Resident Perspectives on Rewards and Challenges of Caring for Ambulatory Patients with Chronic Illness

Purpose To elicit residents’ perspectives on rewards and challenges of caring for ambulatory patients with chronic illness and ways to improve their education in caring for these patients. Method The authors conducted a prospective qualitative study at three Academic Health Centers from October 2011 through February 2012. Focus groups were conducted with Internal Medicine residents during their ambulatory block rotation. Qualitative analysis was used to identify themes. Results Discussions produced 224 comments, which were categorized in 5 domains and 36 themes. Twelve (12) themes related to perceptions of challenges in providing care and 3 themes related to perceptions of rewards in providing care. Eight (8) themes focused on strategies to improve the patient experience. Strengths of the residency program were identified in 7 themes. Six (6) themes related to ways for improving learning about caring for patients with chronic disease in the ambulatory setting. Conclusion Residents perceive both challenges and rewards in caring for patients with chronic illness in the ambulatory setting. Residents identified a number of barriers in caring for patients with chronic illness, from both the provider and from the patients’ perspectives. Nevertheless, they have developed strategies to provide effective care for their patients. Residents also identified best practices within their residency for resident education and patient care as well as making suggestions for improvement. These results have implications for curriculum development and practice redesign in the 21st century for care of patients with chronic illness.