title: Feasibility of self-directed learning in clerkships.
abstract: BACKGROUND
  Self-directed learning has been well described in preclinical settings. However, studies report conflicting results when self-directed initiatives are implemented in clinical clerkships.
  
  
  OBJECTIVE
  To explore the feasibility of self-directed learning stimulated by clinical encounter-cards (CECs) in clinical clerkships.
  
  
  METHODS
  Two focus groups of year-four and year-five students were interviewed about the usefulness of CECs to their learning in clerkships. The CECs were then introduced in two cohorts of 248 year-four and 250 year-five medical students and evaluated on a nine-point scale with regard to usefulness and feasibility.
  
  
  RESULTS
  The pilot groups reported that the CECs had positive effects in terms of engaging in diagnostic reasoning, reflection on management plans, and professional identity formation. However, the two large cohorts of students rated the usefulness of the CECs on learning in clerkship low (year-four: mean 2.92, SD 1.54; year-five: mean 2.28, SD 1.06) along with preceptor support (year-four: mean 2.68, SD 1.62; year-five: mean 2.59, SD 1.78, p = 0.34).
  
  
  CONCLUSIONS
  Self-directed CECs can have a positive effect on participation and clinical reasoning but are highly dependent on the context of use. Self-directed learning initiatives that aim to increase participation in communities of practice may not be feasible without major faculty development initiatives.
authors: University of Copenhagen and Capital Region, Centre for Clinical Education, Blegdamsvej 9, 2100 CopenhagenO, Denmark. martintolsgaard@gmail.com
authors: M G
authors: MG
authors: Tolsgaard
authors: H
authors: H
authors: Arendrup
authors: P
authors: P
authors: Pedersen
authors: C
authors: C
authors: Ringsted
mesh_terms: D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D003479:Curriculum; D003657:Decision Making; D004504:Education, Medical, Undergraduate / Q000379:methods*; D017144:Focus Groups; D006801:Humans; D007858:Learning; D015397:Program Evaluation; D011446:Prospective Studies; D013997:Time Factors