"If You Don't Care, Why Should I?": Residents' Perspectives on Attending Actions that Influence the Educational...

The educational alliance (EA) has garnered attention as a mechanism to foster collaborative relationships between supervising attendings and residents. However, attending behaviors that impact the EA remain underexplored. We aimed to identify attending behaviors that influence the EA, including perceived frequencies and subsequent impact on the learner and clinical care.

The authors conducted a multicenter study utilizing a mixed-methods design. Qualitative analysis was performed of focus groups at 3 residency programs from August-December 2023. Resultant themes informed a quantitative survey sent to current residents at the same 3 institutions. The results underwent descriptive analysis to determine baseline frequency of attending behaviors.

Twenty-two pediatric residents from 3 programs participated in 5 focus groups. Thematic analysis identified key attending behaviors perceived as "investments" into the EA: 1) gets to know the learner, 2) invests in the learner's development, 3) acknowledges the learning environment, and 4) enables safe learning environment. Residents reported the EA impacted their learning and clinical care through influencing professional growth, patient care, and wellness. One hundred and sixteen residents (47%) responded to the survey. Respondents noted that attendings met to discuss expectations (60%) or elicit learning goals (47%) "almost never or once in a while."

Specific attending behaviors that strengthen the EA could amplify benefits to residents and their clinical care, demonstrating broad implications. However, many behaviors are infrequently or inconsistently performed. Targeted faculty development, along with further clarifying faculty perspectives and perceived barriers, could provide an important opportunity to improve the EA.