PurposeThe purpose of this study is to understand how, when, and why emergency medicine residents learn while working in the chaotic environment of a hospital emergency room.Design/methodology/approachThis research used a qualitative interview methodology with thematic data analysis that was verified with the entire population of learners.FindingsAnalysis of the data revealed four different types of learning episodes, each with facilitating factors. The episodes varied in intensity, duration, and the degree of motivation and self‐direction required of the learner. One episode could prompt another. Learning occurred both individually and in social interaction in the workplace during the episode, as well as outside of the workplace environment after the experience had occurred.Research limitation/implicationsRecommendations for individuals to maximize their learning related to this chaotic work environment are identified, along with associated implications for their trainers. These suggestions advocate for current apprenticeship approaches to training to include a developmental perspective, providing effective feedback and supporting learner self‐assessment and reflection.Originality/valueThis paper makes an original contribution to the literature by describing the process of learning by emergency medicine residents in the chaotic work setting of an emergency department. The paper also expands understanding of the types of learning episodes and the factors that contribute to their occurrence. Finally, the research illustrates how the voice of the learners can be used to inform their training.
The Accreditation Council for Graduate Medical Education (ACGME) identifies 6 competencies for emergency medicine (EM) residents. In addition to clinical skills, 5 areas (patient care, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice) include leadership requirements such as decision making, effective communication, collaboration, and team leadership. Emergency departments (EDs) provide mixed conditions for mastering clinical and leadership competencies. The ED is a rich learning environment because of the volume and variety of undifferentiated patients and many experienced professionals from whom to learn.2,3 At the same time, learning may be challenging owing to the unpredictable workload, limited time for high-quality discussions, and frequent interruptions. AbstractBackground Emergency medicine residents are expected to master 6 competencies that include clinical and leadership skills. To date, studies have focused primarily on teaching strategies, for example, what attending physicians should do to help residents learn. Residents' own contributions to the learning process remain largely unexplored. The purpose of this study was to explore what emergency medicine residents believe helps them learn the skills required for practice in the emergency department.
Objectives: We explore attributes, traits, background, skills, and behavioral factors important to top clinical performance in emergency medicine (EM) residency. Methods:We used a two-step process-an ideation survey with the Council of Emergency Medicine Residency Directors and a modified Delphi technique-to identify: 1) factors important to top performance, 2) preresidency factors that predict it, and 3) the best ways to measure it. In the Delphi, six expert educators in emergency care assessed the presence of the factors from the ideation survey results in their top clinical performers. Consensus on important factors that were exemplified in >60% of top performers were retained in three Delphi rounds as well as predictors and measures of top performance. Results:The ideation survey generated 81 responses with ideas for each factor. These were combined into 89 separate factors in seven categories: attributes, personal traits, emergency department (ED)-specific skills and behaviors, general skill set, background, preresidency predictors, and ways to measure top performance. After three Delphi rounds, the panel achieved consensus on 20 factors important to top clinical performance. This included two attributes, seven traits, one general skill set, and 10 ED-specific skills and behaviors. Interview performance was considered the sole important preresidency predictor and clinical competency committee results the sole important measure of top performance. Conclusion:Our expert panel identified 20 factors important to top clinical performance in EM residency. Future work is needed to further explore how individuals learn and develop these factors. U nderstanding the development of expertise and top performance has been the subject of considerable research across fields from chess, to sports, to delivering comedy routines. 1 A subset of this literature focuses on medicine, specifically assessing factors linked with top clinical performance and learning as
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