It is the Unknown That Matters: Program Directors’ Perspectives on Information Gaps in Learner Educational Handovers

PURPOSE: The transition to residency is challenging. Educators often believe they could have been greater help if they knew more about trainees before trainee arrival. Thus, many educators have championed use of learner educational handovers. Unfortunately, success has varied, and the literature offers little regarding the cause of misalignment between trainees' needs and educational supports. To redress this issue, the authors explored program directors' (PDs') experiences with struggling residents and information that might have helped. METHOD: The authors used constructivist grounded theory within an interpretivist paradigm. In 2023, they conducted virtual semistructured interviews with PDs from multiple institutions in the Western United States purposively selected to represent family and internal medicine, obstetrics and gynecology, pediatrics, and surgery. The authors elicited 2 specific narratives in which PDs anticipated new residents might struggle and were surprised by residents' struggles. Thematic analysis was used with constant comparison to interpret narratives. RESULTS: Nineteen PDs provided 38 narratives that encapsulated the notion of residents' difficulty adapting to workplaces. To understand struggles, participants looked for clues in applications but had difficulty interpreting available information. Unknown but desired information was common. It was perceived, given system constraints, to be currently unknown (potentially knowable but not routinely gathered by undergraduate programs) or currently unknowable (aspects of performance that may not be detectable until one enters residency). CONCLUSIONS: The findings suggest a novel conceptual model that indicates ways in which information that is ambiguous or currently unknown to postgraduate training programs could be made more accessible. Innovation, however, will be required to determine whether information that is currently deemed unknowable to undergraduate programs can be generated. Such efforts must take into account that PDs consider it difficult to anticipate which residents will struggle in many circumstances, indicating that efforts to implement learner education handovers will need to be systematic.