Progression of Self-Directed Learning in Health Professions Education: Clarifying Terms and Processes.

As the complexity ofmedical knowledge and clinical practice continues to grow, physicians and physicians-intrainingmust learn to identify gaps in their knowledge and understand and engage in self-directed learning (SDL) in pursuit of academic goals and improved clinical performance. There is a lack of consensus, however, on the precise definition of SDL and how it relates to self-regulated learning (SRL) and co-regulated learning (CRL). We propose a conceptual framework for understanding the progression of a self-directed learner in the health professions and describe the interplay of SRL and CRL.

Voluntary participation in flipped classroom application sessions has a negligible effect on assessment outcomes in an accelerated pass-fail course.

Increasingly, basic science educators at medical and health science programs are faced with the challenge of delivering fundamental science content using evidence-based pedagogical approaches that build students' fund of knowledge while also supporting their development as self-regulated learners. This has led to an increased use of active learning-based pedagogies such as flipped classroom teaching. However, there are many open questions about the conditions necessary for successful flipped classroom sessions. In particular, the role of student compliance (i.e., participation, engagement, attendance) in mediating performance needs to be evaluated. This is especially important in accelerated curricula where multiple basic science disciplines are integrated together in pass-fail courses, presenting challenges to both students' time and cognitive load. Data on prematriculation performance, in-class participation, weekly quiz performance, and summative assessment performance from three cohorts of medical students (n = 146) at a new medical school were collected and analyzed. We found that historically high-performing students more readily participated in flipped classroom application sessions compared with historically lower-performing students. Correlational analysis of performance on weekly formative quizzes and the summative course exam was not related to in-class participation. However, performance on weekly formative quizzes played the most significant role in students' performance on summative exams. Efforts to understand the benefits of in-class participation beyond short-term assessment performance, such as long-term knowledge retention or development of noncognitive skills, should be undertaken to justify using such time- and human resource-intensive pedagogies.NEW & NOTEWORTHY This study explores the use of flipped classroom teaching in a voluntary and accelerated medical school course. We found that historically high-performing students attend class, whereas historically low-performing students do not attend class as readily. Formative assessment performance appears to be more important than participation in determining the final grade. Correlation of high performance (>90%) with participation may differentiate students who excel in our curriculum from those who simply pass with superficial knowledge.

Learning New Skills in Innovation, Leadership, and Discovery During a 9-Month Scholarly Concentration: Results from the First Cohort at a New Medical School.

Dell Medical School (DMS) has weaved health systems science (HSS) throughout its curriculum. During the third year, students complete a master's degree program or an immersive distinction in research or design during a 9-month Innovation, Leadership, and Discovery (ILD) block. Faculty assessments revealed all students met expectations, but dual-degree students were rated higher than distinction students in leading future innovative teams competencies. Student self-assessments revealed statistically significant improvements in HSS competencies during the block with little difference by ILD choice (dual degree or distinction). We will continue to examine the long-term impact of these experiences and skills in career trajectories.

Words of advice: preparing to teach.

You have spent most of your training learning how to be successful in a research laboratory. But are you ready to step in front of a class and teach? This Words of Advice article provides guidance and resources for designing a course using backward design and for becoming an effective teacher, especially in today's new format of large, interactive classes.

From Knowing to Doing: Integrating Systems-Ready Physician Competencies in the Clerkship Setting.

There are increasing calls to graduate physicians with a strong understanding of health systems science (HSS). Many schools have incorporated didactics on health systems science content such as quality improvement, patient safety, or interprofessional education. Creating a systems-ready physician requires more than teaching content in classroom settings. Using Miller's pyramid of assessment of clinical performance, we have developed strategies to move our learners from the cognitive-based "knows" level to the behavior-based "does" level of understanding of the HSS competencies. Our medical students begin learning HSS in classroom settings. Next, the students apply this knowledge during their core clerkships. This gives them an opportunity to get feedback increasingly from high-fidelity clinical settings. We embedded assessment strategies and tools in the clerkship year to facilitate the demonstration, observation, and assessment of HSS competencies in the setting of our core clerkships. We also have students self-assess their competence in our graduation competencies at the end of each year. Student self-assessment from the beginning of the clerkship year to the end showed significant increases in the HSS competencies. Our clerkship student assessment data from our first cohort suggest that faculty had difficulty observing and assessing some of the competencies unique to health systems science. The clerkships have developed multiple projects and assignments to allow students to demonstrate HSS competencies. Faculty and resident training to prompt, observe, and assess these competencies is ongoing to close the assessment gap. In the area of professionalism, student self-assessment and faculty clinical assessment correlate strongly.