Why Didn't You Call Me? Factors Junior Learners Consider When Deciding Whether to Call Their Supervisor

Area of Science:

• Medical Education
• Clinical Decision-Making
• Patient Safety

Background:

• Junior learners (JL) often feel pressure to work independently, leading to infrequent communication with senior residents (SR).
• The decision-making process for JL contacting SR in non-emergent situations is not well understood.

Purpose of the Study:

• To identify factors JL consider when deciding to page SR.
• To compare these factors with those identified by SR.

Main Methods:

• Fifteen cognitive interviews were conducted with 5 general surgery SR and 10 JL (5 senior medical students, 5 junior residents).
• Participants reviewed sample clinical scenarios and discussed decision-making factors.
• Inductive coding using interpretative phenomenological analysis (IPA) was applied to interview transcripts.

Main Results:

• Both JL and SR agreed on the need to contact SR for high-acuity pages (e.g., hemodynamic instability, codes).
• JL considered 10 patient-related and learner-related factors for non-high-acuity pages, including patient appearance, need for intervention, nurse's concern, and time of day.
• SR identified patient-related and clinical learner factors but not the social learner factors (time of day, interpersonal dynamics) cited by JL.

Conclusions:

• JL utilize a range of patient and learner-specific factors when deciding to page SR for non-urgent matters.
• Explicitly discussing these factors can guide JL's decision-making.
• Addressing social factors is important to foster a supportive environment and enhance patient safety.