The result is presented in two sections reflecting different conceptual levels of overview and analysis. The first section provides a quantitative overview of all coded themes in two categories. The second section focused on the analysis of responses to three individual questions.
Quantitative overview of all coded themes in two categories
We received a total of six hundred three comments from PGY1 physicians. Of these, we coded 563 (96%) comments, and 22 (4%) did not match any code themes. We sorted a total of thirty-two themes essential to characterize the clinical experiences during EM rotation into two categories. Twenty-six were clinically relevant to professional development, with an overall code frequency distribution of 74%. (Figure 1) We further classified the coded themes based on the six ACGME competency domains in the professional development category. Patient care was the domain with the most frequently coded competency themes (33%), followed by system-based practice (25%), and interpersonal and communication skills (19%). (Figure 2) Among the patient care domain, ACGME competency most salient to PGY1, decision-making was the most frequently coded theme (39%).
Of the emotional issue category, we identified six codes with the coding frequency distribution of 26%. The three most common codes were senses of growth and improvement (27%), followed by pressure at the workplace (26%), and on-the-spot-feedback (19%). (Figure 3) We noted that two of the most common codes occupied the fourth and fifth positions in overall frequency counts. (Figure 4) This finding indicated that a hard and stressful EM rotation could be a rewarding learning experience.
Quantitative and qualitative analysis of comments on three survey questions
The analysis revealed thirty-one codes from the responses to the first question, "What were the most valuable lessons you learned from EM rotation?", twenty-six of them were relevant to professional development. Five belonged to the emotional issue category. Three most valuable lessons learned were decision-making (n=70), team and patient communication (n=59), and prioritize tasks (n=48). No themes from the emotional issue category entered the top ten list. (Table 1)
Table 1. Ten most valuable lessons perceived by PGY1 physicians.
Theme
|
number of Trainees
(n=201)
|
Importance rank-order*
|
Overall coding frequency rank-order
|
Decision-making
|
70
|
1
|
1
|
Team & patient communication
|
59
|
2
|
3
|
Prioritize tasks
|
48
|
3
|
7
|
Time management
|
47
|
4
|
2
|
Differential diagnosis
|
40
|
5
|
5
|
Critical thinking
|
34
|
6
|
6
|
Effective communication
|
32
|
7
|
9
|
Patient evaluation
|
29
|
8
|
8
|
Handover
|
17
|
9
|
4
|
Disposition
|
14
|
10
|
13
|
*Importance rank-order was established based on the number of PGY1 physicians who expressed priority for each theme in question one.
Furthermore, three out of the ten most important lessons, their coding frequency ranks, were in the same order as the priority list. PGY1 physicians perceived decision-making as the most valuable theme, consistent with the most frequently coded theme in the patient care domain. Of coding frequency distribution, the themes in the professional development category were dominant, with 94%.
Of the dataset from responses to the second question," What were the differences between your anticipated and actual learning experiences in EM rotation?", fifty PGY1 physicians (25%) reported no difference existed for the anticipated and actual rotation experiences, eleven (6%) reported exceeding expectations with valuable experiences, and nine (5%) reported experiences less useful. Although only seventy trainees (36%) answered directly to the question with comparative description, most of them seized the opportunity to elaborate on other themes in the responses. There were 23 themes recognized in the professional development category, and the coding frequency distribution in this category was 59%, less dominant compared to the result of the first question, and no themes from this category entered the top three most frequently coded list. We identified six themes in the emotional issue category, and the three most frequently coded themes were patient volume pressure (n=41), followed by pressure at the workplace (n=30), and senses of growth and improvement (n=30).
Complex ER environment contributes to various forms of pressure like patient visit volume pressure, workplace pressure, or peer pressure. We have frequently noticed the concern of pressure relevant to the rotation from the trainees during our orientation, and some PGY1 physicians were anxious about this issue on their first day. Nevertheless, the tone of that pressure switched from a negative emotion to a motivation later in the review session. It is worth noting that the number of PGY1 physicians felt less useful regarding their clinical experiences did not match closely to the total frequency of the pressure themes in the emotional issue category. This result may suggest that PGY1 physicians perceived pressure as acceptable and could manage it as a driving force to work and learn during rotation.
There were thirty themes identified to the third question" Any afterthoughts regarding your EM rotation experience?". The three most common themes were senses of growth and improvement (n=58), followed by pressure at the workplace (n=48), and two themes tied in third place, on-the-spot-feedback (n=37), and handover (n=37). The emotional issue category dominated the most frequently coded list but had less overall frequency distribution of 41%. The data from the response of this question may suggest a productive and positive role of EM rotation for undifferentiated physicians in the PGY1 program and the valuable lessons identified by the trainees were the evidence supported the role.