Project: PRIDE – Professional Identity in Doctor–NP Environments

Background & Importance:

Globally, primary healthcare delivery has undergone profound transformations since the 70s. Solo practices have been abandoned in favour of interdisciplinary ones. Teamwork is an international trend encouraged by health policy reforms in most Western countries. The benefits of effective interdisciplinary teamwork in clinical practice have been well-documented, as have the essential professional and organizational challenges it entails. Dynamics in multidisciplinary teams might be complicated when two (or more) autonomous health providers develop similar roles at the practice level. Among others, this is the case of family physicians (FPs) and nurse practitioners (NPs), as the latter may perform not only the traditional role proper to a nurse but also several medical activities, such as requesting diagnostic exams and prescribing medical treatments. The tensions that this overlap might generate and their implications for the development of professional identities, and consequently, the quality of healthcare delivered, have been suggested but rarely examined empirically.

PRIDE → Professional Identity in Doctor–NP Environments

Project Overview

Goals

Methods

Expected Outcomes

Team

The goal of this study is to examine identity work, i.e., the processes of (re)construction of professional identities, of NPs and FPs working together in primary care interdisciplinary teams. More specifically, the investigation is guided by the following research questions:

  1. What is the meaning that FPs and NPs give to their respective professional identities in primary care?
  2. How do individual, group, organizational, and institutional factors influence their respective identity work in interdisciplinary primary care teams?

A longitudinal, interpretive, and comparative multiple-case study (n=2) is being conducted. Identity work theory in organizations serves as the theoretical perspective for this investigation. To maximize transferability, the cases involve primary care urban multidisciplinary teams from two different Canadian provinces: Quebec and Ontario. Participants include primary care stakeholders, such as NPs, FPs, managers, and patients. Methods for collecting data will consist of in-depth individual semi-structured interviews, focus group interviews, audio diaries, and documentary and archival materials. Narrative and metaphorical techniques are employed to analyze qualitative empirical material.

For practice, the results of this investigation will: (a) be instrumental for clinicians, primary care managers, and policy decision-makers responsible for the implementation of interdisciplinary teamwork in primary healthcare delivery to improve decision-making processes and primary care team performance over time; (b) inform continuing interdisciplinary professional development educational initiatives that support competency in health professionals’ identity construction in interdisciplinary primary care organizations. For research, the project will contribute to enriching the theory about identity construction dynamics in health professions, both in the fields of health services and primary care education research. Additionally, the results of this investigation will provide solid grounds for conceiving, implementing, and evaluating an interprofessional continuing professional development intervention focused on professional identity, which will form the basis of an upcoming PhD doctoral dissertation.

Lead Investigator: Charo Rodríguez, MD, MSc, PhD
Dr. Rodríguez’s research program includes two main streams: organizational studies in healthcare organizations and medical education. She was awarded Research Scholar by the Fonds de recherche du Quebec en santé (FRQS) from 2004 to 2016. She was also awarded the 2013-2014 Cruess Faculty Scholarship in Medical Education. Since 2015, she is Director of the Family Medicine Educational Research Group (FMER), and Director of the MSc in Family Medicine – Medical Education Option.

Co-Investigator: Roland Grad, MDCM MSc FCFP
Dr. Grad is a practising family doctor. In addition to his guidelines work with the Canadian Task Force on Preventive Health Care, he recently completed a cluster randomized trial of an educational intervention in the residency as well as a prospective study of physician willingness to implement Shared Decision Making.

FMER Researchers on the Team
Kelley Kilpatrick, RN, PhD, Douglas Archibald, PhD, and Katya Loban, PhD,

Research Assistants
Raymond Tolentino and Jarvis Dongmo.