Blissett Sarah, Mensour Emma, Shaw Jennifer M, Martin Leslie, Gauthier Stephen, de Bruin Anique, Siu Samuel, Sibbald Matt
Centre for Education Research and Innovation (CERI), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Medicine, Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Med Educ. 2024 Mar;58(3):308-317. doi: 10.1111/medu.15180. Epub 2023 Jul 31.
Learning is optimised when postgraduate trainees engage in clinical tasks in their zone of proximal development (ZPD). However, workplace learning environments impose additional non-learning goals and additional tasks that may lead to trainees engaging in tasks that do not fall within their ZPD. We do not fully understand how trainees select clinical tasks in the workplace learning environment. If we knew the goals and factors they consider when selecting a task, we could better equip trainees with strategies to select tasks that maximise learning. We explored how postgraduate trainees select clinical tasks using echocardiography interpretation as a model.
Canadian General Cardiology residents and Echocardiography fellows were invited to participate in semi-structured interviews. Aligning with a theory-informed study, two independent researchers used a deductive, directed content analysis approach to identify codes and themes.
Eleven trainees from seven Canadian universities participated (PGY4 = 4, PGY5 = 3, PGY6 = 1 and echocardiography fellows = 3). Goals included learning content, fulfilling assessment criteria and contributing to clinical demands. Trainees switched between goals throughout the day, as it was too effortful for them to engage in tasks within their ZPD at all times. When trainees had sufficient mental effort available, they selected higher complexity tasks that could advance learning content. When available mental effort was low, trainees selected less complex tasks that fulfilled numerically based assessment goals or contributed to clinical demands. Trainees predominantly used perceived complexity of the echocardiogram as a factor to select tasks to achieve their desired goals.
Postgraduate trainees select tasks within their ZPD that enable them to maximise learning when they perceive to have sufficient mental effort available and workplace affordances are adequate. These findings can inform individual and systemic strategies to maximise learning when selecting tasks.
当研究生学员在其最近发展区（ZPD）内参与临床任务时，学习效果最佳。然而，工作场所的学习环境会带来额外的非学习目标和额外任务，这可能导致学员从事不属于其ZPD范围内的任务。我们尚未完全了解学员在工作场所学习环境中如何选择临床任务。如果我们知道他们在选择任务时考虑的目标和因素，就能更好地为学员提供策略，以选择能使学习最大化的任务。我们以超声心动图解读为例，探讨了研究生学员如何选择临床任务。
邀请加拿大普通心脏病学住院医师和超声心动图研究员参与半结构化访谈。两位独立研究人员采用基于理论的研究方法，运用演绎式定向内容分析法来识别代码和主题。
来自加拿大七所大学的11名学员参与了研究（四年级住院医师 = 4人，五年级住院医师 = 3人，六年级住院医师 = 1人，超声心动图研究员 = 3人）。目标包括学习内容、满足评估标准以及满足临床需求。学员们在一天中会在不同目标之间切换，因为让他们始终参与ZPD范围内的任务对他们来说太费力了。当学员有足够的脑力时，他们会选择能推进学习内容的更高复杂度任务。当可用脑力较低时，学员会选择不太复杂的任务，这些任务能满足基于数字的评估目标或满足临床需求。学员主要将超声心动图的感知复杂度作为选择任务以实现其期望目标的一个因素。
当研究生学员认为自己有足够的脑力且工作场所条件合适时，他们会在ZPD内选择任务，以使学习最大化。这些发现可为选择任务时最大化学习的个人和系统策略提供参考。
