270 - “We’ve Got A New One”—Exploring the Resident-Fellow Interaction Around New Admissions

Poster Number: 270
Publication Number: 270.420

David A. Mahoney, Stanford University School of Medicine, Los Altos, CA, United States; Sara Pavitt, University of Texas at Austin Dell Medical School, Austin, TX, United States; Rebecca Blankenburg, Stanford University School of Medicine, Palo Alto, CA, United States

Background: In teaching institutions, new hospital admissions offer an important learning opportunity for collaborating residents and fellows. Their effective completion is important for delivering safe, high-quality care. The provider level outcome of this interaction ranges from motivating to burnout-inducing. Improving the quality of the new admission interaction would improve both the educational experience of trainees and patient care.

Objective:
Elicit qualities of ideal and non-ideal new admission interactions according to residents and fellows and delineate motivating or demotivating interaction qualities.
Generate a theoretical framework for describing how new admission interactions impact residents’ and fellows’ motivation and engagement.

Design/Methods: IRB-approved, qualitative grounded-theory study using semi-structured focus groups of pediatric residents and fellows at Stanford in March 2021. Questions were developed by expert consensus to address study objectives using Self-Determination Theory as a sensitizing concept. Focus groups were audio-recorded and transcribed verbatim. Two investigators independently coded the transcripts and reconciled codes to develop categories and themes using constant comparison. The third author reviewed categories and themes for validation. To further ensure trustworthiness, we asked participants to review and comment on the themes’ accuracy.

Results: 21 residents and 18 fellows participated in 6 focus groups (3 resident, 3 fellow groups). Five themes emerged: 1) Effective new admission interactions require trust between the resident and fellow and buy-in that new admissions are a learning opportunity; 2) Resident trust and buy-in is achieved by the fellow fostering feelings of autonomy, competence, and relatedness within the resident; 3) Fellow trust is dependent on their confidence that a resident is keeping patients safe. Fellow buy-in is dependent on self-efficacy in fostering resident growth. Both are achieved by the resident demonstrating thoughtful investment in a new admission; 4) Several barriers exist to developing trust and buy-in, but strategies to combat these barriers have been identified (Tables 1, 2); 5) Lack of trust or buy-in from either party leads to a self-perpetuating cycle of decreasing engagement (Figure 1).Conclusion(s): Trust and educational buy-in are the foundations upon which a positive new admission interaction are built. Several strategies exist that residents and fellows may employ to improve this interaction, thereby enhancing trainee learning and quality of patient care.
David Mahoney CVMahoney_David_CV_January2022.pdf
Table 2: Fellow-identified barriers to ideal new admission interactions and strategies to overcome these barriers.