Identifying competency gaps in intra- and post-learning of a pediatric residency program: a qualitative study
Abstract
Background The purpose of the pediatric residency program is for aspiring pediatricians to develop the core competencies needed to care for the children’s health. Upon graduation, pediatricians encounter competency challenges related to diverse populations, cultures, and medical facilities across the nation. Enhancing the efficacy and efficiency of medical education in pediatric residency programs requires identifying and addressing gaps in the post-learning outcomes and intra-learning processes.
Objective To investigate competency gaps between the core competencies taught in the pediatric residency training program and the actual necessitates in the professional experience of pediatricians.
Methods This qualitative study was conducted by a focus group discussion using semi-constructed questions. Twelve pediatricians who graduated from the Pediatric Residency Program of Universitas Sebelas Maret and had professional work experience of 3 to 18 months were included. Focus group discussions were held online and moderated by the research team using guided questions. Two FGD sessions of 5 and 7 subjects each were conducted. The discussions were recorded and transcribed for analysis in a stepwise manner involving data grouping, information labeling, and data coding to identify the main themes.
Results All subjects were working in type B, C, and D hospitals in six different provinces at the time of the study. The competency gaps in intra-residency learning domain covered two topics: curriculum content (core competencies, medicolegal education, effective communication, vaccination, and longitudinal case management) and training (case variations, patient complexity, and affiliated hospital rotations). The smallest competency gaps was core competency; and there was a need for improvement in other topics, particularly in effective communication and vaccination. The competency gaps in the post-learning domain included 4 topics: daily practices (demographic differences, popular topics, and effective communication), health facilities (the gap between individual competency and availability of health facilities), professional relationships with senior/other center colleagues, and strategic plans (continuing medical education). The cultural social background of the population and limited health resources were the main issues in the post-learning are-sxa that need be acknowledged. Effective communication was the theme that emerged and should be to be taught in both ares of learning and post-learning.
Conclusion Pediatric residency graduates should address some gaps in learning after completing the pediatric residency program. Effective communication was identified as a learning gap during and after training. Based on our findings, we recommend for the program to provide additional steps to prepare pediatric residents before their graduation.
References
2. Lower TK. The continuum of pediatric medical education and life-long learning. J Pediatr. 2011;159:1-2. DOI: https://doi.org/10.1016/j.jpeds.2011.04.017
3. St Clair NE, Pitt MB, Bakeera-Kitaka S, McCall N, Lukolyo H, Arnold LD, et al; on behalf of the Global Health Task Force of the American Board of Pediatrics. Global health: preparation for working in resource-limited settings. Pediatrics. 2017;140:e20163783. DOI: https://doi.org/10.1542/peds.2016-3783
4. Kolegium Ilmu Kesehatan Anak Indonesia. Standar Nasional Pendidikan Dokter Spesialis Anak. Jakarta:KIKAI;2018. [cited 2024 March 12]. Available from: https://kikai.id/wp-content/uploads/2021/04/1d.-Standar-Nasional-Pendidikan-Spesialis-IKA.pdf
5. Rassbach CE, Blankenburg R. A novel pediatric residency coaching program: outcomes after one year. Acad Med. 2018;93:430-4. DOI: https://doi.org/10.1097/ACM.0000000000001825
6. Rosenberg AA, Kamin C, Glicken AD, Jones MD. Training gaps for pediatric residents planning a career in primary care: a qualitative and quantitative study. J Grad Med Educ. 2011;3:309-14. DOI: https://doi.org/10.4300/JGME-D-10-00151.1
7. Tassone MC, Jegathesan T, Han R, Atkinson A, Ng S, Young E. Gaps in Developmental Pediatrics training: a Canadian resident physician perspective. MedEdPublish. 2018;7:136. DOI: https://doi.org/10.15694/mep.2018.0000136.1
8. Opipari VP, Daniels SR, Wilmott RW, Jacobs RF. Association of Medical School Pediatric Department Chairs principles of lifelong learning in pediatric medicine. JAMA Pediatr. 2016;170:1087-92. DOI: https://doi.org/10.1001/jamapediatrics.2016.2258
9. McMillan JA, Land M, Tucker AE, Leslie LK. Preparing future pediatricians to meet the behavioral and mental health needs of children. Pediatrics. 2020;145:e20183796. DOI: https://doi.org/10.1542/peds.2018-3796
10. Iyer MS, Way DP, Schumacher DJ, Lo CB, Leslie LK. What procedures are important to general pediatricians and why? Acad Pediatr. 2021;21:1281-7. DOI: https://doi.org/10.1016/j.acap.2021.03.012
11. Martakis K, Czabanowska K, Schröder - Bäck P. Teaching ethics to pediatric residents: a literature analysis and synthesis. Klin Padiatr. 2016;228:263-9. DOI: https://doi.org/10.1055/s-0042-109709
12. Sawatsky AP, Santivasi WL, Nordhues HC, Vaa BE, Ratelle JT, Beckman TJ, et al. Autonomy and professional identity formation in residency training: a qualitative study. Med Educ. 2020;54:616-7. DOI: https://doi.org/10.1111/medu.14073
13. Hess JS, Straub DM, Mateus JS, Pelaez-Velez C. Preparing for transition from pediatric to adult care: evaluation of a physician training program. Adv Pediatr. 2015;62:137-164. DOI: https://doi.org/10.1016/j.yapd.2015.04.003
14. Meerkov MS, Fischer JB, Saba TG. A simulation procedure curriculum to increase pediatric resident exposure to procedures rarely performed in clinical practice. Med Educ Online. 2019;24:1611305. DOI: https://doi.org/10.1080/10872981.2019.1611305
15. Prakash J, Chatterjee K, Srivastava K, Chauhan VS, Sharma R. Workplace based assessment: A review of available tools and their relevance. Industrial Psy J. 2020;29:200-4. DOI: https://doi.org/10.4103/ipj.ipj_225_20
16. Cate OT, Taylor DR. The recommended description of an entrustable professional activity: AMEE Guide No. 140. Med Teach. 2021;43:1106–14. DOI: https://doi.org/10.1080/0142159X.2020.1838465
17. Larrabee JG, Agrawal D, Trimm F, Ottolini M. Entrustable professional activities: correlation of entrustment assessments of pediatric residents with concurrent subcompetency milestones ratings. J Grad Med Educ. 2020;12:66-73. DOI: https://doi.org/10.4300/JGME-D-19-00408.1
18. Sousa RCR de, Paula WKAS de, Alves FAP, Albuquerque MIN de, Albuquerque GA, Coriolano-Marinus MW de L. Continuing education on child development in primary care: healthcare workers’ perspectives. Rev Esc Enferm USP. 2023;57:e20230189. DOI: https://doi.org/10.1590/1980-220x-reeusp-2023-0189en
19. Shugerman R, Linzer M, Nelson K, Douglas J, Williams R, Konrad R. Pediatric generalists and subspecialists: determinants of career satisfaction. Pediatrics. 2001;108:e40. DOI: https://doi.org/10.1542/peds.108.3.e40
Copyright (c) 2024 Annang Giri Moelyo
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2024-12-09
Published 2024-12-09