"A Different World": A Qualitative Exploration of the Learning Environment for Residents on Pediatric Surgery Rotations.

Objective: This study aimed to characterize the learning environment for general surgery residents on pediatric surgery rotations across the United States, focusing on common educational challenges, and to identify best practices and interventions that can successfully address these challenges. By conducting this needs assessment, our goal was to help promote a shared understanding between residents and educators on pediatric surgical rotations and highlight opportunities to enhance the learning environment.

Design: General surgery residents and pediatric surgical attendings, advanced practice providers (APPs), and fellows were recruited via purposive and snowball sampling to participate in semi-structured interviews. Transcripts were inductively coded via the constant comparative method. Thematic analysis was performed.

Setting: Interviews conducted virtually between October 2023 and January 2024.

Participants: Twenty-eight interviewees including 8 residents, 13 attendings, 5 APPs, and 2 fellows from 16 institutions across the United States.

Results: Eleven challenges spanned the 4 domains of the clinical learning environment: Personal, Social, Organizational, and Physical. Personal challenges included residents' discomfort in caring for children, the impact of decreased autonomy on resident self-esteem and initiative, and inconsistent learning opportunities. Social challenges included the unique culture of pediatricians, the need for different communication patterns with families and other providers, and role ambiguity within the surgical team. Organizational challenges included unclear performance expectations related to insufficient onboarding, the existence of new protocols and procedures, and limited opportunities for teaching amidst high clinical volume. Physical challenges included navigating new facilities and having inadequate workspaces.

Conclusions: Recommendations to address these challenges include (1) aligning resident and educator expectations by clearly articulating learning goals; (2) optimizing informal teaching interactions with faculty, fellows, and APPs; and (3) providing residents access to high-quality reference resources. These interventions can be implemented at the local and national levels.