Table 1 Supporting quotations for themes in the process of resident SDL

Knowledge framework

The main goal was building a knowledge framework required to be a physician

“In a perfect world I’d spend 2 h every day going through topics categorically and have this nice wide knowledge base and really have a good comprehensive understanding” (group 5).

“To formulate a framework on my own that works for me … I was able to synthesize my own kind of format” (group 4).

“Every time I have a patient that comes in with a problem that I don’t necessarily grasp, and I have to pull up whatever resource, that’s SDL, …I’m going to remember that framework that I’m starting to develop” (group 4).

Faculty and senior residents who “ask the right questions” (group 2) can trigger SDL by making it “clear an area I’m weak in, and that’s the area I go try and fill the void. …So I like people asking me questions because that tells me where I’m weak and helps me get stronger in those areas” (group 4).

Uncover knowledge gap

The trigger uncovered a gap in the resident’s current framework

“SDL is the process of identifying your weaknesses and your goals for learning” (group 5).

“It’s about filling in your own gaps of knowledge. …I’m taking care of a patient and they have [a problem] so you go read about it. … you’re filling in your own gaps of knowledge” (group 4).

“You get a concise and a clear question and say, ‘We’re trying to decide between these two drugs, which one is better?’ That’s a clear and concise question that’s directly [clinically] relevant and easy to answer” (group 4).

“It’s such an open, broad, vast sea of stuff that I could be studying. Triaging what I should study, what order I should study it, how much time I should dedicate to it. The system, …I consider it to be SDL” (group 6).

“Knowing what resources give you what information and what amount of time you’ll take to find it” (group 1).

“So for example, when you’re trying to figure out how to treat a specific condition, a well-written review article can be very high yield. …I’ve had to go through a lot of trial and error to find out what resources I like for what topics and in what situations and I’ve had some guidance” (group 3).

“A lot of this learning is not so much learning the topic but learning where to find information, how to access the right information at the right time, and what resources are available to us. …Those things are much more important to learn” (group 2).

Apply knowledge

Residents applied the knowledge gained through SDL

“If I read something and I don’t apply it anywhere for a few months, then it won’t stay with me, but applying it clinically and seeing it in a patient, making some difference with what you learned, is a very important factor in making it stay with you” (group 7).

“I’ve found that I learn the best when I have to teach someone about something…when I have to actually read and understand everything fully so I can teach it to others” (group 7).

“You need some external assessment; it’s really hard to assess yourself. You definitely need some external evaluation of your performance because you’re not objective about yourself” (group 4).

“I don’t really feel convinced that I’ve learned anything until I encounter the same scenario again and feel more comfortable with it…or if you feel like you’re thinking about other things than you would have the first time around, those are some of the clues that make me feel like I’ve learned something” (group 3).

“I didn’t realize I learned everything first year until I got an intern second year. … You always just feel like you are struggling to stay afloat. But when you get someone below you, that’s when I actually found out that it was working” (group 3).