Abstract 6
Informal and Incidental Learning in Complex Clinical Environments:
An Examination of Critical Incidents of Frontline Physicians
during the COVID-19 pandemic and Implications for Medical Education
Dimitrios Papanagnou (Sidney Kimmel Medical College, Thomas Jefferson University);
Karen Watkins (The University of Georgia);
Urvashi Vaid (Sidney Kimmel Medical College, Thomas Jefferson University);
Henriette Lundgren (Teachers College, Columbia University);
Grace Alcid (Sidney Kimmel Medical College, Thomas Jefferson University);
Deborah Ziring (Sidney Kimmel Medical College, Thomas Jefferson University);
Victoria J. Marsick (Teachers College, Columbia University)
Introduction:
The uncertainty of clinical practice was amplified by COVID-19. It illuminated the gap in training students receive to function in uncertain environments. Formal training to navigate uncertainty is lacking. Educators require an understanding of informal and incidental learning (IIL) to prepare students for this uncertainty. We explore IIL as a guiding framework for developing a curriculum that prepares students to navigate uncertainty.
Methods:
Using a constructivist, grounded theory approach, we describe physicians’ IIL while working during times of heightened uncertainty. The critical incident technique was used to elicit narratives from 6 frontline emergency medicine and 6 critical care physicians who worked during the height of the pandemic (March-June 2020) and asked them to describe their learning in the clinical environment. Interviews were virtual, recorded, and transcribed. We re-storied narratives to build a cohesive, chronological story in the participants’ own words. We reviewed re-storied narratives as part of an inductive analysis, which allowed for the collection of patterns, assertions, and organizing themes. We examined what participants did in the face of uncertainty, and how IIL manifests in the narratives.
Results:
Physicians were challenged by not being able to rely on evidence-based medicine. They reported an increased reliance on the interprofessional team to overcome fears of failure. They highlighted the importance of team consensus. Learning was characterized by pattern recognition, intuition, and reliance on past experiences. They had to comfortably engage in trial and error and “pivoting on the fly” to navigate learning.
Conclusions:
Physicians rely on consensus, previous expertise, and abductive problem-solving to navigate uncertainty in practice. Findings are translatable into educational interventions that prepare students to navigate uncertainty in clinical practice.
