A Qualitative Study of Senior Residents' Strategies to Prepare for Unsupervised Practice

Area of Science:

• Medical Education
• Physician Training
• Emergency Medicine

Background:

• Emergency medicine (EM) residents transition from supervised training to unsupervised practice.
• This transition requires anticipating new roles and responsibilities as attending physicians.
• The self-regulated learning framework guides the understanding of this transition.

Purpose of the Study:

• To explore how senior EM residents proactively identify goals and enact learning strategies for the transition to unsupervised practice.
• To investigate the application of the self-regulated learning framework in this context.

Main Methods:

• A constructivist grounded theory approach was used.
• Interviews were conducted with 16 senior EM residents from two programs.
• Inductive coding of transcripts was performed, guided by the self-regulated learning framework.

Main Results:

• Residents identified knowledge/skill gaps and autonomy gaps.
• Specific learning strategies were employed: cherry-picking, case-based hypotheticals, parachuting, and making the call.
• Reflection on internal and external feedback was used to assess strategy effectiveness.

Conclusions:

• EM residents strategically use learning strategies to bridge self-assessed capability gaps before unsupervised practice.
• Trainees demonstrate agency through goal setting, strategic actions, and reflection.
• Residency programs can support senior residents' agency in preparation for future practice.