Asking what do residents value most: a recent overview of internal medicine residents’ learning preferences

Figures & data

Table 1 List of codes and thematic groupings

Codes		Thematic groups
• Synthesizing information • Solidifying learning • Skill practice		Repetition in Learning
• Expert teaching • Multiple learning modalities • High yield/useful • Varied teaching settings • Clarity of teaching • Relevance		Effective Pedagogy
• Creative thinking • Honing clinical judgment • Diversity of perspectives • Clinical tool • Learning from error		Clinical Problem Solving as an Individual or Collaboratively
• Interactive • Small group • Ability to ask questions • Collaborative learning		Opportunity for Active Engagement
• Patient as teacher • Expert modeling patient care • High-stakes learning • Longitudinal care		Bedside Learning

Table 2 Participating residents’ year of training and current rotation

	N (%)
Postgraduate year
1	111 (37)
2	76 (25)
3	87 (29)
4+	25 (8)
No response	4 (1)
Rotation
Inpatient rotation at the main teaching hospital	115 (38)
Ambulatory rotation	67 (22)
Night float rotation	45 (15)
Other	21 (7)
Intensive care unit rotation	14 (5)
Inpatient rotation at another site	13 (4)
Clinical elective	13 (4)
Research elective	12 (4)
Inpatient rotation at the VA	3 (1)

Abbreviation: VA, Veterans Health Administration Medical Center.

Figure 1 Internal medicine residents were surveyed during the 2016–2017 academic year about their most valuable learning experiences and were asked to rate these experiences on a 5-point Likert-type scale.

Note: This figure depicts the frequency of each response on that scale (N=303).

Table 3 Participants’ most valuable learning experience and experience setting

“Who else was involved?”a	N (%)
Attending	152 (50)
Coresident	109 (36)
More senior resident	77 (25)
More junior resident	66 (22)
Medical student	42 (14)
Just me	40 (13)
Patient	25 (8)
Consulting service	21 (7)
Other	15 (5)
Nurse	14 (5)
Other allied health care professional	12 (4)
“Where did this experience occur?”b	N (%)
Team workroom	94 (31)
Other	75 (25)
Patient bedside	37 (12)
Medical ward	27 (9)
Missing/no answer	24 (8)
Clinic room	19 (6)
At home	15 (5)
Library	8 (3)
Radiology reading room	3 (1)
Pathology microscope	1 (<1)

Notes:

a Multiple answers were allowed.

b Only one answer was allowed.

Table 4 Internal medicine residents were surveyed during the 2016–2017 academic year about their most valuable learning experiences

