43. WHAT DO YOU WANT TO LEARN OR WORK ON TODAY?: BENEFITS AND BARRIERS TO ASKING RESIDENTS FOR SELF-IDENTIFIED LEARNING GOALS IN THE PEDIATRIC EMERGENCY DEPARTMENT

Abstract

Background In the clinical setting of the pediatric emergency department (PED), residents and preceptors may have a short-term relationship, such as a single shift. This poses challenges to performing learner assessment, selecting instructional strategies, and providing substantive feedback. Objectives 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 PED. The purpose of this study was to determine how asking residents to self-identify learning goals for their PED shifts affected residents’ and preceptors’ experiences with learning, teaching, and feedback. Methods This was a qualitative study with attending physicians and residents from fourteen training programs that rotate through an academic PED. Residents were asked to write a learning goal for their shift and to share it with their attending. Semi-structured interviews were conducted with a convenience sample of residents and a purposive randomized sample of attending physicians about their experience. Interviews were audio-recorded, transcribed, parallel coded, and analyzed until thematic saturation was reached. Results During the 19-week study period, 358 unique learning goals were collected. Nineteen residents and ten attending physicians were interviewed. Major themes included: (1) Goal-setting facilitated learning. Residents and attendings reported that learning was attending-dependent and identified multiple ways in which attendings facilitated accomplishing residents’ goals, such as prioritizing teaching on shift, doing verbal teaching, and directing residents to patients and resources. (2) Residents’ perceived weaknesses, future practice settings, and available patients informed their goals. (3) Goal identification helped determine residents’ educational needs, as there was often mismatch between resident and attending-identified goals. (4) Ideal goals were specific and achievable. (5) There were multiple barriers and facilitators to goal-setting, accomplishment, and feedback. The most commonly reported barriers to goal-setting, accomplishment, and feedback were the busyness of the ED, available patients, and resident difficulty creating goals. Conclusions Asking residents to self-identify learning goals for their shifts in the pediatric ED as an instructional strategy facilitated perceived learning, goal accomplishment, and feedback.