Workplace affordances and learning engagement in a Thai paediatric intensive care unit

Background: Workplace learning in critical care settings is complex and challenging. Research has explored learner-, teacher-, and context-related factors that influence medical residents' engagement in critical care workplaces in Western but not in non-Western cultures. This limits our understanding of workplace learning globally and how we can better support resident learning in diverse cultures.

Objective: To explore how paediatric residents engage in workplace learning in a Thai Paediatric Intensive Care Unit (PICU) and how this culturally situated workplace shapes their learning.

Methods: In this qualitative study, we recruited paediatric residents (n = 16) from a tertiary care hospital in Thailand for semi-structured interviews. We used reflexive thematic analysis to describe, analyse and interpret residents' experiences of workplace learning, and to capitalise on our own experience as an analytic resource.

Results: We constructed three themes to represent participants' narratives: PICU cases and context as dynamic affordances; impact of psychological safety; and the role of attending physicians. While Thai PICU cases and context could afford participation and thus learning, Thailand's collectivist culture, which prioritises group needs over individual needs, contributed to a sense of psychological safety within culturally-endorsed, professional and social hierarchies, and set the stage for workplace learning. Despite their higher status in these hierarchies, attending physicians facilitated resident learning by fostering open dialogue, joint problem-solving and a low-stress atmosphere.

Conclusions: Workplace learning in a Thai PICU while challenging, is uniquely facilitated by Thailand's collectivist culture that fosters psychological safety and attending physicians' invitation in, and learn from, the workplace optimises learning.