Dataset Information

A story half told: a qualitative study of medical students' self-directed learning in the clinical setting.

ABSTRACT:

Background

Medical educators have promoted self-directed learning (SDL) as an important means of enabling students to take responsibility for their own learning throughout their training and practice. While SDL has been well-studied in classroom settings, it remains a story half told: barriers to and facilitators of SDL in the clinical setting are not yet well described. The goals of this study were to explicate student experiences of SDL in their clinical training and to identify the roles that local social and cultural contexts play in shaping their experiences of SDL.

Methods

To understand students' conceptualization and experiences of SDL in the clinical setting, we carried out a qualitative study with 15 medical students at Harvard Medical School. The semi-structured interviews were recorded and transcribed. Using an interpretivist approach, data were analyzed both deductively and inductively using the Framework method of content analysis.

Results

Participants described patient care activities as primary motivators for engagement in SDL in the clinical setting. Participants' descriptions of SDL aligned with Knowles' steps in SDL, with an additional step of consolidation of learning related to their patients' diagnosis and management. Participants described using a range of cognitive, social-emotional, and peer learning strategies to enhance their SDL. Participants who described a growth mindset appeared to engage in SDL more easily. Learning environments that fostered SDL were those in which faculty and residents demonstrated an educational orientation, promoted psychological safety, and invited student engagement. Teams with perceived excessive work demands were perceived to be less supportive of SDL.

Conclusions

Our study enhances previous classroom-based models of SDL by providing specific, practical implications for both students and faculty in the clinical training setting. Participants described SDL in the clinical setting as patient-centered, and when effectively implemented, SDL appears to support a mastery rather than performance orientation. Our study paves the way for improving medical students' clinical SDL and helping them become lifelong learners in the field of medicine.

SUBMITTER: Liu TH

PROVIDER: S-EPMC8444548 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Experiential learning plays a critical role in learner development. Kolb's 4-part experiential learning model consists of concrete experience, reflective observation, abstract conceptualization, and active experimentation in a recurring cycle. Most clinical environments provide opportunities for experiences and active experimentation but rarely offer structured means for reflection and abstract conceptualization that are crucial for learners to learn through experience. We created Learning Moment, a novel Web-based educational tool that integrates principles of asynchronous learning and learning portfolios to fulfill the reflection and abstract conceptualization aspects of Kolb's learning cycle in the modern clinical learning environment. Medical students log concise clinical "pearls" in the form of "learning moments" for reflection, review, and sharing with peers in a community of practice. OBJECTIVE:We sought to evaluate learners' experiences with Learning Moment via a qualitative study. METHODS:We employed purposive sampling to recruit medical students who used Learning Moment during their rotation. We conducted 13 semistructured interviews (10 individual interviews and one 3-person group interview) between January and March 2017 using an ethnographic approach and utilized a general inductive method to analyze and code for potential themes. RESULTS:A total of 13 students (five in their third year of medical school and eight in their fourth year) voluntarily participated in our qualitative interviews. Five of the 13 (38%) students intended to pursue emergency medicine as their chosen field of specialty. The median number of "learning moments" logged by these students is 6. From our analysis, three key themes emerged relating to the perceived impact of Learning Moment on student learning: (1) logging "learning moments" enhanced memorization, (2) improved learning through reflection, and (3) sharing of knowledge and experiences in a community of practice. CONCLUSIONS:Learning Moment was successfully implemented into the educational infrastructure in our department. Students identified three mechanisms by which the application optimizes experiential learning, including enabling the logging of "learning moments" to promote memorization, encouraging reflection to facilitate learning, and fostering the sharing of knowledge and experiences within a community of practice. The Learning Moment concept is potentially scalable to other departments, disciplines, and institutions as we seek to optimize experiential learning ecosystems for all trainees.

Project description:PurposeOne of the aims of medical education is to generate lifelong learners, leading to the identification of self-directed learning (SDL) as an essential component of medical education. While SDL is focused on an individual learner, collaboration is critically important in medicine. We developed an online course using the collaborative SDL (CSDL) framework. A goal for the course was for students to gain a better appreciation for the SDL process by exploring the COVID-19 pandemic.MethodsWe utilized CSDL to implement a 2-week elective attended by fifteen M3 and M4 medical students. Students submitted short videos reflecting on their course experience and the relevance of the material to their future training. Qualitative analysis of reflections was conducted to determine the effectiveness of the CSDL framework, and an assessment of the course evaluations was performed to explore student perceptions of the course and its effectiveness at preparing them for practice. A survey regarding student perceptions of SDL was offered to M3 and M4 students in order to explore their experiences with SDL and perceptions of its importance in the context of the school curriculum.ResultsThe CSDL framework was effective in making students aware of the importance of SDL in medical practice. Students gained basic and clinical knowledge about the subject, experienced increased confidence, and appreciated collaborating with their peers. The survey offered to the general student body reflected that all students perceived that they employed SDL in their time as medical students. However, many students indicated that they had not utilized components of SDL beyond synthesizing and assessing their learning needs.ConclusionCSDL is an effective method for promoting self-directed learning. Undergraduate medical course constructs utilizing CSDL will benefit students as they continue their career development.Supplementary informationThe online version contains supplementary material available at 10.1007/s40670-021-01493-7.