This study provided an innovative way to teach residents about care transitions. Through the reflections of these PGYs, we have found that they are aware of their important role in discharge planning and are willing to play an active part in it.
We use situated learning theory to design the program for PGY to learn the difficulties patients may encounter when returning home. We asked them to draw and reflect. Currently, medical education is increasingly using the arts and humanities as a teaching method . Drawing can support the promotion of higher mental functions. It goes from simple spontaneous concepts to more complex concepts .
The qualitative data underwent a grounded theory approach and were guided by theoretical constructs related to modified trauma-informed care. Through the modified TIC operating framework, PGYs can connect with the patient and know what the patient is experiencing at home. Based on Kirkpatrick’s model This curriculum on new teaching and learning methods significantly improved PGY behavior and practice transfer in discharge planning for the patient.
It is recommended that educational programs for PGYs should include a curriculum for offload planning.
As Taiwan enters an aging society, medicine policy must move with the times. Discharge planning training for physicians is more important than ever. Prior research is to conduct how to perform . This study aims to get them to reflect and strengthen their beliefs about planning discharge into care and, moreover, to improve their future practice.
Getting PGYs to rethink draw-and-talk discharge
Discharge from the hospital is a vulnerable and potentially dangerous transition . One-third of patients experience an adverse event after discharge, and data from Medicare reporting shows that approximately one in five patients is readmitted . Transition of care policy statements from the American College of Physicians, the Society of General Internal Medicine, the Society of Hospital Medicine, and others emphasize the importance of timely and accurate information sharing during the transition of care . Improved communication between inpatient and outpatient care providers allows for smoother care transitions and helps mitigate risk.
In 1993, Taiwan announced a policy to promote release planning for all. However, initially only a few patients received interdisciplinary discharge planning, since there were no standard procedures at that time. As a result, a high percentage of patients felt that hospitals were inadequate in handling long-term care referrals after discharge. Many doctors still show unsatisfactory knowledge and behavior regarding discharge planning in Taiwan . Improved physician awareness of the importance of discharge planning, particularly with regard to transitional care, is needed to improve its implementation .
Similarly, in our study, PGY residents initially failed to perceive that physicians play an important role in discharge planning. One-third of PGY residents believe participation by a physician is less than 20%. This may be due to government policy and the NHI system, both of which emphasize acute and critical care. Although Taiwan’s health care is known for its short wait times and relatively low costs, its weakness lies in the inconsistent quality of care . Only recently have efforts been made to improve long-term care . However, the attitudes of senior physicians can affect those of PGY residents. Therefore, it is important to understand the challenges faced by PGY residents and counteract their stereotypical beliefs.
Through the use of drawing and reflection, this study prompted PGY residents to review their perceptions about older adults’ out-of-hospital health care needs and their needs during care transitions. We used the approach in trauma-informed nursing and modified it to include four processes: cognition, recognition, reflection and response.
This study analyzed participants’ responses and used them to develop critical thinking and empathy among PGY residents, encouraging them to share, reflect, and put themselves in their patients’ shoes when patients return home .
Art has been used in the teaching of medical humanities for over two decades, for example paintings were used to improve observation skills increase attention span when listening to patients and deepen compassion for suffering . A recent review found that drawings were used in virtually every category of chronic disease in patients . However, to our knowledge, this may be the first clinical teaching study in Taiwan to use drawing as a means to teach nursing transitions; Traditionally, it is taught primarily through lectures and clinical practice .
Drawing their homes and lives as older adults and answering questions about their patients helps PGY residents connect with their patients, as drawings are likely to sidestep issues of social desirability and personal beliefs . Drawings make parts of one’s own person and/or stages of development visible . Artistic imagery helps us access elusive, non-verbalizable aspects of thoughts that would otherwise be hidden or ignored. Drawing as a research method often involves participants drawing and talking, or drawing and writing, about the meaning embedded in their drawing .
In our study, all PGY residents had different backgrounds and interpretations of “home” and “age.” Through detailed questions, participants learned to think empathetically about patients in their care.
Implications for educators and researchers
During curriculum development, we found that residents in the hospital course were not consistently addressing discharge planning needs.
The curriculum we designed not only serves to standardize teaching discharge record writing with an emphasis on care transition, but also encourages PGY residents to engage in deeper communication through drawing. An interactive workshop with real examples from colleagues led to more investment and active participation. Subjectively, residents felt that the workshop improved their attitudes towards using discharge planning for patients in transition. This reflection showed the achievement of the learning objectives.
As facilitators, we found this curriculum easy to implement as it only required pencil and paper and no technical equipment was required. Most importantly, as it is grounded in self-reflection, the values taught through this curriculum can become ingrained in PGY residents.
The addition of a drawing and reflection section to the discharge planning lesson ensured key points were communicated during the transition and resulted in a greater focus on anticipating home care needs.
Data collection was performed in a single institutional setting due to limited study resources. In addition, the level of detail in these drawings was insufficient to examine relationships between drawing features and other variables. Respondents who have agreed to take part in the survey may represent a biased sample. Therefore, it is recommended to include more participants in future studies to create a larger sample pool.
There are currently few published resources for teaching nursing transitions using drawing and SLT methodology. Through situational awareness, PGY residents pose with the problem and can communicate and reflect deeply through drawing and speaking. We believe this syllabus can serve as a useful resource to improve PGY residents’ attitudes and awareness of the importance of documentation in care transitions.