We’ve Got A New One—Exploring The Resident-Fellow New Admission Interaction and Opportunities for Enhancing Motivation

OBJECTIVE:To characterize the phases of a new admission interaction between collaborating pediatric residents and fellows; to explore trainee perspectives on motivating and demotivating qualities of that interaction; and to identify behaviors that lead to an optimal new admission interaction. METHODS:The authors used modified grounded theory with experiential learning theory and self-determination theory as sensitizing concepts to conduct six focus groups and journey mapping at Stanford Children's Health from January - March 2021. The sessions were audio recorded and transcribed verbatim. Two authors independently coded the transcripts and developed categories and themes using constant comparison, while a third author reviewed these findings. The qualitative data was triangulated with surveys and journey mapping data, and conceptualized into a model of trainee motivation during the new admission interaction. They outlined an optimal new admission interaction using behaviors consistently described by participants as motivating. RESULTS:Developing inter-trainee trust and educational buy-in are essential for both residents and fellows to feel intrinsically motivated and engaged during a new admission. Residents need to feel autonomous, competent, and related to the team in order to develop trust and buy-in. Fellows require assurance of patient safety to develop trust, and a sense of self-efficacy in fostering resident growth to develop buy-in. Lack of trust or buy-in from either party leads to a cycle of trainee disengagement. CONCLUSIONS:Trainee motivation and engagement with patient care can be impacted by discreet, modifiable behavior by their fellow or resident counterpart, which may help improve the quality of care delivered. WHAT'S NEW?: This primarily qualitative study of pediatric residents and fellows outlines what trainees need to stay engaged and motivated during the new admission interaction. It demonstrates that discreet, modifiable trainee behavior can inspire improved engagement in their fellow or resident counterpart.