What are Residents Learning at Night? A Qualitative and Quantitative Assessment of Resident Self-Identified Learning Themes

Abstract

BACKGROUND: Nighttime rotations bring a unique challenge for providing the teaching that was previously available during daytime conferences and rounds. In order to improve nighttime education, many educators havewondered what residents actually learn at night and how to best capture these learning experiences, especially in the context of the new work hours. METHODS: During a 6 month period, pediatric residents on nighttime rotations at Lucile PackardChildren sHospital at Stanfordwere given a survey requesting 4 self-identified learning topics and 4 triggers which prompted the associated learning points. 58 surveys were completed (response rate of 91%). 267 learning topics and 238 learning triggers were identified. Qualitative analysis was conducted by three authors and responses were categorized by theme. Chi-square analysis compared themes based on resident level. RESULTS: 1) Learning theme categories differed significantly between R1s, R2s, and R3s (p 1⁄4 .03). Medical knowledge was the most frequent learning theme for all three levels. R1s identified learning points on practice-based learning and improvement (R1 8%, R2 4%, R3 2%) and systems-based practice (R1 15%, R2 2%, R3 11%) more often than R2s and R3s. R2s identified clinical decision-making learning points more frequently (R1 19%, R2 32%, R3 18%). R3s identified learning points on supervising more often (R1 2%, R2 0%, R3 9%). 2) Learning triggers also differed significantly betweenR1s,R2s, andR3s (p1⁄4.002). Specific patient encounterwas themost frequent learning trigger for all three levels. R1s identified formal teaching as a learning trigger more frequently than R2s and R3s. (R1 21%, R2 0%, R3 5%). CONCLUSIONS: What residents learn at night and what triggers their learning differ significantly by resident level. Understanding these learning points and triggers can help guide educators in better creating nighttime curricula and tailoring teaching to the level of learner.