Exploring Medical Student Learning Needs in the Pediatric Emergency Department: "What Do You Want to Learn Right Now?".

BACKGROUND: When precepting medical students in the emergency department, faculty physicians often have only minutes per patient encounter to devote to direct teaching. Instructional strategies that promote independent student learning after each case may have merit. It is not known, however, to what degree patient-triggered learning needs are amenable to independent study. OBJECTIVE: The aims of this study were to determine self- and faculty-reported learner needs at the time of patient encounters and to assess the degree to which these perceived needs may be satisfied by independent study. METHODS: We interviewed medical students and faculty in our pediatric emergency department. Immediately before or after they saw a patient, we asked "What do you want to learn right now?". For half of the student interviews, we separately asked the same questions of their preceptors. Interviews were taped and transcribed. Responses were coded by 3 investigators who did content analysis to identify dominant themes and the extent to which the learning need could be addressed independently. Investigators agreed that Accreditation Council for Graduate Medical Education competency domains could be used to classify the responses. RESULTS: We interviewed 82 students and 44 preceptors yielding 126 patient-triggered learning needs. Competency area(s) were medical knowledge (70), patient care (1), interpersonal skills (27), systems-based practice (2), practice-based learning (3), and professionalism (4). Two raters independently assigned the same competency in 89%. Medical knowledge competency learning needs were almost all at least moderately amenable to independent learning (68/70, 98%), but the other competencies were not (22/57, 39%) according to the raters (interrater reliability, 0.7). Preceptor responses were congruent in competency type with students' responses in 29 (67%) of 43. Students listed interpersonal skills deficits far more often than did faculty (24% vs 5%, P < 0.05). CONCLUSIONS: Most student learning needs in the pediatric emergency department focus on medical knowledge. These deficits could be amenable to structured independent study at the point of care.

"Where Does the Circle End?": Representation as a Critical Aspect of Reflection in Teaching Social and Behavioral Sciences in Medicine.

OBJECTIVE: This paper describes a reflective learning program within a larger curriculum on behavioral and social science that makes use of close reading, written representation of experience, discussion, and textual response. This response may in turn lead to further reflection, representation, and response in a circular pattern. A unique feature of this program is that it pays attention to the representation itself as the pivotal activity within reflective learning. Using the narrative methods that are the hallmark of this program, faculty writings were analyzed to characterize the essential benefits that derive from these practices. METHODS: In the context of a faculty development seminar on the teaching of behavioral and social sciences in medical curricula, a group of 15 faculty members wrote brief narratives of reflective learning experiences in which they had made use of the methods described above. Their responses were submitted to iterative close reading and discussion, and potential themes were identified. RESULTS: Four themes emerged: writing as attention to self, writing as attention to other, writing as reader/writer contract, and writing as discovery. In each instance, writing provides a new or deepened perspective, and in each case, the dividends for the writer are amplified by the narrative skills of those who read, listen, and respond. CONCLUSIONS: The narrative pedagogy described and modeled herein provides a potentially promising approach to teaching the social, cultural, behavioral, and interpersonal aspects of medical education and practice. Future research will deepen our understanding of the benefits and limitations of this pedagogy and expand our appreciation of its applications.

PBL and beyond: trends in collaborative learning.

Building upon the disruption to lecture-based methods triggered by the introduction of problem-based learning, approaches to promote collaborative learning are becoming increasingly diverse, widespread and generally well accepted within medical education. Examples of relatively new, structured collaborative learning methods include team-based learning and just-in-time teaching. Examples of less structured approaches include think-pair share, case discussions, and the flipped classroom. It is now common practice in medical education to employ a range of instructional approaches to support collaborative learning. We believe that the adoption of such approaches is entering a new and challenging era. We define collaborate learning by drawing on the broader literature, including Chi's ICAP framework that emphasizes the importance of sustained, interactive explanation and elaboration by learners. We distinguish collaborate learning from constructive, active, and passive learning and provide preliminary evidence documenting the growth of methods that support collaborative learning. We argue that the rate of adoption of collaborative learning methods will accelerate due to a growing emphasis on the development of team competencies and the increasing availability of digital media. At the same time, the adoption collaborative learning strategies face persistent challenges, stemming from an overdependence on comparative-effectiveness research and a lack of useful guidelines about how best to adapt collaborative learning methods to given learning contexts. The medical education community has struggled to consistently demonstrate superior outcomes when using collaborative learning methods and strategies. Despite this, support for their use will continue to expand. To select approaches with the greatest utility, instructors must carefully align conditions of the learning context with the learning approaches under consideration. Further, it is critical that modifications are made with caution and that instructors verify that modifications do not impede the desired cognitive activities needed to support meaningful collaborative learning.