Abstract
BackgroundMedical 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.MethodsTo 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.ResultsParticipants 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.ConclusionsOur 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.
Highlights
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
To further understand how medical students experience SDL and employ SDL strategies in the clinical setting, we carried out a qualitative interview study with medical students in a single medical school in the Northeastern U.S The goals of this study were (1) to describe student experiences of SDL in their clinical training, and (2) to identify the role that social contexts play in shaping their experiences of SDL
We drew on the Standards for Reporting Qualitative Research (SRQR) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) to guide our analysis and reporting of findings [24, 25]
Summary
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. As Knowles defined it, “A self-directed learner takes responsibility for their own learning and has internal motivation to develop, implement, and evaluate their approach to learning.” [4, 5] Knowles described SDL as a learning contract between a learner and an instructor and a linear process comprising six major steps: (1) climate setting (creating an atmosphere of mutual respect and support); (2) diagnosing learning needs; (3) formulating learning goals; (4) identifying human and material resources for learning; (5) choosing and implementing appropriate learning strategies; and (6) evaluating learning outcomes [4] Some criticism of this model includes the primary emphasis placed on individual learners, which, in certain contexts, may be synonymous with a lack of support, and a lack of attention to the social and cultural dimensions of learning [6].
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