Patients of Our Own: Defining Ownership of Clinical Care in Graduate Medical Education

Phenomenon: Learning to assume ownership of patient care is a critical objective of medical training. However, little is known about how ownership is best defined and measured or about its value to trainees. The authors aimed to define ownership and elucidate the significance of developing ownership skills over the course of pediatric residency training. Approach: Focus groups and phone interviews were held with pediatric residency program directors (N = 18) and pediatric residents (N = 14). Focus groups and interviews were audio-recorded, transcribed verbatim, and qualitatively analyzed using thematic analysis. Findings: Program directors and residents characterized ownership as essential to good patient care. Ownership was defined as including personal responsibility, a connection to patients/families, and follow-up and follow-through. For many, ownership was most conspicuous in its absence. Respondents found meaning in their work when exerting ownership and lack of ownership was linked to burnout and frustration. Ownership was recognized as a critical skill that requires development during training to form a professional identity, avoid burnout, become an independent practitioner and function as an integral member of medical teams. Insights: Pediatric residents and faculty considered ownership a cornerstone of patient care and critical to forming a professional identity. The defining characteristics of patient care ownership-personal responsibility, connections with patients and families, and continuity of care-can be used to develop an instrument to assess trainee development of ownership. These findings reinforce the value of ownership in graduate medical education and support creating curricular interventions to foster ownership.