“Rewarding and Challenging at the Same Time”: Emergency Medicine Residents' Experiences Caring for Patients Who Are Homeless

摘要: Objectives The objectives were to examine how emergency medicine (EM) residents learn care for patients in the department (ED) who are homeless and providing influences residents' education professional development as physicians. Methods We conducted in-depth, one-on-one interviews with EM from two programs. A random sample of stratified by training year was selected each site. Interviews digitally recorded professionally transcribed. team researchers diverse content-relevant expertise reviewed transcripts independently applied codes text segments using a grounded theory approach. The met regularly reconcile differences code interpretations. Data collection analysis occurred iteratively, continued until theoretical saturation achieved. Results Three recurring themes emerged 23 resident interviews. First, unique aspects caring homeless. This learning encompasses both specific knowledge skills (e.g., disease processes infrequently seen other populations) an physician core value service EM). Second, through experience informal teaching rather than formal curriculum. Residents noted little curricular time dedicated homelessness instead learned during clinical shifts personal observing more senior physicians. One method stories “misses,” which had bad outcomes. Third, affects emotionally complex, multifaceted ways. Emotions dominated feelings frustration. frustration often related futility truly helping patients, particularly frequent visitors ED concomitant alcohol dependence. Conclusions Caring is important part residency training. Our findings suggest need increased medical social challenges inherent treating homeless, well enhanced support resources improve ability this vulnerable population. Future research needed determine if such interventions and, ultimately, result improved homeless. Resumen Objetivos Examinar como los residentes de medicina urgencias y emergencias (MUE) aprenden atender pacientes indigentes en el servicio (SU), la atencion influye educacion desarrollo profesional urgenciologos. Metodos Se llevaron cabo entrevistas profundidad forma individual con MUE dos programas. Se selecciono una muestra aleatoria estratificada por ano formacion cada lugar. Las se grabaron digitalmente transcribieron profesionalmente. Un equipo investigadores experiencia diversa sobre contenidos relevantes reviso las transcripciones independiente aplico codificacion fragmentos texto usando aproximacion teoria fundamentada. El reunio regularmente para conciliar diferencias interpretaciones codificacion. La obtencion analisis datos ocurrio iterativa, continuaron hasta que alcanzo saturacion teorica. Resultados Tres temas recurrentes emergieron residentes. En primer lugar, aspectos unicos mediante indigentes. Este aprendizaje incluye tanto conocimientos especificos habilidades (por ejemplo, procesos patologicos vistos infrecuentemente otras poblaciones), urgenciologo valor principal asistencia MUE). segundo traves ensenanza mas un plan oficial formacion. Los senalaron existe poco tiempo dedicado indigencia, su lugar durante guardias asistenciales observacion medicos mayor experiencia. metodo unico fue historias “errores”, tuvieron malos resultados. tercer afecta emocionalmente compleja multiples facetas. emociones fueron dominadas sentimientos frustracion. Esta frustracion relaciono menudo inutilidad ayudar verdaderamente indigentes, particularmente acudieron frecuencia al SU ademas dependencia alcohol. Conclusiones La es parte importante residencia MUE. Nuestros resultados indican necesidad aumentar retos sociales inherentes del tratamiento asi apoyo recursos mejorar capacidad esta poblacion vulnerable. requiere investigacion adicional determinar si estas intervenciones mejoran residente y, ultima instancia, resultan mejor SU.