Advertisement

Using Trainee Failures to Enhance Learning: A Qualitative Study of Pediatric Hospitalists on Allowing Failure

Published:November 24, 2022DOI:https://doi.org/10.1016/j.acap.2022.11.010

      Abstract

      Introduction

      Attendings allow trainee failure when perceived educational benefits outweigh potential patient harm. This strategy has not been explored in pediatrics, where it may be shaped by unique factors. Our objectives were to understand if, when, and how pediatric hospitalists allow trainees to fail during clinical encounters.

      Methods

      Using constructivist grounded theory, we conducted semi-structured interviews with 21 pediatric hospitalists from a children's hospital in the U.S. Iterative, constant comparative analysis took place concurrent with data collection. During regular team meetings, we refined and grouped codes into larger themes.

      Results

      19 of the 21 participants shared that they intentionally allowed failure as a teaching strategy, acknowledging this strategy's emotional power and weighing the educational benefits against harms to current and future patients, caregivers, and trainees. Participants described a multi-step process for allowing failure: 1) initiate an orientation to signal that they prioritize a psychologically safe learning environment; 2) consider factors which influence their decision to allow failure; and 3) debrief with trainees. However, participants did not explicitly alert trainees to this teaching strategy. They also avoided using the word ‘failure’ during debriefs to protect trainees from psychological harm.

