Needed competence for registered nurses working at a patient-centred telehealth service aimed to engage and empower people living with COPD: A five-month participatory observational study.

BACKGROUND: The global population of older aged 65 and over is increasing, which means an increase in people living with long-term health conditions and multimorbidity. Implementing new digital health technologies enables increased patient empowerment and responsibility, and the ability to respond to changes in their condition themselves, with less involvement of healthcare professionals. Important parameters need to be addressed for this digitally enabled empowerment to be successful, these include increased individual and organizational health literacy, the establishment of joint decision-making activities among patients and healthcare professionals, and efforts that target the individual's ability to manage their condition, which include education to increase skills and providing technology for self-monitoring. OBJECTIVE: To identify needed competencies of digital healthcare professionals to be able to provide the needed services to service users with chronic obstructive pulmonary disease in a 24/7 digital healthcare service. METHOD: Five registered nurses' work was observed weekly for five months. In total 13 participatory observations were conducted. Data from the observations was transcribed and analysed through inductive content analysis. RESULTS: Five main categories were identified in the analysis; 1) tasks, 2) communication, 3) the relationships between the registered nurses, 4) service users, and 5) technology. These categories contain different competencies needed for registered nurses working in a digitalized healthcare system. CONCLUSIONS: Future digital healthcare professionals will require several competencies, to be able to deliver proper care in a digital health community that goes beyond traditional healthcare competencies, including social, technological, and communication skills.

How do mandatory emergency medicine rotations contribute to the junior residents' professional identity formation: a qualitative study.

BACKGROUND: This study aims to investigate the impact of short-term mandatory emergency medicine rotations on professional identity formation of Japanese junior residents. Using situated learning theory as a theoretical framework, we explore how this rotation, which is part of a two-year Junior residency in the transition period from students to qualified physicians. METHODS: We conducted a qualitative study conducting semi-structured face-to-face interviews with Year 1 postgraduate residents in the 2020-2021 classes of the junior residency program in Okinawa Chubu Hospital, Japan (n = 10). The data obtained from the interviews were analysed using inductive thematic analysis to identify the themes regarding professional identity formation. RESULTS: Four main themes regarding professional identity formation emerged from the data analysis: patient care, teamwork, role models, and peers. Junior residents said they had the opportunity to participate in the emergency department community and experience training in authentic clinical contexts. Clinical exposure influenced the professional identity formation of the junior residents. Nurses and peers played a crucial role in this. Junior residents see the training in the emergency department as the beginning of their careers. CONCLUSION: Short-term mandatory rotations enabled junior residents to integrate into the emergency department community, demonstrating autonomy and responsibility. These experiences fostered their professional identity by helping their socialisation within the community of practice.

Immunology in Practice: a modular framework to support Master of Science students conference attendance and engagement.

Sharing a passion for the advancement of the discipline, the scientific community provides an authentic environment for new members to acquire the knowledge and develop the professional identity needed for their future careers. Supporting opportunities for higher education students to participate in this community can complement their classroom-based education and be extremely beneficial to their learning. Situated in the authentic environment of the scientific community, conferences are organized events where professionals meet to advance their discipline, and which have been shown to provide unique learning opportunities for university students. Here we present a modular framework created to support Imperial College London's Master of Science in Immunology students' attendance at the British Society for Immunology Annual Congress. The module's evaluation indicates an overall students' satisfaction with the content, organization, teaching, assessment, feedback and community aspects of the framework and draws attention to areas of potential improvements. Furthermore, the data emphasize the importance of preconference preparation, of academic mentoring and discusses the role of peer support. Finally, the data highlight the benefits for students of discovering the true breadth and depth of their discipline, of interacting with members of the community and how these contribute to the development of their professional identity.

Siloed mentality, health system suboptimization and the healthcare symphony: a Canadian perspective.

Measuring and optimizing a health system is challenging when patient care is split between many independent organizations. For example, patients receive care from their primary care provider, outpatient specialist clinics, hospitals, private providers and, in some instances, family members. These silos are maintained through different funding sources (or lack of funding) which incentivize siloed service delivery. A shift towards prioritizing patient outcomes and keeping the patient at the centre of care is emerging. However, competing philosophies on patient needs, how health is defined and how health is produced and funded is creating and engraining silos in the delivery of health services. Healthcare and health outcomes are produced through a series of activities conducted by diverse teams of health professionals working in concert. Health professionals are continually learning from each patient interaction; however, silos are barriers to information exchange, collaborative evidence generation and health system improvement. This paper presents a systems view of healthcare and provides a systems lens to approach current challenges in health systems. The first part of the paper provides a background on the current state and challenges to healthcare in Canada. The second part presents potential reasons for continued health system underperformance. The paper concludes with a system perspective for addressing these challenges.

