Abstract for: Residency Program Cultures: Dynamic Interactions Shape Learning Outcomes

Physician trainees face many challenges throughout their training in residency programs. This paper calls attention to how a trainee's progress is impacted by interactions with the learning environment created by their attending physician faculty and interprofessional colleagues, such as nurses and other healthcare workers. These interactions are more powerful than we realize. The paper uses simulation analysis to show how influential these forces can be on a trainee’s long-term training and performance trajectory. We develop a system dynamics model to highlight the complex and often invisible interactions between trainee and learning environment. We propose a causal loop diagram, grounded in descriptions of actual trainee experiences in several residency and fellowship programs from multiple connected large academic institutions, and build a simulating model that highlights the costs and consequences of vicious reinforcing cycles that may propagate the underperforming trainee’s vulnerabilities. Simulation analysis demonstrates that even talented and diligent trainees can succumb to dysfunctional cultures in a system that exhibits tipping points distinguishing improving and worsening trajectories of performance.