Table 2 Themes related to learning processes in interviews with 29 residents

38 (29)

 Lack of medical competencies and confidence

I may have my own method of thinking when encountering common diseases. However, for complex cases, such as when patients have comorbidities, I’m inadequately equipped to treat and prescribe medicines to them (S6).

21 (18)

 Communication and language barriers

When I first came here, because I barely interacted with [patients] and was completely inexperienced, whenever [patients] saw me, they read my name tag and asked if I was a resident. At first, they did not trust me…For example, in a task as simple as history taking, when I had just begun my residency, I used to stutter when asking a patient about their medical history. It did not go well (S23).

24 (19)

Because I am not from Guangdong, I do not speak Cantonese…It was difficult to ask [the patients] precise questions (S28).

 Distrust in residents: Patients and their family members

[Patients] doubted us and asked us questions repeatedly, probably because [residents] look young. Sometimes, they asked us difficult questions that we were unable or not allowed to answer. We would then tell them that we must ask our superior. In such instances, they did not want to ask us any more questions but preferred to ask our teacher questions directly because they did not trust us (S26).

20 (17)

 Distrust in residents: Members of the medical team

People do not trust younger doctors. Even nurses do not trust us (S21).

7 (6)

 Fulfillment from learning experiences

[I] wanted to be a doctor to cure patients…We can diagnose and treat simple common diseases by ourselves. Sending patients home after they are cured is fulfilling (S12).

1 (1)

Reflection on learning experiences

[I] feel that there is still a lot to learn…Medicine is about accumulating experience…The greater the number and variety of cases you handle, the more experience you gain (S22).

18 (17)

49 (29)

  Large-group teaching

A broad range of knowledge is taught in large classroom settings (S27).

6 (5)

  Small-group teaching

Because [teachers] use cases of actual patients, such as the cause of the onset of a patient’s disease, I believe that this approach not only helps us learn but also provides us with an in-depth look at clinical examples. I am receptive to this particular type of learning (S18).

14 (10)

  Bedside teaching (physicians)

This patient is your patient. You can have face-to-face interactions with them. You can completely understand the disease from diagnosis to treatment. If you do not understand something, you can read texts and ask your teacher questions. In this manner, you obtain greater understanding of the disease (S8).

17 (10)

In bedside teaching, the director leads all the doctors in the department around the ward and selects specific patients so they can explain difficult cases. The director asks us challenging questions that require discussion. The next step is diagnosis and treatment. The director encourages us to broaden our thinking. After completing a round, we return to the conference room and review the patients’ information. The director asks us questions individually and discusses cases with us, enabling us to develop our diagnostic thinking (S2).

  Bedside teaching (nonphysicians)

Patients sometimes believe that nurses are better than doctors. I believe that I can learn some communication skills from [nurses]… [Nurses] are more considerate than others. They pay more attention to patients’ problems than we do, and patients recognize that they care about them (S18).

10 (9)

Pharmacists might know more about medications than we do. We can ask them for tips, interact with them, or question why their approach is preferable to ours. This process represents the process of learning (S29).

  Effective teaching methods in skills training and competitions

A clinical skills competition is organized every year…It is a way of rewarding us in our training program and makes us more eager [to acquire skills] (S12).

2 (2)

17 (10)

  Large-group teaching

Some of the knowledge imparted is a bit too complex for me to understand (S3).

11 (8)

Sometimes, teachers are overly focused on the data in a paper, which is not exactly useful for novices like us…Those who focus excessively on statistics or big data probably do not know us well yet (S12).

  Small-group teaching

A rule states that we must attend study class [small-group learning] every week. Some departments are very busy, and no one has the time to attend these classes… I believe that [small-class learning] is quite tiring (S16).

6 (3)

  Bedside teaching

N/A

0 (0)

48 (29)

  Large-group teaching

Some teachers are skilled at lecturing eloquently and give us examples of the types of diseases observed in a department (S19).

