POSTER

Technical skill in the pediatric setting: A qualitative study of acquisition, attitudes, and assumptions

Bannister SL; Hilliard RI; Regehr G; Lingard LA.

Objective: While the effective acquisition of technical skill is essential for excellent paediatric care, little is known about how technical skills are learned in the paediatric setting. This study sought to describe and theorize the variables influencing technical skill acquisition in a tertiary care inpatient setting.

Methods: Using non-participant field methodology, paediatric residents and their teachers (nurses, respiratory therapists, neonatology staff and fellows) were observed at various times in the NICU for 8 weeks. Thirteen semi-structured interviews of these teachers and learners and 1 focus group of additional learners were conducted and used to triangulate observational findings. Using a constant comparative process, field notes and interview and focus group transcripts were analyzed by two researchers for emergent themes in the grounded theory tradition.

Results: The data from >90 hours of observation and 21 observed technical procedures, and both individual and group interviews, are presented thematically. Dominant themes include:

e)The nature, timing, and purpose of feedback;
f)Opportunities to learn technical skills;
g)Multiple demands that intersect with technical procedure attempts;
h)Competing priorities; and
i)Teachers and learners' differing perspectives.

These themes interact to affect the learning environment.

Conclusions: The NICU learning environment is a complex interplay between competing priorities, learning opportunities, and attributions about learners. Understanding this interplay is required to develop improvements to technical skill training in this domain.