Did I answer your question? Attending physicians' recognition of residents' perceived learning needs in ambulatory settings

Accurately recognizing the learning goals of trainees should enhance teache rs' effectiveness. We sought to determine how commonly such recognition occ urs and whether it improves residents' satisfaction with the teaching inter action. In a cross-sectional survey of 97 internal medicine residents and 4 2 ambulatory clinic preceptors in five ambulatory care clinics in Washingto n and Oregon, we systematically sampled 236 dyadic teaching interactions. E ach dyed participant independently indicated the residents' perceived learn ing needs from a standardized list. Overall, the preceptors' recognition of the residents' learning needs, as measured by percentage of agreement betw een preceptors and residents on the learning topics, was modest (kappa 0.21 , p =.02). The percentage of agreement for all topics was 43%, ranging from 8% to 66%, Greater time pressures were associates with lower agreement (38 % vs 56% for the highest and lowest strata of resident-reported time pressu re; 15% vs 43% for highest and lowest strata of preceptor-reported time pre ssure). Agreement increased as the number of sessions the pair held worked together increased (62% for palm with >20 vs 17%, for pairs with 0 previous sessions). Satisfaction with teaching encounters was high (4.5 on a 8-poin t scale) and unrelated to the degree of agreement (p = .92). These findings suggest that faculty development programs should emphasize precepting skip s in recognizing residents' perceived learning needs and that resident clin ics should be redesigned to maximize preceptor-resident continuity and mini mize time presure.