42. WHAT DO YOU WANT TO LEARN OR WORK ON TODAY?: FEASIBILITY OF ASKING RESIDENTS FOR SELF-IDENTIFIED LEARNING GOALS IN THE PEDIATRIC EMERGENCY DEPARTMENT

Abstract

Background In the unique clinical setting of the emergency department (ED), residents and preceptors may have only a short-term relationship, such as a single shift. This poses challenges to performing accurate learner assessment, selecting ideal instructional strategies, and providing substantive feedback. Objectives The aims of this study were to determine if implementing a formal process in which residents self-identified learning goals for their ED shifts was feasible and to characterize the goals that residents self-identified. We used the conceptual framework that learner-driven goal-setting would increase engagement in learning and teaching, which would promote reflective feedback and guided discovery learning in the pediatric ED. Methods In this prospective cohort study in the ED of an academic children's hospital, residents were prompted to write a learning goal for their shift on a study card. At the end of the shift, residents were asked three yes/no questions to determine if they had identified, accomplished, and received feedback related to their goal. Logistic regression was used to determine if shift time, number of residents on shift, PGY level, and residency program type were predictors of goal identification, accomplishment, and receiving feedback. Goals were categorized by the six ACGME core competencies. Results During the 19-week study period, residents completed 306 end-of-shift surveys (74% response rate) and identified 358 learning goals. Residents reported that they identified a goal 54% of the time, accomplished 89% of identified goals, and received feedback related to their goal 76% of the time. Residents were less likely to identify goals on evening shifts (odds ratio [OR]=0.62, 95% confidence interval [CI] 0.41-0.94). The odds of receiving feedback were greatest on an overnight shift (OR=3.66, 95% CI 1.87-7.14) and lowest on an evening shift (OR=0.19, 95% CI 0.10-0.37). The number of residents on shift, PGY level, and program type did not influence the odds of goal identification, accomplishment, or receiving feedback. Most learning goals related to Patient Care and Procedural Skills (56%) or Medical Knowledge (41%) competencies. Conclusions Asking residents to self-identify learning goals for their shifts in the pediatric ED is a feasible instructional strategy. Residents were able to identify, accomplish, and receive feedback related to their goals.