When precepting medical students in the emergency department, faculty physicians often have only minutes per patient encounter to devote to direct teaching. Instructional strategies that promote independent student learning after each case may have merit. It is not known, however, to what degree patient-triggered learning needs are amenable to independent study.
The aims of this study were to determine self- and faculty-reported learner needs at the time of patient encounters and to assess the degree to which these perceived needs may be satisfied by independent study.
We interviewed medical students and faculty in our pediatric emergency department. Immediately before or after they saw a patient, we asked “What do you want to learn right now?”. For half of the student interviews, we separately asked the same questions of their preceptors. Interviews were taped and transcribed. Responses were coded by 3 investigators who did content analysis to identify dominant themes and the extent to which the learning need could be addressed independently. Investigators agreed that Accreditation Council for Graduate Medical Education competency domains could be used to classify the responses.
We interviewed 82 students and 44 preceptors yielding 126 patient-triggered learning needs. Competency area(s) were medical knowledge (70), patient care (1), interpersonal skills (27), systems-based practice (2), practice-based learning (3), and professionalism (4). Two raters independently assigned the same competency in 89%. Medical knowledge competency learning needs were almost all at least moderately amenable to independent learning (68/70, 98%), but the other competencies were not (22/57, 39%) according to the raters (interrater reliability, 0.7). Preceptor responses were congruent in competency type with students' responses in 29 (67%) of 43. Students listed interpersonal skills deficits far more often than did faculty (24% vs 5%, P < 0.05).
Most student learning needs in the pediatric emergency department focus on medical knowledge. These deficits could be amenable to structured independent study at the point of care.
From the *Division of Pediatric Emergency Medicine; †Department of Human Development, Teachers College; and ‡Division of General Pediatrics, Columbia University, New York, NY.
Disclosure: The authors declare no conflict of interest.
Reprints: Martin V. Pusic, MD, PhD, Division of Pediatric Emergency Medicine, Columbia University, 622 W 168th St, PH1-137, New York, NY 10032 (e-mail: firstname.lastname@example.org).
Presented as an abstract at the Society for Academic Emergency Medicine Annual Meeting, May 2011.
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