Learner Influence on Pediatric Patient Experience: Exploring Family Members’ Perspectives

University of Nebraska Medical Center

Background: The patient experience in pediatric settings is influenced by complex interactions between the patient, parent/guardian, learners, and providers. This study aimed to understand the influence of healthcare learners on care satisfaction in pediatric settings using patient experience feedback from family members. Methods: NRC Health “Feedback Management” data from a regional Children’s hospital was collected from August 1st, 2020 to August 31st, 2023 using key identifiers related to learners (e.g. “Student,” “Resident,” “Trainee,” “Learner,” “Fellow”). Each viable survey underwent reflexive thematic analysis by two independent reviewers. Additionally, two investigators independently assigned values to each comment regarding both the learner and overall interactions using a three-point scale (3=positive, 2=neutral, 1=negative). Inter-rater reliability was 0.983 for learner-specific comments and 0.970 for overall experience comments. Strongly positive and strongly negative remarks of the learner interaction were isolated and evaluated. Results: The dataset consisted of 302 eligible narrative comments from patients/parents that included one or more keywords. The average rating was 2.273/3 for learner interactions and 2.199/3 for overall interactions. The reflexive thematic analysis generated 24 primary themes and 21 subthemes that were grouped under five overarching categories of learner-specific patient care experience: Communication, Learner Effects, Rapport, Care Delivery, and Competency. Feedback involving positive interactions focused on recognition of the learner, positive rapport building, and effective information explanation. Feedback involving negative learner interactions emphasized task repetition, lack of communication, poor bedside manner, and increased visit time. Conclusions: Learners fill an important role on the pediatric medical team through experiential learning. This study shows that the presence and involvement of learners can influence pediatric care satisfaction, both positively and negatively. The resulting themes from family member narratives emphasize relevant clinical learning environmental factors that impact perceptions of the pediatric care experience.