284 - A qualitative study of pediatric resident behaviors, skills and strategies that enhance learning

Poster Number: 284
Publication Number: 284.421

Katherine Rosengard, Boston Children's Hospital, Boston, MA, United States; Ariel Winn, Boston Children's Hospital, Weston, MA, United States; Laura Chiel, Boston Children's Hospital, Boston, MA, United States; Carolyn Marcus, Boston Children's Hospital, Boston, MA, United States

Background: Pediatric residency facilitates new doctors’ development into pediatricians. While multiple learning theories inform what we know about how learning is achieved, the specific behaviors, skills, and strategies that trainees can employ to maximize learning during residency is less well described.

Objective: To explore resident, chief resident, fellow, and attending physician perceptions of the resident behaviors, skills and strategies that enhance learning during pediatric residency.

Design/Methods: Applying constructivist grounded theory methodology, we conducted 4 focus groups from March 2020 to November 2021 with pediatric residents and chief residents from the Boston Combined Residency Program (BCRP) at Boston Children’s Hospital (BCH) and Boston Medical Center, 2 focus groups with attending physicians, and 2 focus groups with fellows at BCH who supervise residents. Two authors generated a codebook that they then applied to focus group transcripts, meeting frequently to reconcile differences to ensure coding uniformity and accuracy. The broader research team additionally met to hone the broader themes and develop the conceptual framework. Iterative analysis was performed until theoretical saturation was achieved.

Results: Eight residents, 7 chief residents, 9 fellows and 8 attending physicians participated in the eight focus groups (Table 1). Participants identified an array of behaviors, skills and strategies employed by pediatric residents that enhanced their learning during clinical and non-clinical experiences. We identified four domains that encompass the core behaviors, skills and strategies: (1) those that promote learning regardless of the learning environment; (2) those that encourage others to teach residents more; (3) those that facilitate entrustment thereby allowing residents to participate in experiences at their learning edge; and (4) those that enable residents to fully engage in learning. Example behaviors and quotes are listed in Table 2 and include core behaviors that cut across each domain. A conceptual framework is depicted in Figure 1. Conclusion(s): Trainees can influence their learning during residency by employing certain behaviors, skills, and strategies. For example, contrasting experiences promotes learning regardless of training environment; showing engagement encourages others to teach them more; demonstrating help-seeking behaviors promotes entrustment; and being efficient allows residents to better engage in learning. Proposing, questioning, and understanding are key behaviors. This study can translate into actionable curricula.
Table 1. Demographics of participants in a series of focus groups on the behaviors, skills and strategies to optimize learning in residency.
Table 2. Exemplary quotes from the focus groups regarding the key behaviors based on their learning domain.