268 - “If you don’t care, why should I?”: A mixed methods study of learners' perspectives on inpatient supervising attending behaviors that influence the educational alliance

Publication Number: 268.3583

Michael D. Fishman, Boston Children's Hospital, Boston, MA, United States; Laura Chiel, Boston Children's Hospital, Boston, MA, United States; Danielle Cirillo, Hasbro Children's Hospital at Rhode Island Hospital, Providence, RI, United States; Jonathan Danel, Tufts University School of Medicine, South Portland, ME, United States; Molly Rideout, The University of Vermont Children's Hospital, Burlington, VT, United States; Katherine E.. mason, The Warren Alpert Medical School of Brown University, barrington, RI, United States; Lori Newman, Boston Children's Hospital, Boston, MA, United States; Alan Leichtner, Boston Children's Hospital, Chestnut Hill, MA, United States

Background: The educational alliance (EA) has garnered increasing attention as a mechanism for fostering collaborative and supportive relationships between supervising attendings and learners. Despite its acknowledged importance, understanding how specific supervising attending behaviors impact the EA, particularly from the learners’ perspective, remains inadequately explored. Identifying these behaviors can help inform strategies to optimize the EA; thereby maximizing its benefits for both attendings and learners.

Objective: To determine, from the learners’ perspective: 1) the inpatient supervisory attendings’ behaviors that impact the educational alliance and 2) the baseline perceived frequency of identified behaviors to help inform faculty development.

Design/Methods: This project was a multicenter study utilizing a mixed methods exploratory sequential design. An initial qualitative thematic analysis of pediatric resident focus groups from 3 programs was performed from August to December 2023. Two authors independently read the first 2 transcripts to generate a codebook and then coded the remaining transcripts in parallel until thematic sufficiency was attained. The research team discussed and revised candidate themes until consensus was achieved. These themes informed a survey that was sent to all current residents at the 3 institutions. The results of the survey then underwent descriptive analysis to determine baseline frequency of specific attending behaviors.

Results: 22 pediatric residents from 3 programs participated in 5 focus groups. Participants reported attending behaviors they viewed as ‘investments’ in the EA, which in turn positively impacted the residents’ learning and clinical care (Figure 1). One hundred and sixteen residents (47%) responded to the survey (Table 1), with significant findings that attendings infrequently meet to discuss expectations (17% “often or almost always”) or elicit learning goals (20% “often or almost always”) on or prior to the first day (Table 2).

Conclusion(s): Participants identified specific behaviors of inpatient supervising attendings that influence the EA. These behaviors could potentially amplify benefits to the learners and their clinical care. Many of these behaviors are infrequently or inconsistently performed, specifically regarding investing in learners’ professional growth. Structured faculty development targeting the themes could provide an important opportunity to improve feedback, clinical care, and medical student and resident professional development.

Figure 1.
Conceptual model representing identified themes and subthemes of behaviors that influence the educational alliance from semi-structured focus groups.

Table 1.
Demographics for participants in quantitative survey study phase.

Table 2.
Participant responses to survey during quantitative survey study phase.

Figure 1.
Conceptual model representing identified themes and subthemes of behaviors that influence the educational alliance from semi-structured focus groups.

Table 1.
Demographics for participants in quantitative survey study phase.

Table 2.
Participant responses to survey during quantitative survey study phase.