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Two sides of the same coin: elements that can make or break clinical learning encounters

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Global Surgical Education - Journal of the Association for Surgical Education Aims and scope Submit manuscript

Abstract

Purpose

This project explored how faculty, residents, and students at an academic medical center have experienced meaningful learning moments and what contributed to such moments within the clinical learning environment.

Methods

During AY 2018–19, the authors interviewed faculty (n = 8) and residents (n = 5) from the Surgery and OBGYN departments at the University of Utah School of Medicine. The authors also conducted interviews (n = 4) and focus groups (n = 2) with 20 third- and fourth-year students. The authors used an appreciative inquiry approach to conduct interviews and focus groups, which were audio-recorded and transcribed verbatim. Transcriptions were coded using qualitative content analysis.

Results

The authors found that three factors determined whether learning encounters were successful: learner-centeredness, shared understanding, and learner attributes. Situations that were characterized by learner-centeredness and shared understanding led to successful learning. Likewise, some learner attributes facilitated successful learning moments.

Conclusion

The clinical learning environment is characterized by both successful and challenging moments. Paying attention to the factors which promote successful learning may be key to fostering a positive learning environment for all learners, but particularly for medical students.

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Funding

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Utah School of Medicine, 27 S Mario Capecchi Drive, Salt Lake City, UT, 84132, USA

    Candace J. Chow & Todd Christensen

  2. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    Boyd F. Richards

  3. UTIA Extension, University of Tennessee, Knoxville, USA

    Chanta’l Rose

  4. Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA

    Luke Buchmann & Brigitte K. Smith

  5. Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Tiffany Weber

  6. Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Sara M. Lamb

Authors
  1. Candace J. Chow
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  2. Boyd F. Richards
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  3. Chanta’l Rose
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  4. Todd Christensen
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  5. Luke Buchmann
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  6. Brigitte K. Smith
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  7. Tiffany Weber
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  8. Sara M. Lamb
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Corresponding author

Correspondence to Candace J. Chow.

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Conflict of interest

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Ethical approval

[removed for review] IRB_ 00117983.

Appendices

Appendix

This is a semi-structured interview protocol, adapted from a guide originally developed by Drs. Williamson and Suchman [50]. Probes will be used as necessary to elicit additional pertinent information.

Interview questions

  1. 1.

    Introduction: This is going to be what we call an appreciative interview. I am going to ask you questions about times when you experienced educational things working at their best here at the University of Utah School of Medicine. Many times, we try to ask questions about things that are not working well—the problems—so that we can fix them. In this case, we are trying to find out about the things at their best—the successes—so that we can find out what works and why, and find ways to infuse more of it into our practice.

  2. 2.

    As we get started, I would like to know a little bit about you. Just so you know, this information will not be associated with any of your stories or quotes, but will just be used to provide context to our findings.

  • What’s your role here at the university and how long have you been here?


  • People do their best work when they are doing things that they find personally meaningful, and when they feel that their work makes a difference. During your time at Utah, there have no doubt been high points and low points. For now, I would invite you to think of a teaching and learning moment that meant a lot to you, when things went right, a time that brought out the best in you.

  • Please tell the story of that time. (If they are very general, try to probe for more specificity.)

  • Without worrying about being modest, please tell me what it was about you—your unique qualities, gifts or capacities; decisions you made; or actions you took—that contributed to this teaching/learning experience?

  • What did others contribute or do?

  • What aspects of the situation made this a success (for example, the place, the time of day or year, recent events)?


  • Now, think of a time at Utah when you or your values were challenged.

  • Please tell me a story about that time. (If participant needs clarification about what a value is, explain that a value is “a person's principles or standards of behavior; one's judgment of what is important in life.”)

  1. 3.

    We each have different qualities, gifts and skills we bring to the world and to our work. Think about the things you value about yourself, the nature of your work and the university. At work, we are always dealing with challenges and change.

  2. 4.

    How have your strengths and values helped you deal with challenges and change?

  • Your work: When you are feeling good about your work, what do you like about the work itself?

  • Yourself: Imagine you are at your retirement party. What do you think your colleagues would say they liked most about you?

  • Yourself: Now what do you think your students would say they have liked most about you?

  • How do your personal values match those of [institution]? (For example, honesty, compassion, teamwork)?

  • Where have you seen examples of these values at [institution]?

  1. 5.

    Where do you think these reports of mistreatment are coming from?

Focus group questions

  1. 6.

    What was it about you—your unique qualities, gifts or capacities; decisions you made; or actions you took—that contributed to these peak learning experiences? What did others contribute or do?

  • What aspects of the situation made this a success (for example, the place, the time of day or year, and recent events)?

  • What are the commonalities among all of your stories?

  • What are two things you can do, as students, to promote more of these experiences?

  • What are two things that curricular leaders can do to promote more of these experiences?

  1. 7.

    This project arose out of a desire to understand why student mistreatment in clerkships occurs. So next, I would like you to think about how these moments of success differ from moments of challenge.

  • Assuming that moments of success were to happen all the time, how likely is it that mistreatment would occur?

  • What are two things that need to happen to prevent mistreatment?

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Chow, C.J., Richards, B.F., Rose, C. et al. Two sides of the same coin: elements that can make or break clinical learning encounters. Global Surg Educ 1, 3 (2022). https://doi.org/10.1007/s44186-022-00006-3

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