Perceptions of educational experience and inpatient workload among pediatric residents

Education of residents in academic medical centers occurs as part of clinical care, but little is known about the relationship between clinical workload and educational experiences among pediatric residents. The goal of this study was to assess residents' perceptions of learning on inpatient services at a children's hospital in relation to perceived workload and actual patient census.

This was a prospective cohort study of pediatric residents at 1 urban academic children's hospital. Surveys on educational experience were administered weekly to residents on 12 inpatient units from October 2010 to June 2011. Daily peak medical inpatient census data were collected, and Pearson correlations were performed.

Mean weekly response rate was 25%. Perceived workload was correlated with weekly peak of patient census for interns (r = 0.66; P= .00) and senior residents (r = 0.73; P = .00). Many aspects of perceived learning were negatively correlated with perceived workload among interns and residents in "acute care" units. Activities beyond direct patient care (eg, attending conferences, independent reading) revealed more negative correlation than educational experience during rounds. Among seniors, scores of aspects of perceived learning did not correlate with workload.

The study found mostly negative associations between high perceived workload and perceived learning, especially for interns. Results suggest varied impact of workload on perceived learning by training year. Although patient care is essential for resident education, higher workload may adversely affect learning opportunities for pediatric trainees. More research is needed to identify if generalizable thresholds of patient census and/or clinical workload cause declines in perceived or real education.