An immersive virtual reality communication skills training for dietitians: A feasibility study.

Objective: The training of dietitians emphasizes the development of strong communication skills. Immersive virtual reality (IVR) has been successfully employed for various healthcare scenarios; however, it is yet understudied in dietetics education. Therefore, we conducted a feasibility study to investigate the usefulness of IVR for the purpose of communication skills training. Methods: We designed a multi-user virtual hospital environment that enabled the training of professional conversations between dietitians and patients. Divided into groups of three, 30 dietetics students participated in a role-play task. Taking a qualitative approach to inquiry, we evaluated how participants assessed the benefits and limitations of the IVR training. Results: Participants appreciated the authenticity of the training environment and mentioned various advantages of IVR (e.g., sense of privacy, better focus on conversation) over traditional modes of instruction. On the other side, participants frequently mentioned that the lack of avatars' facial expressions might present an obstacle for effective communication skills training. Conclusion: IVR enables authentic communication skills trainings for dietitians. Special consideration should be given to providing ample social cues during training. Innovation: The study demonstrates that the promising results from other healthcare professions regarding the usefulness of IVR training also apply to dietetics.

Becoming a doctor: using social constructivism and situated learning to understand the clinical clerkship experiences of undergraduate medical students.

BACKGROUND: Despite the emphasis on the uniqueness and educational importance of clinical clerkships in medical education, there is a lack of deep understanding of their educational process and outcomes. Especially due to an inherent trait of clinical clerkships which requires participation in the workplace outside the classroom, it is difficult to fully comprehend their educational potential using traditional learning perspectives such as imbibing outside knowledge. Accordingly, this study aims to explore the experiences of a rotation-based clerkship of medical school students from the perspective of social constructivism of learning, which can empirically examine what and how medical students learn during clinical clerkship in South Korea. By providing an insight into the workings of the clerkship process, this study contributes to a better understanding of how a learning-friendly environment can be cultivated at clinical clerkships. METHODS: The study utilized a basic qualitative study to understand what and how medical students learn during their clinical clerkships. Semi-structured, in-depth individual interviews were conducted with eight sixth-graders who had experienced a two-year clerkship at Ajou University Medical School. Data were analyzed based on Lave and Wenger's situated learning theory and Wenger's social theory in learning. RESULTS: We found that the medical students had developed different aspects of their professional identities such as values, functionality, career decisions, sociality, and situating during their clinical clerkships. Further, professional identity was formed through a combination of participation and reification-the processes involved in the negotiation of meaning. This combination was facilitated by the students' first experience and relationships with professors, classmates, and patients. Finally, non-learning occurred in the context of over-participation (learning anxiety and alienation) or over-reification (evaluation and e-portfolio). CONCLUSIONS: This study revealed five sub-professional identities and their formation process from the learners' perspective, thereby uncovering the unique learning characteristics and advantages of rotated-based clerkship and contributing to a further understanding of how gradual improvements can be made to the traditional clerkship education of medical students.

Exploring the sociocultural experiences of student veterinary nurses in the clinical learning environment through the lens of situated learning theory.

BACKGROUND: Student veterinary nurses (SVNs) complete significant time in clinical placements and this training can have a positive or negative impact on the development of professional skills and identity. METHODS: A cross-sectional design, using semi-structured interviews, explored 12 SVNs' experiences of clinical placements. Interpretative phenomenological analysis was used to explore each individual participant's experience, prior to the identification of themes across participants' experiences. RESULTS: Most students reported a sense of belonging within the practice team, which fostered engagement. Clinical supervisors were considered key role models and vital support for student progress. Students reported conflict between the demands of the practice and the requirements of their student status. Some poor interpersonal interactions led to reduced confidence. LIMITATIONS: The results may not reflect experiences of the diversity of student demographics, such as those students with protected characteristics, as described in the Equality Act 2010, who may encounter specific workplace challenges. CONCLUSION: To ensure parity and positive experiences, accredited educational institutes can plan regular engagement with student feedback and support of the training practice. Training practice teams can ensure they are meeting the student's needs and fostering a positive learning environment by adhering to the RCVS Framework for Veterinary Nurse Education and Training, which will, in turn, benefit the whole team. Clinical supervisors can play a convening role in increasing belonging and participation within the clinical learning environment.

