Building bridges in the emergency room: educational alliances between junior residents and attending physicians

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Introduction: Emergency rooms (ERs) offer valuable learning opportunities for junior residents, yet the time constraints and complexity of interprofessional collaboration often hinder the development of strong educational relationships with attending physicians. This study aimed to explore how junior residents perceive and build educational alliances with attending physicians during a short-term ER rotation, using the framework of the "educational alliance" (EA). Methods: We conducted semi-structured interviews with fourteen junior residents who completed a two-month ER rotation at an emergency center in Japan. Thematic analysis was applied using an inductive approach, guided by the three core components of the EA: shared goals, agreement on strategies, and development of mutual trust. Results: Nine themes emerged, which aligned with the three core EA components. Residents actively explored and shared their learning goals through both formal discussions and informal interactions with attendings, adjusting them as needed. While struggling with variations in clinical teaching strategies among attendings, residents developed their own styles through reflection and adaptation. Conversely, some residents experienced diminished autonomy due to unilateral instruction or felt conflicted between patient safety and educational challenges. Trust and appreciation toward attendings were formed progressively and were based on their attitudes, communication, and clinical judgment, contributing to psychological safety and deeper engagement. Conclusion: Despite time constraints, junior residents can gradually build educational alliances with attending physicians during short-term ER training. The quality of attending physicians' engagement plays a critical role in supporting residents' learning and relational development in fast-paced clinical settings.

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