TOP 20 - Where Learning Happens: Resident Perspectives and Levels of Medical Learning Across Clinical Rotations

Publication Number: 1780.TOP 20

Nikolaos Angelopoulos, Medstar-Georgetown University Hospital, Washington, DC, United States; Kirsten B. Hawkins, MedStar Georgetown University Hospital, Washington, DC, United States

Background: All residents navigate dual roles as learners and physicians. This is especially exemplified in Pediatrics, which offers multiple careers; inpatient/outpatient, specialty/primary care, research/clinical work, academic/community based. The ACGME requirements reflect this by exposing residents to diverse aspects of pediatrics. Because of that, most residents complete mandatory portions of their training that are not fully aligned with future plans. With intense schedules and burn-out being prevalent, many struggle to engage equally with all rotations, whereas learning is left to occur “on the job” or only during protected time.
On clinical rotations there are numerous implicit learning opportunities, yet residents often lack a structured framework to articulate the knowledge that is necessary for patient care. To address this, we introduced the 3 levels of medical learning:
Level 1: systems learning, using the EMR and understanding health care systems
Level 2: actual medical knowledge, often delivered via “just-in-time" or “just-in-case" learning
Level 3: production/dissemination of knowledge via research or teaching

Objective: Primary: Evaluate changes in residents' perception of learning opportunities across rotations after introduction to the 3 levels of learning framework.
Secondary: Have residents engage mindfully with learning moments and use insights to advocate for a better-defined role as learners.

Design/Methods: This mixed-methods study employed a qualitative, anonymized pre-post design with cross-sectional elements.
Residents from our program were recruited in person. Each participant received a randomized unique identifier and was prompted to reflect on “where does learning happen”, for nine mandatory rotations on our main practice sites. No demographic information beyond PGY was collected to preserve anonymity. Residents also indicated whether they consider teaching as learning.
After pre-survey completion, an educational intervention was delivered in person during academic half-day and asynchronously via a slide deck for those unable to attend. Participants were introduced to the 3 levels of learning and had the opportunity to ask questions.
On the post-survey, participants identified opportunities for learning of each level for the selected rotations and whether they are self-directed, peer-led or expert-led. They also indicated future career plans.
Survey responses are now being analyzed qualitatively to identify themes regarding pre- and post- perceptions and ability to recognize the different levels of learning. Patterns are investigated by PGY and career goals.