Learning through connections: clinical participation and interpersonal relationships in longitudinal integrated clerkships and traditional block rotations in Taiwan.

BACKGROUND: Longitudinal integrated clerkships (LICs) and traditional block rotations (TBRs) employ different designs that provide various learning experiences for students. In this study, we explored students' clinical participation and interpersonal interactions in LICs and TBRs at 2 metropolitan hospitals in Taiwan. METHODS: In April 2018, we enrolled 15 LIC and 29 TBR students. We conducted a cross-sectional survey which required the students to outline a typical daily schedule during their internal medicine rotations and draw an ecomap of the clinical team members. With the patient in the center as a reference, the size of each circle in an ecomap indicated the importance of the member; the distances and number of connecting lines between two circles represented the relationship and frequency of interaction, respectively, between the corresponding members. We analyzed the results and compared the responses of the LIC and TBR students. RESULTS: The LIC students spent more time on direct patient care and in the outpatient clinic/operation room, whereas the TBR students participated more in educational activities and in observation behind their seniors. In the ecomap analysis, the LIC students had a closer relationship with attending physicians and had better interactions with patients and preceptors than did the TBR students. Conversely, the TBR students felt closer to and interacted more frequently with interns and residents. CONCLUSIONS: The LIC students had more opportunities to care for patients directly and engaged in interactions with patients and attending physicians more frequently than did the TBR students. TRIAL REGISTRATION: Ethical approval for the study was obtained from the Institutional Review Board of Tri-Service General Hospital (TSGHIRB 2-106-05-018).

Professionalism-training in undergraduate medical education in a multi-cultural, multi-ethnic setting in the Gulf Region: an exploration of reflective essays.

BACKGROUND: Despite the established need to prioritize professionalism-training in developing future physicians, very few medical programs in the Gulf Region embed in their curricula discrete contextualized courses aimed at developing the corresponding competencies, while fostering self-directed learning. This study aims at exploring the perception of undergraduate medical students in a multi-cultural, multi-ethnic setting regarding their understanding of, and personal experience with professionalism through their engagement with the content of an innovative curriculum-based professionalism course, offered at a Medical School in Dubai, United Arab Emirates. METHODS: The study used a qualitative phenomenological research design. Out of 33 students, 29 students had submitted reflective essays. The content of these essays was inductively analyzed following a six-step framework for conducting thematic analysis. The framework's steps include familiarizing oneself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. FINDINGS: The inductive qualitative analysis generated the Professionalism Learning Journey model. This conceptual model includes four interconnected themes: Awareness, Acknowledgement, Realization, and Application. The generated model depicts the trajectory that the learners appear to experience while they are engaging with the content of the course. CONCLUSION: Integrating a professionalism-training course into an undergraduate medical curriculum is likely to be positively appraised by the learners. It raises their awareness, enables them to value the subject matter and the sophistication of its application, and empowers them to put into practice the taught principles, on an individual basis and collectively. This is especially true when the course is entrenched in constructivism experiential learning theory and designed to foster self-directed learning. The introduced conceptual model, in conjunction with the innovative professionalism-training course curriculum, can serve as a template for other competencies and other schools.

[Retrospective on ESP Courses in the Global English Era].

With the rise of the medical tourism industry in Taiwan and changes in the country's population structure, nurses are facing greater challenges than ever before. Both professional knowledge and English proficiency are indispensable. Various types of English for Specific Purposes (ESP) courses have emerged to assist healthcare professionals to build their English abilities and cope with the changing demands of their profession. However, related research indicates that the deficient state of English communication skills among nurses in Taiwan may hinder the country's ability to effectively promote medical internationalization and handle ongoing changes in its population structure. To effectively face this predicament, educators must re-examine the current design of ESP courses. Therefore, this article was developed to explore ESP courses from the three perspectives of language descriptions, needs analysis, and learning theories. Furthermore, the concepts and research related to these three perspectives, including the nurse-patient relationship, community of practice, situated learning, and English as a medium of instruction, were reviewed. Some insights into how these concepts may be applied to ESP courses are also proposed with the goals of better incorporating the needs of learners into course designs and placing learners at the center of language learning.

