Paths to learning: How residents navigate transience in supervisory relationships in the emergency department

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES
Kelsey A. Miller MD, EdM, Sarah C. Cavallaro MD, Kate Dorney MD, MHPEd, Alexander Hirsch MD, Michael Monuteaux ScD, Joshua Nagler MD, MHPEd
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Abstract

Background

Strong relationships between trainees and physician supervisors can positively influence how trainees navigate workplace learning. How trainees act and learn in clinical workplaces characterized by rapidly developing and dissolving supervisory pairings is less well understood. This study uses the emergency department (ED) to examine the impact of transient supervisory relationships on how residents approach clinical learning opportunities.

Methods

We retrospectively analyzed pediatric and emergency medicine resident rotations in an urban, tertiary, academic pediatric ED between July 2018 and June 2022. Using social network analysis (SNA), we identified resident–attending dyads and patients seen by each dyad. This informed semistructured interviews to understand how transience in supervisory relationships influences how residents approach and interpret clinical experiences. With self-determination theory as an organizing framework, the investigators performed line-by-line coding with constant comparative analysis which supported subsequent theoretical coding.

Results

During the study, 526 residents completed 1013 rotations with 87 attendings. A mean (±SD) of 25 (±7) attendings supervised a resident per rotation, with dyads caring for a mean (±SD) of 4 (±4) patients. Twelve residents were interviewed and described different paths to learning depending on the transience of their relationships with clinical supervisors. More sustained contact presented an opportunity to build competence by fostering autonomy and feedback, while briefer contact advanced residents’ competence by exposing them to variable practice patterns.

Conclusions

Combining SNA with qualitative analysis revealed that residents in the ED experience a spectrum of contact with attendings and perceive different paths to learning depending on the transience of this relationship. The results suggest different educational strategies may be necessary to maximize learning depending on the length or resident–attending interactions.

学习之路:急诊科住院医师如何应对急诊科督导关系中的短暂性
背景受训人员与医生主管之间的密切关系可以对受训人员如何在工作场所学习产生积极影响。在临床工作环境中,督导配对关系会迅速发展和解体,学员如何在这种环境中行动和学习,目前还不太清楚。本研究利用急诊科(ED)来探讨短暂的指导关系对住院医师如何把握临床学习机会的影响。 方法 我们回顾性地分析了 2018 年 7 月至 2022 年 6 月期间在一个城市三级学术儿科急诊科轮转的儿科和急诊科住院医师。通过社会网络分析(SNA),我们确定了住院医师与住院医师之间的关系,以及每个关系所诊治的患者。在此基础上,我们进行了半结构式访谈,以了解督导关系的短暂性如何影响住院医师如何对待和解释临床经验。以自我决定理论为组织框架,研究人员进行了逐行编码和持续比较分析,这为随后的理论编码提供了支持。 结果 在研究期间,526 名住院医师与 87 名主治医师一起完成了 1013 次轮转。每次轮转时,平均(±SD)有 25 名(±SD)主治医师指导一名住院医师,每组平均(±SD)护理 4 名(±SD)患者。12 名住院医师接受了采访,他们根据与临床督导关系的短暂性描述了不同的学习途径。较持久的接触可通过培养自主性和反馈来提高能力,而较短暂的接触则可让住院医师接触不同的实践模式,从而提高他们的能力。 结论 将 SNA 与定性分析相结合后发现,急诊科住院医师与主治医师的接触是多种多样的,而且根据这种关系的短暂性,住院医师的学习途径也有所不同。结果表明,根据住院医师与主治医师互动时间的长短,可能需要采取不同的教育策略,以最大限度地提高学习效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
AEM Education and Training
AEM Education and Training Nursing-Emergency Nursing
CiteScore
2.60
自引率
22.20%
发文量
89
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