where trainees are educated through their clinical experience. Few studies have explored trainees' perceptions of the educational value of these patient care experiences. The aim of this study was to identify pediatric patient characteristics that medical trainees perceive as educationally valuable.
METHODS:Over 2 months, trainees on pediatric inpatient wards ranked the perceived educational value of patients under their care on a 4-point bipolar Likert scale. Three patient characteristics were examined: complex-chronic and noncomplex-chronic preexisting conditions, difficult social circumstances, and rare diseases. Patient-level predictors of cases perceived as educationally valuable (defined as scores $3) were examined by using univariate and multivariate analyses.
RESULTS:A total of 325 patients were rated by 51 trainees (clinical medical students [45%], first-year residents [29%], third-year residents/fellows [26%]). Rare diseases had a higher educational value score (adjusted odds ratio 1.76, 95% confidence interval 1.08-2.88, P 5 .02). Complex-chronic and noncomplex-chronic preexisting conditions and difficult social circumstances did not affect the perceived educational value.
CONCLUSIONS:Trainees attribute the most educational value to caring for patients with rare diseases. Although trainees' perceptions of learning do not necessarily reflect actual learning, they may influence personal interest and limit learning from an educational experience. Knowledge of trainee perceptions of educational experience therefore can direct medical educators' approaches to inpatient education. Because of the critical role it has to play, there has been a call to expand research on workplace learning in residents to include an exploration of organizational practices, experiences, and learning attitudes.2 In addition to these contributors to the intended and explicit curriculum of workplace learning, one must also consider the important contribution of the so-called "informal and hidden curriculum."The hidden curriculum is defined as the unscripted and highly interpersonal forms of teaching between faculty and students (the informal curriculum) and/or a set of influences at the level of organizational structure and culture (the hidden curriculum).3 One manifestation of the informal and hidden curriculum is the potential for the development and/or consolidation of biases and attitudes related to specific patient types.3-5 It has been well documented that physicians experience bias toward specific patient social and demographic traits, with ethnicity being the most well documented.6,7 Studies of bias toward patients with chronic disease, 8 physical disabilities, 9 and children with cerebral palsy 10 have suggested that these biases develop in the early stages of training as medical students express less optimistic views of outcomes for these patients. Physicians may develop cynicism and frustrations because of an inability to "cure" patients with chronic conditions and disabilities who often have many comorbidities, communi...