Transition From Observational to Collaborative Learning to Augment Practical Skill Training in First-Year Medical Students.

Introduction Students exhibit less interest in hematology demonstration experiments as they are not expected to do it during their examination. Adopting a different strategy, like collaborative learning, might spark interest, motivate them to work together towards a shared objective, and help further learning and understanding. The current study aimed to assess the effectiveness of collaborative learning in comparison with traditional practical demonstration. Methodology First MBBS students were divided into two groups of 50 each (1 - collaborative learning, 2 - traditional demonstration). In the traditional demonstration, the experiment was demonstrated by faculty using the required materials. In the collaborative learning method, 50 students were divided into groups (seven of seven each) and each group was provided with procedural details of the experiment and requisite materials. At the end of the experiment, assessment was done. In collaborative learning groups, the team cohesion scale (TCS) was employed to analyze group dynamics. Students' perceptions, and feedback regarding collaborative learning as a tool in practical experiments were collected using a five-point Likert scale. Results Post-experiment assessment scores in collaborative learning (8.65±1.54) were significantly higher than the traditional demonstration group (7.06±1.46). High scorers in TCS consistently belonged to groups that completed the experiment on time (positive outcome), whereas students with low scores often belonged to groups that did not complete the experiment (negative outcome). Conclusion Collaborative learning may be used for practical teaching in medical education as it fosters good communication, enables problem-solving, aiding the Indian medical graduate in fulfilling the role of a team member.

Do All Roads Lead to Full Participation? Examining Trajectories of Clinical Educators in Graduate Medical Education through Situated Learning Theory.

Phenomenon: As new faculty members begin their careers in Graduate Medical Education, each begins a journey of Professional Identity Formation from the periphery of their educational communities. The trajectories traveled vary widely, and full participation in a given educational community is not assured. While some medical school and post-graduate training programs may nurture Professional Identity Formation, there is scant support for faculty. To date, the trajectories that Graduate Medical Education faculty travel, what may derail inbound trajectories, and what tools Graduate Medical Education faculty use to navigate these trajectories have not been explicitly described. We explore these three questions here. Approach: Communities of Practice, a component of Situated Learning Theory, serves as a helpful framework to explore trajectories of educator identity development among Graduate Medical Educators. We used a inductive and deductive approach to Thematic Analysis, with Situated Learning Theory as our interpretive frame. Semi-structured interviews of faculty members of GME programs matriculating into a Health Professions Education Program were conducted, focusing on participants' lived experiences in medical education and how these experiences shaped their Professional Identity Formation. Findings: Participants noted peripheral, inbound, boundary, and outbound trajectories, but not an insider trajectory. Trajectory derailment was attributed to competing demands, imposter syndrome and gendered marginality. Modes of belonging were critical tools participants used to shape PIF, not only engagement with educator roles but disengagement with other roles; imagination of future roles with the support of mentors; and fluid alignment with multiple mutually reinforcing identities. Participants identified boundary objects like resumes and formal roles that helped them negotiate across Community of Practice boundaries. Insights: Despite a desire for full participation, some clinical educators remain marginal, struggling along a peripheral trajectory. Further research exploring this struggle and potential interventions to strengthen modes of belonging and boundary objects is critical to create equitable access to the inbound trajectory for all of our colleagues, leaving the choice of trajectories up to them.

Using team-based learning to optimize undergraduate family medicine clerkship training: mixed methods study.

BACKGROUND: Team-Based Learning (TBL) is an established educational strategy which has become increasingly popular in the training of healthcare professionals. TBL is highly suitable for teaching Family Medicine (FM) especially that teamwork and collaborative care, in this medical discipline, are at the core of safe and effective practice. Despite the established suitability of TBL for teaching FM, there are no empirical studies that capture the students' perception of a TBL in FM undergraduate learning experience in the Middle East and North Africa region (MENA). OBJECTIVE: The overall objective of this study was to investigate the perception of students regarding a TBL in FM intervention (in Dubai, United Arab Emirates), that was designed and implemented in alignment with a constructivist learning theory. METHODS: A convergent mixed methods study design was utilized to develop a thorough understanding of the students' perceptions. Qualitative and quantitative data were concurrently collected and independently analyzed. The output of thematic analysis was systematically merged with the quantitative descriptive and inferential findings using the iterative joint display process. RESULTS: The qualitative findings shed light on the students' perception of TBL in FM, and the interplay between team cohesion and engagement with the course. As for the quantitative findings, they showed that the percentage of the total average of the Satisfaction with TBL in FM score was 88.80%. As for change in impression of FM discipline, the percentage of the total average was 83.10%. The perception of team cohesion, with a mean of agreement of 8.62(1.34), seemed to be significantly associated with the students' perception of the team test phase component, only (P < 0.05). As for the perception of the level of engagement with the course, with a mean of agreement of 9.29(0.84), it turned out to be significantly associated with the change in impression of FM discipline (P < 0.05). Lastly, the joint display analysis showed how the quantitative and qualitative findings built upon each other, revealing how best to leverage TBL in FM trainings. CONCLUSION: The current study showed that TBL embedded in a FM clinical clerkship was well-received by students. It is worth leveraging the lessons learned from the first-hand experience reported upon in the current study to optimize the utilization of TBL in FM.

