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Med Educ. 2012 Dec;46(12):1189-93. doi: 10.1111/medu.12014.

Changes in residents' opportunities for experiential learning over time.

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Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada.



Learning in the clinical environment is believed to be a crucial component of residency training. However, it remains unclear whether recent changes to postgraduate medical education, including the implementation of work hour limitations, have significantly impacted opportunities for experiential learning. Therefore, we sought to quantify opportunities to gain clinical experience within medical-surgical intensive care units (ICUs) over time.


Data on the numbers of patients admitted and invasive procedures performed per day between 1 July 2001 and 30 June 2010 within three academic medical-surgical ICUs in Calgary, Alberta, Canada were obtained from electronic medical records. These data were matched to resident doctor on-call schedules and residents' opportunities to admit patients and participate in procedures were calculated and compared over time using Spearman's rho.


We found that over a 9-year period, the opportunities afforded to residents (n = 1156) to admit patients (n = 17 189) and perform procedures (n = 52 827) during ICU rotations decreased by 32% (p < 0.001) and 34% (p < 0.001), respectively.


Our results suggest that there has been a significant decrease in residents' clinical experiences in the ICU over time. Further investigations to better understand these changes and how they may impact on performance as residents become independent practising doctors are warranted.

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