Excellence in inter-provider communication is an essential component of providing high-quality care to hospitalized pediatric patients. Concerted efforts to improve this communication—for example, through the use of standardized communication tools—have demonstrated resultant reduction in patient harm and an increase in workflow efficiency, physician preparedness, and subjective quality of transfers.1, 2, 3, 4, 5, 6, 7

There has been increasing interest in the resident-fellow interaction in existing communication literature, with a particular focus on inpatient consultation requests.8, 9, 10, 11, 12 Several strategies for increasing engagement and reducing mistrust between fellows and residents have been identified.13 A previously unstudied point of contact between pediatric residents and fellows is the new admission interaction, when trainees admit a patient together. On its face this interaction impacts patient safety due to anchoring bias, when providers remain “stuck” on an initial diagnosis or clinical narrative despite future contradictory evidence.14, 15 New admissions also offer an important learning opportunity for trainees, which is consistent with Kolb’s experiential learning theory or “learning by doing.”16 A recent qualitative study of effective fellow supervision of residents emphasized the importance of this near-peer learning relationship.17 In addition, we wondered if effective new admission interactions may enhance feelings of autonomy, competence, and relatedness amongst trainees. This triad, as is stated in self-determination theory, is important for feeling intrinsically motivated—fostering such motivation (and thereby avoiding disengagement) in trainees may help them optimally care for patients and learn from one another.18, 19, 20, 21

Our study aimed to elicit qualities of new admission interactions that residents and fellows deemed to be motivating; explore common “bright spots” and “pain points” residents and fellows experience during this interaction; and to identify behaviors necessary for an optimal new admission interaction.