“What Do You Want to Learn or Work on Today?”: Benefits and Barriers to Asking Residents for Self‐identified Learning Goals

Abstract

Background: In the emergency department (ED), residents and attendings may have a short-term relationship, such as a single shift. This poses challenges to learner assessment, instructional strategy selection, and provision of substantive feedback. We implemented a process for residents to identify goals for ED shifts; characterized residents' goals; and determined how goal identification affected learning, teaching, and feedback. Methods:This was an observational study in a large, tertiary pediatric ED using mixed methods. Residents were asked to identify learning goals for each shift and were asked postshift if they had identified, accomplished, and/ or received feedback on these goals. Goals were categorized by Accreditation Council for Graduate Medical Education Core Competencies. Predictors of goal identification, accomplishment, and receipt of feedback were determined. Residents and attendings were interviewed about their experiences.Results: We collected 306 end-of-shift surveys (74% response rate) and 358 goals and conducted 29 interviews. We found that: 1) Goal setting facilitated perceived learning. Residents identified goals 54% of the time. They accomplished 89% of and received feedback on 76% of goals. 2) Residents' perceived weaknesses, future practice settings, and available patients informed their goals. Most goals mapped to patient care (59%) or medical knowledge (37%) competencies. 3) Goal identification helped attendings determine residents' needs. 4) Ideal goals were specific and achievable. 5) Common barriers were busyness of the ED and difficulty creating goals. Residents were less likely to identify goals (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.41 to 0.94) and receive feedback on busy evening shifts (OR = 0.19, 95% CI = 0.10 to 0.37) and were most likely to receive feedback overnight (OR = 3.66, 95% CI = 1.87 to 7.14). Conclusions:Asking residents to identify goals for ED shifts as an instructional strategy facilitated perceived learning, goal accomplishment, and receipt of feedback. Resident-driven goal identification is a simple and effective instructional strategy that physicians can incorporate into their precepting in the ED.

Applying simulation learning theory to identify instructional strategies for Generation Z emergency medicine residency education

“…116 Additional difficulties for educators may include negotiating learning goals that are too vague, too broad, or too specific and remaining learner-centered while giving voice to educator concerns. 112,116 Educators can manage these concerns by establishing time for learner-set goals outside of the on-shift environment, for example through a longitudinal mentorship program; committing to a short goal-setting session at the start of the shift; and engaging in assessments of goal characteristics. 118,119 Frequent facilitative feedback It is worthwhile to note that the preponderance of feedback literature focuses on educator-driven strategies for feedback delivery.…”

“…In the EM clinical training environment, learner-set goals can be identified within an educational alliance by soliciting learner experiences and encouraging them to reflect on their knowledge gaps through self-assessment. Benefits may include improved rapport between educators and learners and streamlined teaching time that directly addresses learner interests and needs, 112,116,117 which are adaptive to Generation Z learner preferences.…”

“…In a single‐institution study piloting a start‐of‐shift learner goal‐setting process in the ED, authors noted that high patient volume was a consistent barrier to goal‐setting, due to lack of time 116 . Additional difficulties for educators may include negotiating learning goals that are too vague, too broad, or too specific and remaining learner‐centered while giving voice to educator concerns 112,116 . Educators can manage these concerns by establishing time for learner‐set goals outside of the on‐shift environment, for example through a longitudinal mentorship program; committing to a short goal‐setting session at the start of the shift; and engaging in assessments of goal characteristics 118,119 …”

“…It can be challenging to enact learner‐set goals in the teaching environment, particularly in the fast‐paced setting of the emergency department (ED). In a single‐institution study piloting a start‐of‐shift learner goal‐setting process in the ED, authors noted that high patient volume was a consistent barrier to goal‐setting, due to lack of time 116 . Additional difficulties for educators may include negotiating learning goals that are too vague, too broad, or too specific and remaining learner‐centered while giving voice to educator concerns 112,116 .…”

Making goals count: A theory‐informed approach to on‐shift learning goals

“…In practice, there are numerous barriers that can prevent questions such as "what are you working on this shift" from resulting in meaningful goal development or feedback. 1 Similar to other feedback seeking practices, 19 the success (or failure) of on-shift learning goals depends on interrelated factors relating to the learner, supervisor, and learning environment in which the exchange takes place. While there are many obstacles to goal setting-including systems-based, structural issues and characteristics that are intrinsic to the individual learner and supervisor-we focus our discussion on barriers related to the learner, supervisor, and learning environment that one may practically address during a typical shift.…”