Theme	Subtheme	Enablers	Challenges
Dual learning path	Workplace learning	Being actively involved in performing various aspects of the job	Too little training time with an imbalance between working, and learning or teaching
			Not experiencing an educational culture
	MSM curriculum	Regularly organized courses	Frequency is highly variable
		Virtually available courses	Too little choice in offered courses
		Physically organized courses	Lacking structure in offered courses
		Courses compliant with daily clinical practice	Many distractions during physical courses
		Discipline-specific exam	The imbalance between courses given by peers and by experienced professionals
			Insufficient training in technical skills
			Insufficient training in transferable skills
			The MSM curriculum is perceived as separated on top of WPL
			Clearly defined training objectives not available or being unclear
			Preparation for the discipline-specific exam
Feedback	Frequency and timing	Systematic and scheduled feedback	Feedback being given far later than the learning experience or event
			No feedback is given at all
			Feedback fatigue due to high resident turnover
			Opposing perceptions between residents and supervisors about the quantity of feedback
			Opposing perceptions between residents and supervisors’ responsibility for initiating feedback.
	Quality	Mentioning points of improvement during feedback	Lacking positive enforcement
			Poor quality of feedback
	Two-way feedback	Supervisors wanting feedback about themselves	Residents finding few opportunities to provide supervisors with feedback
Learning support	Residents’ self-directed learning	Self-reflection included in assignments and ePortfolio	Self-reflection is complicated by lack of external input
		Research and self-study are useful	Little guidance with self-study
		Self-directed learning attitude is perceived as important	Insufficient time for self-study
			Self-directed learning skills are not mastered by all residents
			Supervisors are in need of information on how to provide proper guidance to master self-directed learning skills
	Supervisors’ guidance	Encouraging supervisors who ask questions, provide opportunity to safely fail with proper feedback, share clinical reasoning, share knowledge	Wide variation in perception regarding educational competencies of supervisors
		Supervisors being easily accessible	Solely receiving brief advice when asking for help
		Residents being considered as colleagues	A strict hierarchical structure between residents and supervisors
		Direct observation of residents	Insufficient opportunities for direct observation
		Progressively becoming more independent in a safe learning environment	Bearing inappropriate amount of responsibility (too much or too little)
			Lack of protected time for educational activities by supervisors
	ePortfolio support	ePortfolio stimulates learning conversations	ePortfolio mainly considered a logbook instead of a tool to support the learning process

Int J Med Educ. 2023; 14:65-74; doi: 10.5116/ijme.6470.d9ed