Pediatric Hospital Medicine Fellow Cincinnati Children's Hospital Medical Center Cincinnati, Ohio, United States
Background: Clinical reasoning (CR) encompasses cognitive skills that physicians use daily throughout the diagnostic and management process to provide clinical care. The attainment of CR skills is a national educational priority for pediatric residents.
While methods for evaluating CR exist, it is unclear how they are used to assess resident skills, identify deficiencies, and improve skill gaps. Given that CR is a commonly cited deficit for learners referred for remediation, understanding the evaluation of these skills in pediatric residency programs is critical. Furthermore, without frameworks for teaching or assessing CR, educators may struggle to measure the effectiveness of efforts to address CR deficiencies. Objective: We seek to explore how CR skills are assessed and how deficiencies are intervened upon for pediatric trainees by examining the perspective of a diverse representation of pediatric residency program directors. Design/Methods: Taking a social constructionist approach, this multi-center, IRB-exempt qualitative study involves semi-structured interviews with pediatric residency program directors. We are using maximum-variation sampling to ensure representation of diverse sizes and geographic distribution of training programs in the United States. Interviews explore how programs assess resident CR skills, how outliers are identified, and how learners with deficiencies are supported. Interviews are de-identified, transcribed, and inductive thematic analysis will generate salient themes about CR assessment and remediation. Coding will be performed by three co-investigators with each interview being coded by at least two investigators.
Three pilot interviews were conducted with participants outside our sample to refine the interview guide. Recruitment and iterative analysis are underway and will continue until thematic sufficiency is reached; thus far, three interviews have been conducted and coded with an additional five interviews scheduled. We anticipate interviewing and analyzing data from 15-25 participants in total by March 2024.
