Residents' perceptions of the on-call experience and of the supervision of their clinical reasoning skills in the paediatric emergency department: A qualitative study.

Abstract

Background: A substantial number of residents suffer from stress, anxiety, which may be acutely exacerbated by stressful situations such as being on call. When confronted with complex situations, uncertainty, a lack of medical experience, residents experience a mismatch between their theoretical knowledge and their clinical reasoning skills. In a previous study we observed high levels of cognitive weariness and anxiety in residents being on call in the paediatric emergency department, and the reduction of their cognitive weariness by training clinician-educators in the supervision of clinical reasoning.

Objectives: Thereafter we sought to inform the findings of our previous quantitative research by exploring in depth the experience of on-call residents in the paediatric emergency department, including: the factors that impact their well-being, and how supervision of their clinical reasoning might change it.

Methods and setting: We performed a qualitative study using semi-structured interviews. We interviewed medical residents who were on call in the paediatric emergency department, mentored by paediatricians who had received specific training in the supervision of clinical reasoning.

Results: The findings revealed two opposing profiles of how residents experience being on call and having their clinical reasoning supervised. First, there were those who expressed marked discomfort, characterized by anxiety, a strong need for supervision, a fear of being judged by the supervisor, and a major impact of physical fatigue. Residents with this profile seem to be at risk of developing burnout, or symptoms thereof. The second profile of residents expressed little unease, had a sense of self-efficacy, a feeling of personal competence, a high level of self-confidence, greater tolerance of uncertainty, and little difficulty with making decisions.

Conclusions: Supervision of clinical reasoning based on questioning techniques seems to participate to promote development towards second profile, with greater tolerance of uncertainty, ease with decision-making, and a reinforced sense of belonging to a team.