From "See One" to "Do One": Medical Students' Cognitive Processing of Observed Clinical Encounters

Context: Medical trainees spend a significant amount of time observing more experienced clinicians, yet our understanding of how learners process these observations remains incomplete. While previous research on this topic focuses primarily on how learners process positive modeled behaviors, this exploratory study aims to investigate how medical students interpret the observation of a more experienced clinician modeling both positive and negative behaviors as well as how that interpretation influences their subsequent clinical performance. Methods: The authors conducted a video-based intervention with 11 medical students to investigate the effect of observing a mix of positive and negative modeled behaviors on taking a sexual history from a standardized patient. Using an interview methodology and constructive analytic approach, the authors explore the process of learning from clinical observations. Results: The results were organized in three stages of the observation learning process: 1) learner attention, 2) judgement of observed behavior and 3) learner application. Specifically, students focused their attention on negatively modeled behaviors, challenges specific to the task and how areas of their own personal development were accomplished. Students took a piecemeal approach to classifying behaviors as done well or poorly based on previous instruction, experience or perceived downstream effects. When applying their observations, students choose to copy, adapt or avoid modeled behaviors based on their classification of the behavior. Conclusions: Faculty can apply these findings to optimize learning from observation. Specifically, clinicians may consider identifying task-specific challenges and a student’s personal goals, which naturally draw the student’s attention, before a planned observation in order to develop a shared mental model. To frame debriefing of encounters, clinicians may consider the natural targets of learner attention, the challenges specific to learning from observation and the factors likely to influence judgement on observed behaviors identified in this work.