'Trial and Error'-How Do Interns Learn Their Role-Specific Workplace Skills?

Many of the essential workplace skills interns (graduates of US medical schools who are in their first year of supervised practice as physicians) need to function in their roles are taught briefly (e.g., a single didactic session) or are not formally taught at all. These role-specific skills-for example, managing a task list, constructing a patient handoff and calling a consultant-are not addressed like core medical knowledge subjects (e.g., diabetes) or clinical skills (e.g., procedures), which are reinforced through patient interactions, colleague discussions, supervisor feedback and didactics throughout residency. Understanding how interns learn their role-specific skills could empower them to manage their workplace learning opportunities.

We conducted a qualitative study to examine how interns acquire role-specific workplace skills. We conducted semistructured interviews of 16 interns in an internal medicine residency programme. Interview transcripts were analysed using template analysis. Codes were identified, refined and grouped into overarching themes.

Interns described an iterative learning process ('trial and error') informed by peers and supervisors, reflection on the outcomes of completed tasks and technology. Participants identified time and workload pressures as positive influences on their learning. Planning, formal goal setting and direct feedback were not described; instead, interns recognised their progress retrospectively and subjectively, rather than using predefined benchmarks.

Interns learn many role-specific skills through an iterative and unstructured approach that aligns with workplace learning literature. Targeted reflection and teaching and feedback from supervisors may enhance skill acquisition.