Workplace affordances and learning engagement in a Thai paediatric intensive care unit

Background

Workplace learning in critical care settings is complex and challenging. Research has explored learner-, teacher-, and context-related factors that influence medical residents' engagement in critical care workplaces in Western but not in non-Western cultures. This limits our understanding of workplace learning globally and how we can better support resident learning in diverse cultures.

Objective

To explore how paediatric residents engage in workplace learning in a Thai Paediatric Intensive Care Unit (PICU) and how this culturally situated workplace shapes their learning.

Methods

In this qualitative study, we recruited paediatric residents (n = 16) from a tertiary care hospital in Thailand for semi-structured interviews. We used reflexive thematic analysis to describe, analyse and interpret residents' experiences of workplace learning, and to capitalise on our own experience as an analytic resource.

Results

We constructed three themes to represent participants' narratives: PICU cases and context as dynamic affordances; impact of psychological safety; and the role of attending physicians. While Thai PICU cases and context could afford participation and thus learning, Thailand's collectivist culture, which prioritises group needs over individual needs, contributed to a sense of psychological safety within culturally-endorsed, professional and social hierarchies, and set the stage for workplace learning. Despite their higher status in these hierarchies, attending physicians facilitated resident learning by fostering open dialogue, joint problem-solving and a low-stress atmosphere.

Conclusions

Workplace learning in a Thai PICU while challenging, is uniquely facilitated by Thailand's collectivist culture that fosters psychological safety and attending physicians' invitation in, and learn from, the workplace optimises learning.