TY - JOUR
T1 - Connecting Biochemistry Knowledge to Patient Care in the Clinical Workplace
T2 - Senior Medical Students’ Perceptions about Facilitators and Barriers
AU - Fulton, Tracy B.
AU - Collins, Sally
AU - van der Schaaf, Marieke
AU - O’Brien, Bridget C.
N1 - Funding Information:
The authors thank Esteban Dell’Angelica and Sebastian Uijtdehaage for discussions that inspired this work, and David Irby for a robust review of an early version of the manuscript. They also thank the student participants for their time and thoughtful responses; faculty and learners in the UMC Utrecht program for providing critical feedback; and the UCSF Center for Faculty Educators and the UCSF Academy of Medical Educators for funding through the Endowed Chair for Excellence in Foundational Teaching, held by TBF. The authors are especially grateful for the feedback from the journal’s reviewers and editors.
Publisher Copyright:
© 2022 Taylor & Francis Group, LLC.
PY - 2023
Y1 - 2023
N2 - Phenomenon: Medical students have difficulties applying knowledge about biomedical mechanisms learned before clerkships to patient care activities. Many studies frame this challenge as a problem of basic science knowledge transfer predominantly influenced by students’ individual cognitive processes. Social cognitive theory would support extending this framing to the interplay between the individual’s cognition, the environment, and their behaviors. This study investigates senior medical students’ experiences of biochemistry knowledge use during workplace learning and examines how their experiences were influenced by interactions with people and other elements of the clinical learning environment. Approach: The authors used a qualitative approach with a constructivist orientation. From September to November 2020 they conducted semi-structured interviews with 11 fourth-year medical students at one institution who had completed the pre-clerkship curriculum, core clinical clerkships, and the United States Medical Licensing Exam Step 1. The authors identified themes using thematic analysis. Findings: Participants reported that they infrequently used or connected to biochemistry knowledge in workplace patient care activities, yet all had examples of such connections that they found valuable to learning. Most participants felt the responsibility for making connections between biochemistry knowledge and activities in the clinical workplace should be shared between themselves and supervisors, but connections were often recognized and acted on only by the student. Connections that participants described prompted their effort to retrieve knowledge or fill a perceived learning gap. Participants identified multiple barriers and facilitators to connecting, including supervisors’ behaviors and perceived knowledge, and “patients seen” in clerkships. Participants also reported learning biochemistry during USMLE Step 1 study that did not connect to patient care activities, underscoring a perception of disconnect. Insights: This study identifies specific personal, social, and physical environmental elements that influence students’ perceived use of biochemistry during patient care activities. Though these findings may be most significant for biochemistry, they likely extend to other basic science disciplines. Students’ self-directed efforts to connect to their biochemistry knowledge could be augmented by increased social support from clinical supervisors, which in turn likely requires faculty development. Opportunities for connection could be enhanced by embedding into the environment instructional strategies or technologies that build on known authentic connections between biochemistry and “patients seen” in clerkships. These efforts could strengthen student learning, improve clinical supervisors’ self-efficacy, and better inform curriculum design.
AB - Phenomenon: Medical students have difficulties applying knowledge about biomedical mechanisms learned before clerkships to patient care activities. Many studies frame this challenge as a problem of basic science knowledge transfer predominantly influenced by students’ individual cognitive processes. Social cognitive theory would support extending this framing to the interplay between the individual’s cognition, the environment, and their behaviors. This study investigates senior medical students’ experiences of biochemistry knowledge use during workplace learning and examines how their experiences were influenced by interactions with people and other elements of the clinical learning environment. Approach: The authors used a qualitative approach with a constructivist orientation. From September to November 2020 they conducted semi-structured interviews with 11 fourth-year medical students at one institution who had completed the pre-clerkship curriculum, core clinical clerkships, and the United States Medical Licensing Exam Step 1. The authors identified themes using thematic analysis. Findings: Participants reported that they infrequently used or connected to biochemistry knowledge in workplace patient care activities, yet all had examples of such connections that they found valuable to learning. Most participants felt the responsibility for making connections between biochemistry knowledge and activities in the clinical workplace should be shared between themselves and supervisors, but connections were often recognized and acted on only by the student. Connections that participants described prompted their effort to retrieve knowledge or fill a perceived learning gap. Participants identified multiple barriers and facilitators to connecting, including supervisors’ behaviors and perceived knowledge, and “patients seen” in clerkships. Participants also reported learning biochemistry during USMLE Step 1 study that did not connect to patient care activities, underscoring a perception of disconnect. Insights: This study identifies specific personal, social, and physical environmental elements that influence students’ perceived use of biochemistry during patient care activities. Though these findings may be most significant for biochemistry, they likely extend to other basic science disciplines. Students’ self-directed efforts to connect to their biochemistry knowledge could be augmented by increased social support from clinical supervisors, which in turn likely requires faculty development. Opportunities for connection could be enhanced by embedding into the environment instructional strategies or technologies that build on known authentic connections between biochemistry and “patients seen” in clerkships. These efforts could strengthen student learning, improve clinical supervisors’ self-efficacy, and better inform curriculum design.
KW - basic science
KW - Biochemistry
KW - social learning
KW - student perceptions
KW - workplace learning
UR - http://www.scopus.com/inward/record.url?scp=85133625284&partnerID=8YFLogxK
U2 - 10.1080/10401334.2022.2084400
DO - 10.1080/10401334.2022.2084400
M3 - Article
C2 - 35796605
SN - 1040-1334
VL - 35
SP - 398
EP - 410
JO - Teaching and Learning in Medicine
JF - Teaching and Learning in Medicine
IS - 4
ER -