Discrepancy between attitudes and behaviors of family medicine residents towards interprofessional collaborative practice: A mixed methods study

Abstract

Exceedingly more complex patients are presenting to primary care settings. To meet the needs of these patients, we need well-working interprofessional teams. There has been little study of family medicine resident understanding of specific team member roles, and no research on rehabilitation professions. Here we show a discrepancy between attitudes and behaviors of first year medical residents in working collaboratively with occupational and physical therapists. First year family medicine residents received didactic and experiential education from occupational and physical therapists who were a part of the primary care team. A convergent parallel mixed methods design explored resident attitudes and behaviors towards collaborating with rehabilitation professionals following this educational experience. We triangulated two data types. Qualitative data of 11 residents who participated in four focus groups was analyzed inductively to develop themes. Concurrently, quantitative data was extracted from 2 years’ worth of first year resident (n = 29) referrals (n = 129) to therapy services. These data were analyzed descriptively and with a paired t-test to measure change in referral volume between the first and last half of the education year. Four themes emerged from the qualitative data. The first three themes speak to what the residents learned about the scope and value of occupational and physical therapy in a primary care setting. The last theme speaks to learning preferences of the residents; they valued directly observing and discussing the patient care delivered by the rehabilitation professionals. The referral analysis provided contradictory results regarding resident attitudes towards therapy services. In a clinic population where over a third of the patients have at least one chronic condition, residents referred 1–2% of their patients to therapy services. Referrals increased from the first to the last month of the residency year, but the change was not statistically significant. Family medicine residents expressed value in learning from, and collaborating with occupational and physical therapy in primary care, but resident referral writing patterns did not corroborate these views. There is a need to further examine how to support residents in moving from describing occupational and physical therapy roles, to action in referral writing.