“Learning Happens When Thinking Is Shared”: A Qualitative Exploration of Resident-Fellow Relationships on Inpatient Pulmonary Specialist Teams

BACKGROUND: Inpatient specialist teams present opportunities for clinical learning and professional development. These teams are comprised of both residents and fellows that work together to provide comprehensive patient care. Despite the complexity of these roles, dedicated focus on understanding perceptions of the resident-fellow relationship remains limited. Surgical and pediatric literature has demonstrated the variable impacts of fellows on inpatient teams; however limited data exists on the nature of the resident-fellow relationship in the context of pulmonary specialist teams. Understanding perceptions of these relationships may assist in clarifying expectations and roles and in optimizing learning experiences. OBJECTIVES: We aimed to understand resident perceptions of fellows and fellow perceptions of residents within the inpatient pulmonary specialist team. By doing so, we hope to understand the perceptions of joint team dynamics and collaborative qualities within these supervisory relationships. METHODS: We conducted virtual, individual, qualitative, semi-structured interviews of learners at a single academic health system. Pulmonary critical care fellows (n = 10) and internal medicine residents (n = 10) were included. Responses were transcribed, compiled, and coded thematically to identify perceived characteristics of near-peer relationships and shared stressors. RESULTS: From the fellow perspective, five qualities were identified when describing collaborative residents on inpatient specialist teams: engaged, intellectually curious, accountable, proactive, and independent thinkers. From resident interviews, four recurring characteristics emerged describing fellow counterparts: proactive communication, availability/accessibility, mutual respect, and ability to provide coaching/guidance. Fellow-to-resident feedback was viewed as mutually beneficial but infrequently practiced (requested or received). Both learner types (resident and fellow) described overlapping challenges in the resident-fellow relationship including unclear expectations, unpredictable workload, undefined student roles, and inconsistent feedback. CONCLUSION: Our findings suggest that both residents and fellows value specific behaviors from each other on inpatient pulmonary specialist teams. Both learner types have unique perceptions, and shared stressors that may be utilized to optimize the learning environment.