Theme	Sample responses
Repetition in Learning	“Admitting a patient last night [because] I had to think through how to best summarize the critical aspects of heart failure.” “Me teaching the interns via a case I saw Talking through it solidified my own knowledge.” “As part of the geriatrics rotation, I engaged in an observed clinical experience [OSCE] focused on end-of-life communication. I found it tremendously useful to practice using language around hospice and end-of-life care.” (This was also coded as Opportunity for Active Engagement and Effective Pedagogy)
Effective Pedagogy	“[My most valuable learning experience was] an attending pointing out an EKG finding I had never seen. This was valuable because hearing things out loud from experts makes things stick and makes things make sense in a way that [reading in] a book does not.” (This was also coded as Repetition in Learning) “[My most valuable learning experience] was noon conference with [a senior infectious disease attending] – an incredibly high yield review of HIV management from a topical expert.” “My resident taught me about hyponatremia in an extremely clear way during about [5 minutes] on rounds.” “This AM our team discussed CRT-D. The experience was valuable because the senior resident and attending highlighted the most salient points about said topic.”
Clinical Problem Solving as an Individual or Collaboratively	“I was working in the ED and working collaboratively with one of the ED [senior residents]. I presented a case to her and she provided feedback from a different specialty perspective about my differential that helped remind me not to anchor and highlighted another clinical entity.” “[I] learned about vertigo and the quick way to screen for central [versus] peripheral vertigo from my attending. [This was] useful [because it] imparted a few key points to remember, and gave a useful clinical tool to use [in either the inpatient or outpatient] setting.” “[My most valuable learning experience was in] morning report – it focused on [the case of a patient] that I had taken care of while on [service], so it was helpful to hear the discussion from a lot of different perspectives (on a case that I had already thought about a lot).” “[I admitted] a sick/complicated patient overnight, [which forced] me to try to think creatively about what might explain their presentation.”
Opportunity for Active Engagement	“[My most valuable learning experience was] attending teaching rounds because it was an interactive small group scenario.” “The most valuable learning experience I had…was a lecture I had on readmission risks and quality and safety. The lecture was valuable because it fostered participation and enthusiastic discussion.”
Bedside Learning	“[My most] significant teaching moment [was] with my resident based on a change in patient status [leading to] decompensation. [It was] so salient because I was nervous and every ounce of me was trying to pay attention to details.” “[My most valuable learning experience occurred] in my primary care clinic [with] a patient [experiencing] persistent symptoms after a recent ED diagnosis. [I] learned about the workup required and had a chance to see the [patient’s] course after [he was] discharged from [the] ED/hospital”. (This was also coded as Clinical Problem Solving as an Individual or Collaboratively) “[My most valuable learning experience was] a rapid response … [for] a patient with nearing-unstable atrial fibrillation with RVR. [I] learned [the] steps needed to cardiovert a patient on the floor in an urgent (but not emergent) setting.”

Notes: Internal medicine residents were surveyed during the 2016–2017 academic year about their most valuable learning experiences. Responses were coded and categorized into five thematic groups. This Table lists representative resident responses for each thematic grouping.

* Quotations could be coded into more than one thematic group. This is noted throughout the table.

Abbreviations: AM, morning; CRT-D, cardiac resynchronization therapy defibrillator; ED, emergency department; RVR, rapid ventricular response.

Figure S1 Distribution of thematic groupings.

Table S1 Survey instrument

Survey questions

1. What year are you

○ PGY1

○ PGY2

○ PGY3

○ PGY4+

2. Think back over your last 24 hours, were you on:

• Inpatient rotation at the main teaching hospital

• Inpatient rotation at another hospital site

• Inpatient rotation at the VA

• Intensive care unit rotation (including other hospital sites)

• Night float rotation (including other hospital sites)

• Ambulatory rotation

• Research elective

• Clinical elective

• Other elective (specify)______

• Away rotation (including global health)

• Vacation

• Other _____

3. Please choose your most valuable learning experience in the past 24 hours and give a one sentence description of why it was valuable to you.

4. Please rate this learning experience.

1 = I didn’t learn anything new

2 = I learned something, but it was not particularly memorable or useful

3 = I learned something that may be useful in future clinical encounters

4 = I learned something that will be useful in future clinical encounters

5 = I learned something new and/or important that I believe I will retain and consistently use in future clinical encounters

5. Where did this experience occur? (choose only one)

• Patient bedside

• Clinic room

• Team workroom

• Medical ward

• Library

• Radiology reading room

• Pathology double-headed microscope

• At home

• Other (Please specify: _____)

6. Who else was involved? (Choose as many as applicable)

• Attending

• Co-resident

• More senior resident

• More junior resident

• Medical student

• Nurse

• Other allied health care professional (pharmacist, social work, care coordinator, other) Specify:________

• Consulting service fellow or attending

• Patient

• Just me

• Other (Please specify: ____)

Abbreviation: VA, Veterans Health Administration Medical Center.

Table S2 Daily survey response rate

Study day	Number of responses	Total possible respondents	Response rate (%)
1	59	120	49
2	53	120	44
3	56	120	46
4	42	120	35
5	53	120	44
6	43	116	37
7	35	116	30
8	23	116	20
9	34	116	29