Lessons From a ‘Difficult Patient’ from a ‘Difficult Year’: How to Succeed when Your Patients are not.
A new study published in JAMA Pediatrics demonstrates that despite a variety of challenges, inpatient medical residents have an excellent chance of successful outcomes for their adult patients. The results highlight the unique importance of patient-centered care on the success of care that is delivered in medical education.
In the study, published in JAMA Pediatrics, residents from 2 medical residency programs in the United States participated in a cohort study designed to compare outcomes for the care of patients hospitalized with a variety of medical conditions within 24 hours of admission.
The residents worked alongside the attending physicians in the intensive care unit (ICU), whose experience and expertise served as a positive learning environment. As the study authors note, “It is reassuring to find that, despite the numerous risks associated with the practice of medicine, resident physicians report having a very low mortality rate for their adult medical patients [1].”
In addition to the residents, another group of staff were involved in the study, particularly a hospital pharmacist. She “helped ensure that patients with life-threatening conditions had appropriate medications during their admission to the hospital.”
Although there were a number of limitations associated with the study design, the authors concluded from their findings that the majority of patients were able to be stabilized (with appropriate medication) and discharged.
As can be seen in the graph below, the risk ratios for successful outcomes of patients were less than 1.5, which, for all but one resident, was better than they had been predicted in advance. For the residents in one of the programs, this outcome was even more impressive. For their patients hospitalized with an adult chronic obstructive pulmonary disease (COPD), the residents had a risk ratio of 0.42. This outcome was not predicted in advance, but was not so challenging that it was impossible to achieve.
Additionally, the study authors write, “the risk ratios for successful outcomes exceeded 1.5 for patients with asthma, COPD, or hypertension, or were less than 1.5 for patients with either cardiac, renal, or neurological conditions, reflecting residents’ ability to respond effectively to difficult cases.”
Resident physicians who participated in this study are not alone in their role in ensuring optimal outcomes for patients. The authors cite