Set Up to Fail? Barriers Impeding Resident Communication Training in Neonatal Intensive Care Units.
Journal
Academic medicine : journal of the Association of American Medical Colleges
ISSN: 1938-808X
Titre abrégé: Acad Med
Pays: United States
ID NLM: 8904605
Informations de publication
Date de publication:
01 11 2023
01 11 2023
Historique:
medline:
27
11
2023
pubmed:
20
11
2023
entrez:
20
11
2023
Statut:
ppublish
Résumé
Learning to navigate difficult clinical conversations is an essential feature of residency training, yet much of this learning occurs "on the job," often without the formative, multisource feedback trainees need. To generate insight into how on-the-job training influences trainee performance, the perspectives of parents and health care providers (HCPs) who engaged in or observed difficult conversations with Neonatal Intensive Care Unit (NICU) trainees were explored. The iterative data generation and analysis process was informed by constructivist grounded theory. Parents (n = 14) and HCPs (n = 10) from 2 Canadian NICUs were invited to participate in semistructured interviews informed by rich pictures-a visual elicitation technique useful for exploring complex phenomena like difficult conversations. Themes were identified using the constant comparative approach. The study was conducted between 2018 and 2021. According to participants, misalignment between parents' and trainees' communication styles, HCPs intervening to protect parents when trainee-led communication went awry, the absence of feedback, and a culture of sole physician responsibility for communication all conspired against trainees trying to develop communication competence in the NICU. Given beliefs that trainees' experiential learning should not trump parents' well-being, some physicians perceived the art of communication was best learned by observing experts. Sometimes, already limited opportunities for trainees to lead conversations were further constricted by perceptions that trainees lacked the interest and motivation to focus on so-called "soft" skills like communication during their training. Parents and NICU staff described that trainees face multiple barriers against learning to navigate difficult conversations that may set them up to fail. A deeper understanding of the layered challenges trainees face, and the hierarchies and sociocultural norms that interfere with teaching, may be the start of breaking down multiple barriers trainees and their clinician supervisors need to overcome to succeed.
Identifiants
pubmed: 37983398
doi: 10.1097/ACM.0000000000005355
pii: 00001888-202311001-00012
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
S65-S71Informations de copyright
Copyright © 2023 by the Association of American Medical Colleges.
Déclaration de conflit d'intérêts
Other disclosures: The authors have no conflicts of interest to declare.
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