Paths to learning: How residents navigate transience in supervisory relationships in the emergency department.

Background: Strong relationships between trainees and physician supervisors can positively influence how trainees navigate workplace learning. How trainees act and learn in clinical workplaces characterized by rapidly developing and dissolving supervisory pairings is less well understood. This study uses the emergency department (ED) to examine the impact of transient supervisory relationships on how residents approach clinical learning opportunities. Methods: We retrospectively analyzed pediatric and emergency medicine resident rotations in an urban, tertiary, academic pediatric ED between July 2018 and June 2022. Using social network analysis (SNA), we identified resident-attending dyads and patients seen by each dyad. This informed semistructured interviews to understand how transience in supervisory relationships influences how residents approach and interpret clinical experiences. With self-determination theory as an organizing framework, the investigators performed line-by-line coding with constant comparative analysis which supported subsequent theoretical coding. Results: During the study, 526 residents completed 1013 rotations with 87 attendings. A mean (±SD) of 25 (±7) attendings supervised a resident per rotation, with dyads caring for a mean (±SD) of 4 (±4) patients. Twelve residents were interviewed and described different paths to learning depending on the transience of their relationships with clinical supervisors. More sustained contact presented an opportunity to build competence by fostering autonomy and feedback, while briefer contact advanced residents' competence by exposing them to variable practice patterns. Conclusions: Combining SNA with qualitative analysis revealed that residents in the ED experience a spectrum of contact with attendings and perceive different paths to learning depending on the transience of this relationship. The results suggest different educational strategies may be necessary to maximize learning depending on the length or resident-attending interactions.