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Rotational Learning Plans Help Residents Focus Their Goals

Posted on Nov 16, 2017


Goal setting can be a difficult task for anyone, however, it is a necessary skill–especially for pediatric medical residents. Although it is essential, currently there are few standardized tools to help trainees with meaningful goal setting.

So how exactly do you help residents become more skilled at the task? The leaders of the Johns Hopkins All Children’s Hospital Pediatric Residency Program had an idea: have residents develop goals for each experience in their rotation.

“It is a different approach to goal setting that very few programs do. Most programs will have residents set goals for the year,” explains Raquel Hernandez, M.D., M.P.H., director of medical education at Johns Hopkins All Children’s Hospital and assistant professor of pediatrics at the Johns Hopkins University School of Medicine. The rotational learning plan (RLP) process was developed and implemented in collaboration with Akshata Hopkins, M.D., assistant director of the residency program as well as Kimberly Collins, M.D., co-director of pediatric residency inpatient experience.

A common pitfall of goals set for the entire year is their tendency to be very broad and generic. As a result of their generalized nature, it can be difficult to keep these goals connected with the day-to-day.

Enter the RLP. With this tool, residents develop “SMART” (specific, measurable, accountable, realistic, timely) goals based around the required competencies for each block of their rotation. This framework allows for individual tailoring to meet each resident’s career path and connect directly to the way they care for patients every day.

“We strive to make each rotation more than just a generic experience. The RLP lets residents set unique goals specific to the skills and knowledge base that they will need in order to excel at their individual future careers,” Collins reflects.

Additionally, a key part in the RLP process is faculty guidance. Each resident meets with a faculty member at the start of each rotation to review and revise the goals, ensuring they are realistic and appropriate. If goals are too vague, faculty has the opportunity to challenge residents to make them “SMARTER.” It is a reciprocal relationship that ultimately benefits the patients, allowing for open dialogue on the many aspects of providing care.

“Opening this conversation helps engage our committed faculty and residents to best individualize their experience and therefore truly reinforce our education-driven mission. For one resident, the gastroenterology elective may be used to explore and gain procedural and scholarship experiences in preparation for fellowship. For another, this elective provides insight on when an outpatient pediatrician should make the referral. They both will get the core content but with their own unique spin thanks to the RLP,” Hopkins adds.

The entire process of the rotational learning plan is unique to the pediatric residency program at Johns Hopkins All Children’s. Everything from the RLP template to the language used is a hallmark of the program and its investment in the individual. However, because it is a new concept, implementation itself was a challenging process requiring the full commitment of residents and faculty.

Preliminary data shows it was a clear success. Of the 345 RLPs developed by 35 residents, 76 percent were actually completed. From those that were completed, 74 percent had documented faculty comments and 72 percent had resident revisions based on feedback.

Moving forward the rotational learning plan process will continue to be monitored, but the initial results are promising.

“We’ve been successful in implementing it and that’s why we’re excited about it,” Hernandez says. “We see it continuing in the future.”

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