Table 2 Emergent themes related to the Process dimension of self-directed learning

Step 1: Identifying gaps in knowledge

(application of knowledge)

“I feel the gap is that you have to have that knowledge base of what is the classic way that these diseases present, but then you also have to be okay with ambiguity and weighing different competing factors, that would never happen in a UWorld [an online question bank] question.” (Case No.11)

Step 2: Generating learning topics

(direct patient care)

“It wasn’t like ‘Okay, the patient comes in with this, these are the things that you need to research to figure out how to do and what to do for the patient.’ It was more ‘What do you think you need to do for the patient? What do you think are the important diseases or important problems?‘” (Case No.13)

Step 3: Finding learning resources

(learning from team members)

“I feel usually no hesitation with reaching out to whether it’s fellow medical students who I may be on service with, classmates, residents, attendings, or fellows, proposing to them what my thought process is, and then (asking) whether they’ve experienced similar encounters in the past, how they would think about the case, and what they would recommend us as next steps.” (Case No.5)

Step 4: Implementing learning strategies

(cognitive strategies)

“One of the things I like to do is, whenever something comes up on rounds that I don’t understand. … I’ll write it down on a piece of paper, and then I can look it up when I go home. So that’s one way for me to keep tabs on knowledge capturing me.” (Case No.3)

Step 5: Self-assessing learning outcomes

(self-reflection)

“For most rotations, I would track what I’ve done, how many patients I saw or what they had. Like anything important that happened during the day, I would write down. So, I do like to track all the patients that I’ve seen, what conditions they have, what their diagnosis was. That’s a good way to go back and reflect and see what you’ve done.” (Case No.14)

Step 6: Building the framework in learning

(big picture for learning)

“They [The residents] definitely do not help guide you by telling you, ‘Go read this thing.’ … They do not do that. I think the way they help guide you is they might ask you the leading questions about this particular case, to help you recognize this patient’s big picture.” (Case No.12)