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How Do Postgraduate Trainees Prepare for New Clinical Learning Environments.

Kimberly A Gifford1, Kelly A Kieffer2, Eunjung Choi3

  • 1is Clinical Associate Professor of Pediatrics, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University.

Journal of Graduate Medical Education
|May 4, 2023
PubMed
Summary

Postgraduate trainees preparing for new clinical learning environments (CLEs) primarily focus on task-oriented "what" aspects. More emphasis is needed on understanding the system, learning goals, and other crucial preparation categories for a successful transition.

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Area of Science:

  • Medical Education
  • Clinical Training
  • Graduate Medical Education

Background:

  • Transitioning to a new clinical learning environment (CLE) involves acquiring new skills, roles, teams, workflows, and understanding the culture.
  • Existing literature offers limited insight into how learners proactively prepare for such transitions.
  • Prior work identified key orientation activities and questions categorized as who, what, where, when, why, and how.

Purpose of the Study:

  • To describe the preparation strategies employed by postgraduate trainees for clinical rotations.
  • To analyze narrative responses from a simulated orientation experience to understand learner preparation.

Main Methods:

  • Qualitative content analysis of narrative responses from incoming residents and fellows.
  • Responses were collected via an online simulated orientation in June 2018.
  • Directed and open coding were used to analyze responses based on prior orientation categories and identify emergent themes.

Main Results:

  • The majority of trainees (46%) focused on 'what' preparations (tasks within the CLE).
  • Preparations related to 'who,' 'where,' 'when,' 'why,' and 'how' were significantly less frequent.
  • Commonly mentioned preparation activities included content reading (40%), seeking advice (28%), and self-care (12%).

Conclusions:

  • Trainees predominantly focus on task-specific ('what') preparations when entering a new CLE.
  • There is a tendency to overlook systemic understanding and learning objectives ('who,' 'where,' 'when,' 'why,' 'how').
  • This highlights a potential gap in comprehensive preparation for clinical learning environment transitions.