How Do Postgraduate Trainees Prepare for New Clinical Learning Environments

Transitioning to a new clinical learning environment (CLE) requires learning new skills, roles, teams, workflows, and culture. We previously identified activities and questions to guide orientation in the categories of who, what, where, when, why, and how. There is limited literature about how learners plan for this transition.

Describe how postgraduate trainees prepare for a clinical rotation, based on qualitative analysis of narrative responses within a simulated orientation experience.

In June 2018, incoming residents and fellows in multiple specialties at Dartmouth Hitchcock Medical Center completed an online simulated orientation that asked how they intended to prepare for their first rotation. We used directed content analysis to code their anonymously collected responses using the orientation activities and question categories from our prior study. We used open coding to describe additional themes.

Narrative responses were available for 97% (116 of 120) of learners. While 46% (53 of 116) of learners listed preparations related to what happens in the CLE, responses fitting into other question categories were less frequent: who (9%, 11 of 116), where (7%, 8 of 116), when (4%, 5 of 116), why (<1%, 1 of 116), and how (0%, 0 of 116). Learners also infrequently described activities to aid the transition: reading orientation materials (11%, 13 of 116), speaking with a colleague (11%, 13 of 116), and arriving early (3%, 3 of 116). They more frequently commented on content reading (40%, 46 of 116), asking for advice (28%, 33 of 116), and self-care (12%, 14 of 116).

When describing preparation for a new CLE, residents focused on tasks in the what category more than understanding the system and learning goals in other categories.