Finding Meaning in the K/S/A of Bedside Cardiac Assessment
Authors: Meisel James L. , Navedo Deborah D. , Opole Isaac O. , Cohen Gail March , Bernard Sheilah A. , Carmona Hugo , Nahas Ahmed H. , Eiduson Carly M. , Papps Nick 
Published: August 2022

PURPOSE

Notions of trust are foundational to competency-based medical education. “Entrustability” underlies assessment; assessment is guided by integration into curricula of learners’ knowledge, skills, and attitudes (k/s/a). However, attitudinal notions of trust are not commonly conceptualized as integral to such frameworks. Overlap between concepts of entrustability and trust as an attitude creates opportunity to infuse trust into competency frameworks.

We explored how an original bedside cardiac assessment (BCA) curriculum that supported professional attitudes, knowledge, and skills scaffolded clinical learning in a cohort of internal medicine clerkship students.

METHODS

The curriculum urged students to hear patients’ perspectives with humility and as key to diagnostic reasoning. Assigned short videos preceded two facilitated classes that included discussing a patient’s startling question, “Why should I trust your clinical skills?” and recognizing, in simulated clinical encounters, disparate patients’ perspectives.

To better understand their experiences, we asked sixty-seven students to complete two post-class open-ended questions. We analyzed responses using content and thematic analyses.

RESULTS

Emergent codes clustered around themes in two categories: “Successful Learning” around effective learning strategies and meaningful peer encounters, skills practice, and educator encounters; and “Opportunities for Improvement,” around instructional design, learning preferences, and instruction-related improvements.

CONCLUSION

Themes suggested effective learning and meaningful interactions. Comments affirmed the importance of attitudinal aspects of skills development; human interaction while learning; and humility, a linchpin of expertise development and patient-centered communication. All contribute to professional identity formation (PIF). Instructional design improvements were incorporated into the final version of the curriculum. Limitations included inability to examine nuances of emergent themes from the limited data set.

We are studying the curriculum’s effects on BCA-related k/s/a and trust-worthiness as a learning construct. Research opportunities include impacts on humility, patient-centeredness, and PIF. We hope this exploratory work will stimulate conversations around expanded roles of notions of trust in medical education.

Plain-language Summary

Introduction

The patient–doctor relationship is built upon trust in the doctor’s knowledge, skills, and attitudes (k/s/a). In this study, we explored medical students’ experience of participating in a curriculum that encouraged them to explore the “attitudes” domain related to humility and trust (“Why should I trust your clinical skills?”) while learning to care for patients with heart problems.

Methods

We used an educational approach that sees learning as meaningful, not simply knowledge to be absorbed. To better understand students’ experience of participating in an early version of the curriculum, we asked sixty-seven students to complete two open-ended questions after classes. We analyzed their responses looking for recurring themes.

Results

Thematic analysis suggested that learning strategies were effective and that learning with peers, skills practice, and interacting with educators were meaningful. The analysis also suggested several opportunities for improvement.

Discussion

Students reported that human interaction, that is, learning in the attitudes domain, meaningfully contributed to successful learning. In particular, humility is key to patient-centered communication and building trust. All of this suggests the curriculum may help students develop identities as trustworthy professionals. Limitations of this paper include inability to explore nuances of themes from the limited data set. We hope that this exploratory work will stimulate conversations around expanded roles of trust in medical education.