Janice L. Hanson,University of Colorado School of Medicine,Aurora,CO,Cynthia . Christy,University of Rochester,Rochester,NY,Cori M. Green,Weill Cornell Medical College,New York,NY,T.J. . Jirasevijinda,Weill Cornell Medical College,New York,NY,Amal Khidir,, ,Qatar,Terry . Kind,Children's National Medical Center/The George Washington University,Washington,DC,Leonard J. Levine,Drexel University College of Medicine,Philadelphia,PA,Caroline R. Paul,University of Wisconsin School of Medicine and Public Health,Madison,WI,Makia . Powers,Morehouse School of Medicine,Atlanta,GA,Mary E M. Rocha,Baylor College of Medicine,Houston,TX,Sandra M. Sanguino,Northwestern University School of Medicine,Chicago,IL,Jocelyn H. Schiller,University of Michigan School of Medicine,Ann Abor,MI,Rebecca L. Tenney-Soeiro,Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania,Philadelphia,PA,Jennifer Trainor,Northwestern University Feinberg School of Medicine,Chicago,IL,Daxa P. Clarke,Phoenix Children's Hospital,Phoenix,AZ,Linda R. Tewksbury,New York University School of Medicine,New York,NY
Background: Subinternships often have little formal curriculum. The COMSEP/APPD Pediatric Subinternship (CAPS) curriculum provides a comprehensive set of learning objectives, yet little is known about learning and assessment strategies that subinterns use to work toward these objectives.
Objectives: To identify learning and assessment strategies that pediatric subinterns specify in ILPs. To identify barriers and facilitators to pediatric subinterns’ learning.
Methods: The CAPS curriculum was provided to subinterns at 12 purposely-sampled medical schools; IRBs approved the protocol. With faculty advisors available, subinterns selected objectives, created ILPs and wrote reviews at mid-point and end of subinternships. ILPs were analyzed with semi-structured content analysis to identify rationales for choosing objectives, learning strategies, assessment strategies, challenges to learning, and aspects of learning environment that facilitated progress. Two investigators coded each ILP, resolving disagreements by consensus. All investigators discussed coding to iteratively define codes.
Results: 201 subinterns at 12 medical schools completed ILPs (30 analyzed thus far, approaching saturation). Subinterns’ rationales for selecting objectives included perceptions of student needs, team relationships, good patient care, efficiency, healthcare systems; limited prior clinical exposure; growing sense of accountability; self-reflection that identified areas of personal weakness. Learning strategies included intentional practice; requesting feedback; discussion with team member; self-reflection; proactively seeking exposure; comparing their work to that of role models. Assessment strategies included self-reflection about progress; requesting feedback; discussing progress; monitoring comfort level; teaching about something they had worked on. Challenges to learning included distractions in the clinical environment; hierarchy; limited access to teachers; differing expectations; lack of familiarity with healthcare system; limited experience working with parents; limited access to needed practice. Facilitators of learning included helpful teachers; consistent expectations; opportunities to see patients; opportunities to act independently; opportunities for feedback; the environment created by family-centered care.
Discussion: Written ILPs provide a window into the learning environment, motivations, and approaches to learning of pediatric subinterns. Understanding learning and assessment strategies and challenges and facilitators to learning will help medical educators optimize the clinical performance and progress of students who are moving toward entrustment in caring for children and families.