Developing Master Adaptive Learners: Implementation of a Coaching Program in Graduate Medical Education

Abstract

BACKGROUNDMedical knowledge is expanding exponentially, outpacing the information that can be learned during medical training.1 To keep pace with this rapid acceleration of new information, physicians must continually address practice gaps and adapt to novel situations.2,3 Unfortunately, studies demonstrate physicians frequently perform inaccurate self-assessments and generate learning goals discordant with gaps. 4 This suboptimal approach to learning is attributed, in part, to medical training not preparing physicians to be effective learners and highlights the need to teach learners to learn.2,[5][6] Despite this, there is a paucity of published curricula or programs delineating how to train trainees to learn effectively.This imperative for continuous learning is palpable in the complex and challenging clinical setting of the emergency department (ED).The acuity, fast pace, and variability in patient presentations require physicians to nimbly adapt to novel challenges.7 These same factors that make effective, continuous learning necessary to provide high-quality patient care also make the ED a challenging place to learn.7 Therefore, this intervention focused specifically on a novel coaching approach to develop life-long learning skills in pediatric emergency medicine (PEM) fellows at a large academic center. PROGRAM DESIGNWe performed a needs assessment in December 2020-January 2021 of our PEM fellows to identify their current approach to learning and application of MAL skills.One author (MW) performed semi-structured interviews with three recent graduates, four fellows, and one incoming fellow.We performed focus groups with faculty to understand their approach to fellow education, direct observation, feedback, and learning plan development.The fellows lacked a defined approach to learning and pointed to infrequent and poor-quality feedback as barriers to identifying gaps.The faculty cited multiple challenges to providing feedback and