1. William B. Cutrer, MD, MEd; Lourdes Estrada, PhD; Bonnie Miller, MD; Lillian Nanney, PhD; Neil Osheroff, PhD; Donald Moore, PhD

2.  Background  Methods  Results  Conclusions  Questions

4.  The modern healthcare environment is rapidly changing with a requisite knowledge base that is expanding significantly.  Learning in this environment requires different skills than the structured classroom-based setting to which pre-clerkship medical students are accustomed.  Individual patient encounters routinely highlight knowledge gaps for medical students and practicing physicians, but further investigation for answers is often thwarted in the fast-paced clinical environment.

5.  Building on the master learner 1 construct, we proposed the master adaptive learner who would more successfully learn in the complex healthcare environment by drawing on adaptive expertise when confronted with such challenges.

6.  Based on the medical education literature and the development of a Master Adaptive Learner theory-based model, we developed ◦ Structured process to scaffold and guide learners through the investigation of a basic science knowledge gap arising during a 4 th year clinical rotation

7.  Background  Methods  Results  Conclusions  Questions

8.  Background  Methods  Results  Conclusions  Questions

9.  We offered medical students the opportunity to participate in a pilot of the Master Adaptive Learner (MAL) process to be completed while participating in one of their 4 th year clinical electives  Qualitative interviews were conducted with each participant before and after the experience

10.  Students completed assignments each week that guided them through the MAL process of ◦ 1) Recognizing a knowledge gap as an opportunity to learn ◦ 2) Searching for reliable resources for learning ◦ 3) Engaging in learning ◦ 4) Trying out what was learned

11.  Assignments concluded with ◦ 2-page summary of their findings and reflection on the process ◦ Short presentation to the clinical team

12.  Basic science faculty oriented to the MAL process coached each student  Assignments and interview results were analyzed qualitatively

13.  Background  Methods  Results  Conclusions  Questions

14.  Background  Methods  Results  Conclusions  Questions

15.  Twelve senior students participated in the MAL pilot experience.  One main theme identified was the lack of an explicit approach to learning and investigation of patient questions by the students

16.  Students were noted to follow the prescribed process steps, but generally did so in a superficial manner.  When searching for learning resources, students consistently used digital resources without consultation with resident or faculty, preferentially using ◦ Google Scholar to PubMed, ◦ Routinely beginning their inquiries with the summary reference UpToDate

17.  Despite specific instructions and coaching to dive deeply into the foundational science, students focused primarily on the clinical aspects of diagnosis and treatment

18.  Background  Methods  Results  Conclusions  Questions

19.  Background  Methods  Results  Conclusions  Questions

20. 1) During the pre-participation interviews, it was clear that the medical students lacked an explicit approach for identifying and addressing their own knowledge gaps. 2) Too often learning in the clinical context was piecemeal and incomplete.

21. 3) These findings support the need for an explicit process to help students develop these critical lifelong learning skills. 4) Despite the MAL process directing learners to explore the appropriate foundational sciences, students persisted in their habits of focusing primarily on clinical content, suggesting that introducing the MAL process earlier in the learner’s training might be more beneficial.

23.  Background  Methods  Results  Conclusions  Questions

24.  Background  Methods  Results  Conclusions  Questions

25. How can the MAL process be improved to increase student participation and engagement? Would training students regarding the process earlier in the medical school be more effective?