Background : In the unique clinical setting of the emergency department (ED), residents and preceptors may have only a short-term relationship, such as a single shift. This poses challenges to performing accurate learner assessment, selecting ideal instructional strategies, and providing substantive feedback.
Objective : The purpose of this study was to implement and evaluate an instructional strategy in which residents developed learning goals for their ED shifts. The aims of this study were to determine if implementing a formal process in which residents self-identified learning goals for their ED shifts was feasible, to characterize the goals that residents self-identified, and to determine how asking residents to self-identify learning goals affected residents’ and preceptors’ experiences with learning, teaching, and feedback.
Methods : This was a prospective mixed methods cohort study. Residents wrote learning goals for each pediatric ED shift and were asked if they had identified, accomplished, and received feedback related to their goal. Logistic regression was used to determine predictors of goal identification, accomplishment, and receiving feedback. Goals were categorized by the ACGME core competencies. Semi-structured interviews were conducted with residents and attendings about their experience. Interviews were analyzed until thematic saturation was reached.
Outcomes : Residents completed 306 end-of-shift surveys (74% response rate) and identified 358 goals. Residents identified goals 54% of the time. They accomplished 89% and received feedback on 76% of goals. Residents were significantly less likely to identify goals in evenings. The odds of receiving feedback were greatest on overnight and lowest on evening shifts. Most goals related to Patient Care and Procedural Skills (56%) or Medical Knowledge (41%). Five major themes were generated from qualitative interviews.