Resident Identification of Significant Learning Experiences: A Qualitative Analysis

Abstract

Background: Practice-based learning is a core competency that is required of residency programs. This study uses a simple written system to encourage structured reflection and describes the experiences residents identify as significant for learning.

Methods: Thoracic surgery residents were asked to submit a brief monthly written reflection, highlighting something they learned from a clinical experience. Qualitative analysis of these reflections was performed with grounded theory to generate categories of learning topics. These categories were then combined into themes used to develop theories about how residents learn from their experiences. The frequency of responses within each category was compared between senior and junior residents to examine differences in their approach to learning.

Results: Seven residents submitted 56 learning experiences (19 by seniors, 37 by juniors) over a 1-year period. Open coding revealed 113 learning points in 12 unique categories. Procedure choice was the most common category reported. Senior residents were more likely to report learning points that involved procedure choice (31% versus 18%, p = 0.01) and procedure timing (8% versus 2%, p = 0.04) than junior residents. The 12 categories were combined into four themes: evaluation and management; technical skills; complication identification and management; and teamwork and communication. Seniors were more likely to report learning points in the preoperative phase (46% versus 32%, p = 0.01).

Conclusions: Brief written reflection is a feasible approach to encourage thoughtful reflection and practice-based learning. Faculty members should explicitly help residents improve their practice by using individualized guidance and can influence resident learning by asking targeted questions, clarifying decisions, and modeling behavior.