Barriers to workplace-based learning in the intensive care unit: A qualitative description of internal medicine residents’ and intensivists’ perspectives

Robillard, Nicholas; Vincelette, Christian

doi:10.1080/0142159x.2021.2015533

Cited by 9 publications

(4 citation statements)

References 46 publications

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“…Our findings echo another recent qualitative description of resident perspectives in a Canadian ICU system, which highlighted resident difficulty navigating the complex ICU environment and the mismatch between resident foundational knowledge goals and the teaching on advanced topics that they often received as major learning barriers ( 15 ). These residents were similar in experience to our novice learners, and their identified themes affirm our findings.…”

Section: Discussionsupporting

confidence: 87%

“…Less is known about clinical learning experiences within the intensive care unit (ICU) environment, with studies discussing the optimal approach to specific concepts such as conflict resolution ( 10 – 12 ) and the learner’s perspective of what makes a teacher effective ( 13 , 14 ). There is limited information from a resident perspective about how they learn to perform their entrusted activities within the MICU environment and the barriers they encounter ( 15 ). The MICU provides internal medicine residents with the opportunity to care for patients with a broad range of common and complex clinical conditions and offers them an immersive interprofessional team experience during their training.…”

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confidence: 99%

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The Resident Learning Journey in the Medical Intensive Care Unit

et al. 2023

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Background The medical intensive care unit (MICU) offers rich resident learning opportunities, but traditional teaching strategies can be difficult to employ in this fast-paced, high-acuity environment. Resident perspectives of learning within this environment may improve our understanding of the common challenges residents face and inform novel approaches to transform the MICU educational experience. Objective We conducted a qualitative study of internal medicine residents to better understand their approach to learning the critical care activities that they are entrusted to perform in the MICU. Methods Using a thematic analysis approach, we conducted six focus group interviews with 15 internal medicine residents, separated by postgraduate year. A trained investigator led each interview, which was audio-recorded and transcribed verbatim for analysis. Our diverse research team, representing different career stages across the continuum of learning to minimize interpretive bias, identified codes and subsequent themes inductively. We refined these themes through group discussion and sensitizing social learning theory concepts using Wenger’s community of practice and organized them to create learner archetypes and a conceptual framework of resident learning in the MICU. Results We identified three thematic resident learning categories: learning goals and motivation, clinical engagement, and interprofessional collaboration. We distinguished three learner archetypes, the novice, experiential learner, and practicing member, to describe progressive resident development within the interprofessional MICU team, the challenges they frequently encounter, and potential teaching strategies to facilitate learning. Conclusion We developed a conceptual framework that describes the resident’s journey to becoming a trusted, collaborating member of the interprofessional MICU team. We identified common developmental challenges residents face and offer educational strategies that may support their progress. These findings should inform future efforts to develop novel teaching strategies to promote resident learning in the MICU.

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Section: Discussionsupporting

confidence: 87%

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confidence: 99%

The Resident Learning Journey in the Medical Intensive Care Unit

et al. 2023

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“…In university-level and large ICUs, both rotation residents and fellows are simultaneously present as trainees. This broad span of differences in prior knowledge and clinical experience, comprehension of pathophysiology and special interests makes the design of courses and bedside teaching compliance with and nationally mandated requirements of the speciality training programs significantly more complicated [ 2 ]. To motivate the trainees and drive their development, both formative and summative assessment should be used in line with the specific objectives of their learning [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees

Scholte,

Strehler,

Dill

et al. 2024

BMC Med Educ

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Background Assessing trainees is crucial for development of their competence, yet it remains a challenging endeavour. Identifying contributing and influencing factors affecting this process is imperative for improvement. Methods We surveyed residents, fellows, and intensivists working in an intensive care unit (ICU) at a large non-university hospital in Switzerland to investigate the challenges in assessing ICU trainees. Thematic analysis revealed three major themes. Results Among 45 physicians, 37(82%) responded. The first theme identified is trainee-intensivist collaboration discontinuity. The limited duration of trainees’ ICU rotations, large team size operating in a discordant three-shift system, and busy and unpredictable day-planning hinder sustained collaboration. Potential solutions include a concise pre-collaboration briefing, shared bedside care, and post-collaboration debriefing involving formative assessment and reflection on collaboration. The second theme is the lack of trainees’ progress visualisation, which is caused by unsatisfactory familiarisation with the trainees’ development. The lack of an overview of a trainee’s previous achievements, activities, strengths, weaknesses, and goals may result in inappropriate assessments. Participants suggested implementing digital assessment tools, a competence committee, and dashboards to facilitate progress visualisation. The third theme we identified is insufficient coaching and feedback. Factors like personality traits, hierarchy, and competing interests can impede coaching, while high-quality feedback is essential for correct assessment. Skilled coaches can define short-term goals and may optimise trainee assessment by seeking feedback from multiple supervisors and assisting in both formative and summative assessment. Based on these three themes and the suggested solutions, we developed the acronym “ICU-STAR” representing a potentially powerful framework to enhance short-term trainee-supervisor collaboration in the workplace and to co-scaffold the principles of adequate assessment. Conclusions According to ICU physicians, trainee-supervisor collaboration discontinuity, the lack of visualisation of trainee’s development, and insufficient coaching and feedback skills of supervisors are the major factors hampering trainees’ assessment in the workplace. Based on suggestions by the survey participants, we propose the acronym “ICU-STAR” as a framework including briefing, shared bedside care, and debriefing of the trainee-supervisor collaboration at the workplace as its core components. With the attending intensivists acting as coaches, progress visualisation can be enhanced by actively collecting more data points. Trial registration N/A.

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“…The work is fast-paced, the workload is high, patients’ courses are complex, and their deteriorations are rapid. Educators in this setting are tasked with balancing the often-competing goals of clinical efficiency and effective teaching ( 1 , 2 ). These barriers also contribute to difficulties in assessing trainee performance.…”

mentioning

confidence: 99%