Barriers to workplace-based learning in the intensive care unit: A qualitative description of internal medicine residents’ and intensivists’ perspectives

Abstract

Background

Residency programs leverage the acquisition of critical care competencies through off-service rotations in the intensive care unit (ICU). However, recent literature questions the effectiveness of increasing the exposition of residents to critical care units to improve their critical care competencies. We aimed to describe the barriers to learning in the ICU from the perspective of internal medicine (IM) residents and intensivists.

Methods

A qualitative description methodology was applied to data gathered during an ICU quality improvement initiative in a large tertiary academic hospital. Verbatim transcriptions of 12 focus groups including 22 IM residents and 17 intensivists were assessed through thematic data analysis.

Results

We identified three key themes and 13 subthemes related to barriers to learning. Aspects of the environment such as the slow socialization process of residents to the ICU environment and stakeholders’ perceptions influenced the quality of learning interactions. Dedicated teaching was further influenced by factors related to the IM residency curricula (e.g. competing co-curricular demands) and contributed to tensions in delivering a standardized ICU curriculum.

Conclusion

This study provides a description of educational barriers that may be present during ICU rotations. Recognizing these barriers may help clinical teachers improve their trainees’ educational experience.

Keywords:

• Postgraduate medical education
• internal medicine
• intensive care
• internship and residency

Disclosure statement

The authors report no conflict of interest. However, at the time of pursuing the analysis, CV had received doctoral scholarships from the Canadian Institutes of Health Research, the Fonds de Recherche du Québec – Santé, the Réseau de Recherche en Interventions en Sciences Infirmières and from the Faculty of Medicine and Health Sciences at Université de Sherbrooke. These organizations were not involved in the decision to pursue this research or to submit this manuscript for publication.

Glossary

Workplace-based learning: Based on the theoretical underpinnings of Eraut’s (2004) work, workplace-based learning, or work-based learning, can be defined as a context where: ‘knowledge and skills are fostered, extended and developed through work activity and interactions with others.’ (Morris and Blaney 2013, p.97). Workplace-based learning relates to both formal and informal learning and takes place in a specific work setting.

Additional information

Notes on contributors

Nicholas Robillard

Nicholas Robillard, M.D., MHPE (student), FRCPc, Department of Intensive Care Medicine, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada; Research Centre, Centre Hospitalier de l’Université de Montréal.

Christian Vincelette

Christian Vincelette, RN, M.Sc., Ph.D. candidate, School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada.