of residents' training, is full of negative interactions with the healthcare team, and limits residents' agency. This world is heavily influenced and perpetuated by an established hierarchy and supervisors that uphold the discourse. In contrast, the physician-as-administrator world is enriched by strategies that incorporate the HCM tasks as part of the medical act. In this world, residents collaborate and learn from other healthcare team members, have supervisors who model how to incorporate HCM tasks into their daily activities and demonstrate an expanded sense of agency. Residents either align with one or the other, developing their professional identity according to the world they are being introduced to. Discussion and Conclusion: Educational leaders must understand that the traditional non-managerial physician figured world gives residents a feeling of uprooting and discomfort when carrying out this type of tasks. It could also generate clinical safety risks and financial losses. To transform this world into the physician-as-administrator, it is necessary to reconfigure some workplace hierarchies, consolidate interprofessional collaborations and change the discourse perpetuated by influential role models. Supervisors must also strengthen their knowledge of HCM and improve its integration into clinical practice. Any effort to train residents on HCM competencies could be lost if the workplace underscores their value in patient care.
Palabras clave
Estudiantes de postgrados médicos , Competencias en Gestión Administrativa para médicos , Profesionales de la salud y competencias administrativas
Keywords
Figured worlds , Qualitative research , Constructivist grounded theory , Management , Medical residents , Medical graduate students , Management Skills administrative for doctors , Health professionals and administrative powers
