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 semistructured interviews with
21 pediatric hospitalists from a children's hospital in the United States. Iterative,
constant comparative analysis took place concurrent with data collection. During regular
team meetings, we refined and grouped codes into larger themes.
Results
Nineteen 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 multistep 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
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Article info
Publication history
Published online: November 24, 2022
Accepted:
November 19,
2022
Received:
August 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest or corporate sponsors to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