9 (4)

A good teacher teaches you how to think and solve problems rather than teaching by the book and never teaching you to think for yourself (S21).

  Small-group teaching

[Teachers] incorporate case studies and detail the disease diagnosis, the cause of onset, clinical symptoms, physical examinations, and disease-specific examinations…diagnostic thinking, subsequent treatment plans for this medical case, the next disease, and a preliminary understanding of the recovery process (S7).

12 (5)

  Bedside teaching

[Teachers] lead you around the department to observe patients and inform you about the general diagnosis of a disease. They also talk about treatment plans. They might give you a demonstration or ask you to read books and then allow you to work under their supervision (S13).

37 (25)

[Teachers] allow you to work on your own. For instance, they allow you to do everything, including holding patient consultations, performing work-ups, and reviewing the literature, and then they explain everything to you later (S14).

My senior colleagues really care about us. If they see that we are exhausted from overtime, are planning to leave, or are tired from seeing patients, they ask us to join them for dinner, relax a bit, or sing karaoke. It feels good. If we do not understand certain things in practice, they are always there to help us. If we feel that a patient did not respond well to treatment, they step in and assist us (S12).

37 (15)

  Large-group teaching

The unpreferred teachers are those who teach in public theory classes [large classroom setting]…some of them appear to be in a hurry. They speak very quickly and do not often interact with us. They do not even know if we understand them in class; they just talk, talk, talk (S15).

9 (5)

  Small-group teaching

Communicating [with an unpreferred teacher] is difficult if they teach in a different department or are not my teacher (S11).

1 (1)

  Bedside teaching

Sometimes, I feel that we go through training to learn; however, when a teacher dislikes teaching us, I feel frustrated and less passionate about learning (S14).

27 (12)

Because I do most things, [teachers] sometimes check what I have done. When experiencing difficulties and feeling uncertain about a physical examination, if the teachers do not double-check things, I feel insecure (S23).

103 (29)

 Incompetency in the present stage and reasons for this incompetency

Mentally, I am satisfied; however, I lack certain competencies in practice. Because we are very busy at work—I’m not saying that only we are busy, the entire medical system is backed up—we want some time off to take a break. Mentally, we really want to [improve our competencies]; however, our physical performance cannot keep pace with our mental performance and we therefore slack off a bit (S12).

6 (5)

 Competencies to be improved at the present stage

My diagnostic skills are still developing. With regard to my communication skills, I am definitely not careful enough when managing patients with serious conditions (S1).

21(16)

[I] must improve my theoretical knowledge and skills…because I wish to specialize in intensive care (S29).

 Future learning directions

The most important aspect is diagnostic skills…which require theoretical learning and clinical practice. The more you observe, the more confident you are in making a preliminary diagnosis of a disease. For example, our director conducting ward rounds can accurately identify a disease as soon as he observes the [test] results (S12).

27 (15)

I feel that English is a major weakness of mine. Although I am somewhat proficient [in English], I would like to access more up-to-date information…What I mean by “science and research competency” is not studying various topics but having the ability to obtain up-to-date knowledge (S5).

 Future learning methods

First, I must find a good clinical learning environment. Therefore, I must find a hospital where I can be exposed to numerous cases of various types. I must use this environment as a platform to improve myself. Second, [I must] continually improve my learning [method]…I will examine the relevant forums that I mentioned earlier and read books (S14).

15 (7)

I will attempt to learn and read more, watch videos, and search for information online…I will search for information online and learn from senior doctors with many years of experience (S13).

 Future career planning

To be honest, at one time, I thought about teaching and not becoming a doctor…[I] had this idea of pursuing a teaching career directly after my residency. In practice, some tasks are not what I imagined and not exactly what I wish to do (S4).

7 (5)

 Improvements to education systems

Each department should prepare us before we begin training with them and inform us about the diseases most commonly observed in admitted patients. Because each department has a specialization, especially in the current era of classifying specialties to the smallest detail, as soon as we begin training in a department, we should focus our attention on the commonly observed diseases (S12).

27 (19)