243 - "I felt seen." Leveraging Small Schedule Changes to Enhance Learners' Psychological Safety in the Emergency Department

Publication Number: 243.3608

Anna Weiss, Children's Hospital of Philadelphia/Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Ashley M. Shemonsky, CHOP, Broomall, PA, United States; Telana Fenton, Childrens Hospital of Philadelphia, Rio Rancho, NM 87144-7886, NM, United States; Rachel Rempell, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Megan Lavoie, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Changes in rotation requirements and increases in faculty hiring have led to a loss in longitudinal relationships between Pediatric Emergency Medicine (PEM) faculty and Pediatrics residents. These relationships are critical for establishing psychologically safe learning environments in which trainees receive meaningful feedback on their learning goals and in which faculty grant graduated autonomy based on longitudinal observations of trainee performance.

Objective: We sought to restore aspects of longitudinal faculty-resident relationships by pairing trainees and attending supervisors for 2-4 shifts in the Emergency Department (ED).

Design/Methods: In FY22 and FY23 we paired faculty volunteers with a resident for 2-4 shifts of that resident’s two-week rotation in our ED. We manually paired shifts outside of the automated system usually used for ED scheduling. Pairs were informed they would be working together and upon completion of the resident’s two-week rotation, both members of the dyad were sent an anonymous survey to rate the experience.

Results: In FY22, 54 we paired dyads of 18 faculty and 51 residents. In FY23, we paired 63 dyads of 25 faculty and 40 residents. Post-pairing survey completion was 65% for both groups in FY22 and 44% for both groups in FY23. Residents noted that being paired with a faculty member increased their understanding of their attending’s expectations (83% in FY22; 89% in FY23); increased their ability to discuss their learning goals (86% in FY22; 90% in FY23); increased their comfort in the ED (86% in FY22; 96% in FY23); increased their perceived autonomy (85% in FY22; 82% in FY23), and increased the feedback they received (75% in FY22; 78% in FY23). Six (FY22) and eight (FY23) residents reported newly considering PEM as a career after the pairing experience. Faculty reported that being paired with a resident increased their understanding of the resident’s learning needs (91% in FY22; 100% in FY23); increased the autonomy they gave their resident (82% in FY22; 83% in FY23), and increased their ability to provide meaningful post-shift written assessments (86% in FY22; 96% in FY23). Qualitative comments were superlative, with both groups reporting how much they valued being paired together.

Conclusion(s): With minimal changes to faculty schedules, we demonstrated it is feasible to increase critical aspects of both teaching and learning in the ED with brief longitudinal exposure between supervisors and trainees. This work helps to further our understanding of what it takes to provide psychological safety in an increasingly frenetic and high-acuity clinical learning environment.

Trainee and Faculty Experiences with Shift Pairing
Exemplar quotes on post-pairing surveys from trainees (blue) and faculty (yellow)

Trainee and Faculty Experiences with Shift Pairing
Exemplar quotes on post-pairing surveys from trainees (blue) and faculty (yellow)