      Conclusions

      Most pediatric hospitalists in this study allowed failure for educational purposes. However, they did so cautiously, weighing the educational value of the failure against the safety of both current and future patients, the relationship with the caregivers, and the trainees’ well-being. Future research should involve trainees to more comprehensively understand the experience and effectiveness of this teaching strategy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Edmondson AC.
        Strategies for Learning from Failure.
        Harvard Business Review. 2011;
        • Wu AW
        • Folkman S
        • McPhee SJ
        • Lo B.
        Do house officers learn from their mistakes?.
        JAMA. 1991; 265: 2089-2094
        • Scarff CE
        • Bearman M
        • Chiavaroli N
        • Trumble S.
        Keeping mum in clinical supervision: private thoughts and public judgements.
        Med Educ. 2019; 53: 133-142
        • Klasen JM
        • Lingard LA.
        Allowing failure for educational purposes in postgraduate clinical training: A narrative review.
        Med Teach. 2019; 41: 1263-1269
        • Klasen JM
        • Driessen E
        • Teunissen PW
        • Lingard LA.
        Whatever you cut, I can fix it': clinical supervisors' interview accounts of allowing trainee failure while guarding patient safety.
        BMJ quality & safety. 2019;
        • Klasen JM
        • Teunissen PW
        • Driessen EW
        • Lingard LA.
        It depends': The complexity of allowing residents to fail from the perspective of clinical supervisors.
        Med Teach. 2022; 44: 196-205
        • Jenkins TM.
        Dual Autonomies, Divergent Approaches: How Stratification in Medical Education Shapes Approaches to Patient Care.
        J Health Soc Behav. 2018; 59: 268-282
        • Mieczkowski AE
        • Rubio D
        • Van Deusen R.
        Perceptions of internal medicine-pediatrics residents about autonomy during residency.
        J Grad Med Educ. 2014; 6: 330-334
        • Baldwin CD
        • Shone L
        • Harris JP
        • Craig MS
        • Cellini MM
        • Varade WS.
        Development of a novel curriculum to enhance the autonomy and motivation of residents.
        Pediatrics. 2011; 128: 633-636
        • Fein JA
        • Ganesh J
        • Alpern ER.
        Medical staff attitudes toward family presence during pediatric procedures.
        Pediatr Emerg Care. 2004; 20: 224-227
        • C K.
        Constructing grounded theory. A practical guide through Qualitative Analysis.
        Sage Publications, Thousand Oaks, Calif2006
        • Törrönen J.
        Using vignettes in qualitative interviews as clues, microcosms or provokers.
        Qualitative Research Journal. 2018; 18
        • Jenkins N
        • Bloor M
        • Fischer J
        • Berney L
        • Neale J
        Putting it in context: the use of vignettes in qualitative interviewing.
        Qualitative Research. 2010; 10: 175-198
        • Patton M.
        Qualitative Research and Evaluation Methods.
        4th Edition. Sage, Thousand Oaks2014
        • Tong H
        • Qiu F
        • Fan L.
        Characterising common challenges faced by parental caregivers of children with type 1 diabetes mellitus in mainland China: a qualitative study.
        BMJ Open. 2022; 12e048763
        • Rennick JE
        • St-Sauveur I
        • Knox AM
        • Ruddy M.
        Exploring the experiences of parent caregivers of children with chronic medical complexity during pediatric intensive care unit hospitalization: an interpretive descriptive study.
        BMC Pediatr. 2019; 19: 272
        • Khan A
        • Furtak SL
        • Melvin P
        • Rogers JE
        • Schuster MA
        • Landrigan CP.
        Parent-Provider Miscommunications in Hospitalized Children.
        Hospital pediatrics. 2017; 7: 505-515
        • Khan A
        • Rogers JE
        • Melvin P
        • et al.
        Physician and Nurse Nighttime Communication and Parents' Hospital Experience.
        Pediatrics. 2015; 136: e1249-e1258
        • Kristensson-Hallstrom I.
        Parental participation in pediatric surgical care.
        AORN J. 2000; 71 (1026-1029): 1021-1024
        • Levetown M
        American Academy of Pediatrics Committee on B. Communicating with children and families: from everyday interactions to skill in conveying distressing information.
        Pediatrics. 2008; 121: e1441-e1460
        • Harolds JA.
        Quality and Safety in Health Care, Part III: To Err is Human.
        Clin Nucl Med. 2015; 40: 793-795
        • WEt Bynum
        • AR Jr, Artino
        • Uijtdehaage S
        • Webb AMB
        • Varpio L
        Sentinel Emotional Events: The Nature, Triggers, and Effects of Shame Experiences in Medical Residents.
        Acad Med. 2019; 94: 85-93
        • Wu AW.
        Medical error: the second victim. The doctor who makes the mistake needs help too.
        BMJ. 2000; 320: 726-727
        • WEt Bynum
        • WT P
        • Varpio L
        In the "Shadow of Shame": A Phenomenological Exploration of the Nature of Shame Experiences in Medical Students.
        Acad Med. 2021; 96: S23-S30
        • Mazor KM
        • Fischer MA
        • Haley HL
        • Hatem D
        • Quirk ME.
        Teaching and medical errors: primary care preceptors' views.
        Med Educ. 2005; 39: 982-990
        • Pekrun R.
        The control-value theory of achievement emotions: Assumptions, corollaries, and implications for educational research and practice.
        Educational Psychology Review. 2006; 18: 315-341
        • Scott SD
        • Hirschinger LE
        • Cox KR.
        Sharing the load. Rescuing the healer after trauma.
        RN. 2008; 71 (42-33): 38-40
        • Mak-van der Vossen M.
        Failure to fail': the teacher's dilemma revisited.
        Med Educ. 2019; 53: 108-110
        • Dudek NL
        • Marks MB
        • Regehr G.
        Failure to fail: the perspectives of clinical supervisors.
        Acad Med. 2005; 80 (SupplS): 84-87
        • Detsky AS.
        The art of pimping.
        JAMA. 2009; 301: 1379-1381
        • Slavin SJ
        • Schindler DL
        • Chibnall JT.
        Medical student mental health 3.0: improving student wellness through curricular changes.
        Acad Med. 2014; 89: 573-577
        • McClintock AH
        • Fainstad TL
        • Jauregui J.
        Creating Psychological Safety in the Learning Environment: Straightforward Answers to a Longstanding Challenge.
        Acad Med. 2021; 96: S208-S209
        • WEt Bynum
        • JL Goodie
        Shame, guilt, and the medical learner: ignored connections and why we should care.
        Med Educ. 2014; 48: 1045-1054
        • WEt Bynum
        • L Varpio
        • Teunissen P
        Why impaired wellness may be inevitable in medicine, and why that may not be a bad thing.
        Med Educ. 2021; 55: 16-22
        • Mata DA
        • Ramos MA
        • Bansal N
        • et al.
        Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis.
        JAMA. 2015; 314: 2373-2383
        • Kemper KJ
        • Schwartz A
        • Wilson PM
        • et al.
        Burnout in Pediatric Residents: Three Years of National Survey Data.
        Pediatrics. 2020; 145
        • Gold MA
        • Rosenthal SL
        • Wainberg ML.
        Walking on Eggshells With Trainees in the Clinical Learning Environment-Avoiding the Eggshells Is Not the Answer.
        JAMA Pediatr. 2019; 173: 907-908
        • Telio S
        • Ajjawi R
        • Regehr G.
        The "educational alliance" as a framework for reconceptualizing feedback in medical education.
        Acad Med. 2015; 90: 609-614