How Can Residency Programs Make Learning Goals Meaningful?

Background: Developing physicians' skills in self-directed lifelong learning is a key goal of medical training. Learning goals have been used to develop these skills. Objective: To use qualitative methods to describe residents' and program directors' perceptions of program characteristics that facilitate or hinder the meaningful use of learning goals. Design/Methods: Focus groups with residents and interviews with program directors were conducted, audio-recorded, and transcribed. Programs were selected to maximize diversity of size, geography, private vs. public institutions, academic vs. community programs, and current use of learning goals. All transcripts were coded independently by at least two investigators and analyzed using the constant comparative method associated with grounded theory. Member checking with program directors enhanced the trustworthiness of analysis. Through iterative discussions, investigators built a grounded theory. Results: Ninety-five (95) residents and 12 program directors at 12 pediatric residency programs participated. Saturation of themes was obtained. The analysis identified 21 sub-themes that were grouped into five themes: (1) Goal Characteristics and Purposes (important; specific; measurable; realistic; includes plan; consideration of multiple goal purposes), (2) Resident Attributes (buy-in; reflection; initiative), (3) Faculty Roles (faculty support for reflection, creation of goals, and achieving goals), (4) Accountability (internal and external accountability to help residents accomplish goals), (5) Program Support (orientation to goal-setting, documentation system, frequent use, protected time for goal writing, matching goals to experiences, peer support, and faculty development). The theory that was formulated emerged from reflection about these themes: all five themes contribute to the meaningful use of goals in a pediatric residency. Conclusions: This theory provides a description of an ideal approach to using learning goals in pediatric residency education. Meaningful use of goals must be supported by both the explicit and implicit curriculum.