Susan Bannister, MD1; David Keegan, MD1; Lorelei Lingard, MD2
1University of Western Ontario, London, Ontario
2 University of Toronto, Toronto, Ontario
Purpose: While the effective acquisition of technical skills is essential for excellent pediatric care, little is known about how residents and fellows learn these skills in the pediatric emergency department setting. This study sought to describe and theorize the variables influencing technical skills acquisition in a tertiary care pediatric emergency department (PED).
Methodology: Using non-participant field methodology, residents and fellows and their teachers (nurses, respiratory therapists, emergency staff and fellows) were observed during intermittent periods over 3 months. Nineteen interviews and 4 focus groups with these teachers and learners were conducted and used to triangulate observational findings. Using a constant comparative process, field notes and transcripts from interviews and focus group were analyzed by 2 researchers for emergent themes in the grounded theory tradition.
Results: Data from over 400 hours of observation and 293 observed technical procedures, 19 interviews and 4 focus groups are presented thematically. Dominant themes include: the nature and timing of feedback, opportunities to learn technical skills, competition from other learners, "nursing" skills, supervision, and staff physicians' competing priorities. These themes interact to influence the learning environment by all contributing to lost learning opportunities to acquire technical skills.
Conclusions: The PED is a complex educational environment where technical skill learning opportunities are, unfortunately, frequently lost. Understanding the factors that influence opportunities to learn technical skills in this setting is a first step in developing improvements to technical skill learning in this domain.