title: Learning clinical versus leadership competencies in the emergency department: strategies, challenges, and supports of emergency medicine residents.
abstract: BACKGROUND
  Emergency medicine residents are expected to master 6 competencies that include clinical and leadership skills. To date, studies have focused primarily on teaching strategies, for example, what attending physicians should do to help residents learn. Residents' own contributions to the learning process remain largely unexplored. The purpose of this study was to explore what emergency medicine residents believe helps them learn the skills required for practice in the emergency department.
  
  
  METHODS
  This qualitative study used semistructured interviews with emergency medicine residents at a major academic medical center. Twelve residents participated, and 11 additional residents formed a validation group. We used phenomenologic techniques to guide the data analysis and techniques such as triangulation and member checks to ensure the validity of the findings.
  
  
  RESULTS
  We found major differences in the strategies residents used to learn clinical versus leadership skills. Clinical skill learning was approached with rigor and involved a large number of other physicians, while leadership skill learning was unplanned and largely relied on nursing personnel. In addition, with each type of skills, different aspects of the residents' personalities, motivation, and past nonclinical experiences supported or challenged their learning process.
  
  
  CONCLUSIONS
  The approaches to learning leadership skills are not well developed among emergency medicine residents and result in a narrow perspective on leadership. This may be because of the lack of formal leadership training in medical school and residency, or it may reflect assumptions regarding how leadership skills develop. Substantial opportunity exists for enhancing emergency medicine residents' learning of leadership skills as well as the teaching of these skills by the attending physicians and nurses who facilitate their learning.
authors.forename: Ellen F
authors.initials: EF
authors.lastname: Goldman
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Plack
authors.forename: Colleen N
authors.initials: CN
authors.lastname: Roche
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Smith
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Turley