Knocking on Doors - How Healthcare Workers Informally Develop Expertise in Biomedical and Health Informatics.

With digital systems permeating the healthcare sector, the healthcare workforce (clinical and administrative) need insight in biomedical health informatics (BMHI) to some degree. This study shows how novices in BMHI had to knock hard on several doors to find and become part of a community of practice to gain such expertise within BMHI. While it may be generally understood that gaining access to expertise is important, our findings suggest that more attention is needed to how such access is gained. The study exemplifies that the needed skills and competencies are difficult to identify in the individual projects and are highly situated - not least because it requires access to various experts in communities of practices. Therefore, there is a continued need to reframe the necessary education and training. Knowing when to knock on doors, which doors to knock on, and keeping doors open is central to becoming - and keep on being - a part of a community of practice centring on health information technology and BMHI.

Validation of the Attitude Scale on Prospective Teachers' Perceptions of the Consequences on Their Psychological State: Well-Being and Cognition.

The aim of this study was to analyse the validated psychometric characteristics of the "Scale of Attitudes towards New Post-Pandemic Scenarios" (SANPS) tool using a short version on Perceptions of Future Teachers towards the New Post-Pandemic Educational Scenarios; describe the attitudes of future teachers towards motivation, collaboration, and emerging active pedagogies; and determine the internal consistency and reliability of the tool. The design structure of the instrument consists of the following three latent factors, which were obtained through an exploratory factor analysis (EFA): empowerment/motivation, autonomy/situated learning and emerging digital pedagogies. The questionnaire was administered to a sample of 966 participants. In the confirmatory factor analysis (CFA), a previous hypothesis was established regarding the relationship of the factors and their number and nature, specifying the number of factors and the way in which the variables are related to each other. The 66.53% of total variance was explained. The reliability, calculated with Cronbach's alpha, reached a global value of over 0.90 (α = 0.94). This valid and reliable questionnaire, which incorporates a dimension that measures the transfer of learning in hybrid and multimodal models of digital ecosystems in Higher Education, can be applied in the evaluation of online education processes.

Collaborating within a Lockdown: Students' Online Collaboration to Develop a College Readiness Workshop during the COVID-19 in-person restrictions.

Background: The COVID-19 pandemic created significant disruption within the educational setting, including the rapid shift to a fully online learning environment. Purpose: The purpose of this study was to explore how graduate students collaborated synchronously and reimagined an in-person academic service learning project into an asynchronous workshop format. Methodology/Approach: An explanatory single case study approach was used to explore how educational leadership doctoral students developed content for and transitioned the modality of an academic service learning project-a college readiness workshop for middle school students-during the COVID-19 pandemic. Findings/Conclusions: Overall, the development of and transition to a fully online workshop website format highlighted the importance and additional need for technology to support project content, the challenge of how to best incorporate audience engagement through an asynchronous platform, and the shift in roles and expectations of the graduate students throughout the workshop development process. Implications: Although this learning experience was adapted due to pandemic-related restrictions, this reimagined student-led project provided additional and unique opportunities for collaboration and technology integration that can be useful and applicable to the students' post-lockdown lives.

Impact of online learning on sense of belonging among first year clinical health students during COVID-19: student and academic perspectives.

