Division of Hospital Medicine, University of Colorado Hospital, Aurora, CO, United States of America.
Division of General Internal Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, United States of America.
PLoS One. 2022 Sep 16;17(9):e0274683. doi: 10.1371/journal.pone.0274683. eCollection 2022.
The coronavirus disease 2019 (COVID-19) pandemic has had a transformative effect on individuals across the world, including those in healthcare. Transformative learning is an educational theory in which an individual's worldview is fundamentally altered through conscious reflection (Cognitive Rational), insights (Extrarational), or social reform (Social Critique). We utilized transformative learning theory to characterize the experiences of medical trainees during the pandemic.
We used the Transformative Learning Survey in September and October 2020 to evaluate the processes and outcomes of transformative learning in health professions students and housestaff at an academic medical center during the pandemic. We analyzed survey scores for three process domains and four outcome subdomains. We inductively coded the survey's two open-ended questions and performed qualitative and mixed-methods analyses.
The most prominent TL outcome was Self-Awareness, Acting Differently was intermediate, and Openness and Worldview Shifts were lowest. Cognitive Rational and Social Critique processes were more prominent than Extrarational processes. Students were more likely than housestaff to undergo transformative learning through the Social Critique process (p = 0.025), in particular the sub-processes of Social Action (p = 0.023) and Ideology Critique (p = 0.010). Qualitative analysis via the aggregation of codes identified four responses to the pandemic: negative change, positive change, existential change, or no change. Negative changes (67.7%) were most common, with students reporting more of these changes than housestaff (74.8% vs 53.6%; p < 0.01). Only 8.4% of reported changes could be defined as transformative.
Through the theoretical lens of transformative learning, our study provides insight into the lives of learners during the pandemic. Our finding that medical students were more likely to use Social Critique processes has multiple parallels in the literature. If leaders in academic medicine desire to create enlightened change agents through transformative learning, such education must continue throughout graduate medical education and beyond.
2019 年冠状病毒病（COVID-19）大流行对全球各国的个人产生了变革性影响，包括医疗保健领域的个人。变革性学习是一种教育理论，通过有意识的反思（认知理性）、洞察（超越理性）或社会改革（社会批判），从根本上改变一个人的世界观。我们利用变革性学习理论来描述大流行期间医学实习生的经历。
我们于 2020 年 9 月至 10 月使用变革性学习调查来评估学术医疗中心的医学生和住院医师在大流行期间变革性学习的过程和结果。我们分析了三个过程领域和四个结果子领域的调查得分。我们对调查的两个开放式问题进行了归纳编码，并进行了定性和混合方法分析。
最突出的 TL 结果是自我意识，其次是行为差异，而开放性和世界观转变则最低。认知理性和社会批判过程比超越理性过程更为突出。与住院医师相比，学生更有可能通过社会批判过程（p=0.025），特别是社会行动（p=0.023）和意识形态批判（p=0.010）的子过程，进行变革性学习。通过代码聚合进行的定性分析确定了对大流行的四种反应：负面变化、正面变化、存在变化或无变化。负面变化（67.7%）最为常见，与住院医师相比，学生报告的这些变化更多（74.8%对 53.6%；p<0.01）。报告的变化中只有 8.4%可以定义为变革性。
通过变革性学习的理论视角，我们的研究深入了解了学习者在大流行期间的生活。我们发现，医学生更有可能使用社会批判过程，这与文献中的多个发现一致。如果学术医学领域的领导者希望通过变革性学习培养开明的变革推动者，那么这种教育必须在研究生医学教育及以后继续进行。
