title: Learning across the explicit, implicit, and extra-curricula: an exploratory study of the relative proportions of residents' perceived learning in clinical areas at three pediatric residency programs.
abstract: OBJECTIVE
  This exploratory multisite study investigated relative proportions of residents' perceived learning across the explicit, implicit (typically called hidden or informal), and extra-curricula for six Clinical Learning Environment Review (CLER) focus areas-patient safety, health care quality, care transitions, supervision, fatigue management, and professionalism-using qualitative and numeric data.
  
  
  METHODS
  In April through June 2013, the authors recruited and interviewed third-year categorical pediatric residents from three sites. For each CLER focus area, the authors asked residents to think aloud while they assigned a total of 60 points to the explicit, implicit, and extra-curricula, according to where they perceived their learning occurred. All interviews were audio taped and transcribed verbatim. The authors coded qualitative data from interviews using the constant comparative method, scrutinized qualitative data for themes, and reviewed qualitative and numeric data.
  
  
  RESULTS
  A total of 28/79 (35%) residents participated. Residents perceived learning to occur most often in the implicit curriculum for five of the six CLER focus areas; the one exception being health care quality, which predominantly took place in the explicit curriculum. In the implicit curriculum, role modeling and "learning by doing" were frequently reported modes of learning. The explicit curriculum was perceived as an important baseline for understanding clinical areas. Relatively less learning was perceived to occur in the extra-curriculum.
  
  
  CONCLUSIONS
  The authors believe that recognizing learning in "other-than-explicit" curricula could broaden the medical education community's understanding of the purview of the medical education curriculum and help educators tap into underused educational opportunities for important clinical topics.
authors.affiliation: D.F. Balmer is associate director, Center for Research, Innovation and Scholarship in Medical Education, Texas Children's Hospital, and associate professor of pediatrics, Baylor College of Medicine, Houston, Texas. S. Quiah is education, assessment, and evaluation specialist, Center for Education Research and Evaluation, Columbia University Medical Center, New York, New York. J. DiPace is assistant professor of pediatrics, Weill Cornell Medical College, New York, New York. S. Paik is assistant professor of pediatrics, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, New York. M.A. Ward is associate professor of pediatrics, Baylor College of Medicine, Houston, Texas. B.F. Richards is assistant vice president, Columbia University College of Physicians and Surgeons, director, Center for Education Research and Evaluation, and professor of medical education in pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Dorene F
authors.initials: DF
authors.lastname: Balmer
authors.forename: Samuel
authors.initials: S
authors.lastname: Quiah
authors.forename: Jennifer
authors.initials: J
authors.lastname: DiPace
authors.forename: Steve
authors.initials: S
authors.lastname: Paik
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ward
authors.forename: Boyd F
authors.initials: BF
authors.lastname: Richards
mesh_terms: D003162:Competency-Based Education / Q000458:organization & administration; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D007858:Learning; D008297:Male; D010372:Pediatrics / Q000193:education*; D014481:United States