BACKGROUND: The need to belong is a fundamental human desire that provides the basis for relationships and community; it provides a sense of security that enables growth and development. This sense of belonging is pivotal to new University students, indeed, without it, students are at greater risk of failing or withdrawing from their studies. Yet developing a sense of belonging within a new cohort is complex and multi-faceted and further complicated by a sudden shift away from in-person to online learning. Using the situated-learning framework, our study explores first year clinical health students' sense of belonging in the context of the rapid transition to online learning because of the COVID-19 pandemic. METHODS: We utilised a current mixed-method approach including a survey incorporating previously validated tools, demographic and open-ended qualitative questions. Data was also gathered from three focus groups: two dedicated student groups and one academic focus group. Qualitative data was subjected to thematic analysis whilst descriptive statistics were used to describe the quantitative data. RESULTS: 179 first year students complete the survey and four students, and five academics were involved in the focus groups. All participants were from clinical health science courses at an Australian university. Our qualitative results indicated a global theme of: Navigating belonging during the COVID-19 crisis: a shared responsibility; with four organising themes describing (1) dimensions of belonging, (2) individual experiences and challenges, (3) reconceptualising teaching and learning, and (4) relationships are central to belonging. CONCLUSION: While the rapid transition to online learning did not greatly impact knowledge acquisition of first-year students in this cohort, the lack of sense of belonging highlights the need for further research into development of this essential aspect of learning in the online domain. Although contextualised in the COVID-19 pandemic, it became clear that the findings will remain relevant beyond the current situation, as a student's need to belong will always be present in the face of challenges or change.

Designing a Co-creation System for the Development of Work-process-related Learning Material in Manufacturing.

The increasing digitalization and automatization in the manufacturing industry as well as the need to learn on the job has reinforced the need for much more granular learning, which has not yet impacted the design of learning materials. In this regard, granular learning concepts require situated learning materials to support self-directed learning in the workplace in a targeted manner. Co-creation approaches offer promising opportunities to support employees in the independent design of such situated learning materials. Using an action-design research (ADR) approach, we derived requirements from co-creation concepts and practice by conducting focus group workshops in manufacturing and vocational training schools to develop design principles for a co-creation system that supports employees through the creation process of work-process-related learning material. Consequently, we formulate four design principles for the design of a collaborative learning and qualification system for manufacturing. Using an innovative mixed methods approach, we validate these design principles and design features to demonstrate the success of the developed artifact. The results provide insights regarding the design of a co-creation system to support learners in the co-creation of learning material with the consideration of cognitive load (CL). Our study contributes to research and practice by proposing novel design principles for supporting employees in peer creation processes. Furthermore, our study reveals how co-creation systems can support the collaborative development of learning materials in the work process.

Situated Learning and Transnational Labor Migration: The Case of Canada's Seasonal Agricultural Worker Program.

Grounded in an analysis of interviews with migrant farm workers in Canada, this article explores how learning in the everyday contexts of temporary transnational labor migration is implicated in both migrant identity formation and the social reproduction of an established and growing labor migration regime. The article focuses on thinking through how workers negotiate the intergenerational workplace tensions that permeate life in Canada's Seasonal Agricultural Worker Program. The findings suggest that through their sustained participation in the everyday social practices that develop through dormitory-living, transnational laborers learn to become migrant workers. This formation of migrant worker identities in turn contributes to the reproduction of the social relations that support the ongoing practice of circulatory labor migration in the Canadian agricultural industry.

Socially situated artificial intelligence enables learning from human interaction.

Regardless of how much data artificial intelligence agents have available, agents will inevitably encounter previously unseen situations in real-world deployments. Reacting to novel situations by acquiring new information from other people-socially situated learning-is a core faculty of human development. Unfortunately, socially situated learning remains an open challenge for artificial intelligence agents because they must learn how to interact with people to seek out the information that they lack. In this article, we formalize the task of socially situated artificial intelligence-agents that seek out new information through social interactions with people-as a reinforcement learning problem where the agent learns to identify meaningful and informative questions via rewards observed through social interaction. We manifest our framework as an interactive agent that learns how to ask natural language questions about photos as it broadens its visual intelligence on a large photo-sharing social network. Unlike active-learning methods, which implicitly assume that humans are oracles willing to answer any question, our agent adapts its behavior based on observed norms of which questions people are or are not interested to answer. Through an 8-mo deployment where our agent interacted with 236,000 social media users, our agent improved its performance at recognizing new visual information by 112%. A controlled field experiment confirmed that our agent outperformed an active-learning baseline by 25.6%. This work advances opportunities for continuously improving artificial intelligence (AI) agents that better respect norms in open social environments.