Back to the Future: What Learning Communities Offer to Medical Education

Opening the black box of school-wide student wellbeing programmes: a critical narrative review informed by activity theory

PURPOSE

Medical schools have a duty of care to support student wellbeing but there is little guidance on how to translate this mandate into practice. Often schools focus on implementing and reporting individual-level interventions which typically only address one aspect of wellbeing. Conversely, less attention has been paid to holistic school-wide approaches towards student wellbeing that address multiple wellbeing dimensions. Thus, this review sought to improve our understanding of how support is mediated within such school-wide wellbeing programmes.

METHOD

This critical narrative review was conducted in two stages. First, the authors searched several key databases for papers published up to 25th May 2021, using a systematic search strategy and TREND checklist to guide our data extraction process. We later expanded our search to include literature published from the original date to 20th May 2023. Second, the identified articles were critically analysed using activity theory as a theoretical lens to aid explanation.

RESULTS

We found school-wide wellbeing programmes emphasize social connectivity and building a sense of community. Tutors take a key role in the activity of supporting students' wellbeing. We mapped out the activity system components to describe the complexity of this tutor role. This analysis illustrated: tensions and contradictions in the system which may open up opportunities for change; the importance of context for influencing how system components interact; and that students' trust underpins the whole activity system.

CONCLUSIONS

Our review shines a light into the black-box of holistic school-wide wellbeing programmes. We identified that tutors play a key role in wellbeing systems but confidentiality is a recurring tension which may jeopardise a wellbeing system. The time has come to investigate these systems in more detail, embracing and exploring the role of context at the same time as looking for common threads.

Defining Learning Communities in the Veterinary Medicine Curriculum

Learning communities (LCs) are a type of high-impact, collaborative educational practice where students cooperate with other students in two or more classes to improve learning. Additional criteria used for defining LCs vary across the literature and have focused on high school and undergraduate programs. Similar benefits may also be experienced in professional programs; however, before further studies can investigate and describe these benefits, the structure for LCs in the veterinary curriculum must first be defined. To accomplish this, a survey instrument was developed and distributed to veterinary students attending Iowa State University College of Veterinary Medicine during the 2019 to 2020 academic year. The survey focused on a number of criteria and included both qualitative and quantitative questions. Criteria included demographics, prior experiences, and structure of an ideal LC. Recurring themes in the qualitative responses were identified, reviewed, and categorized based on an established coding theme. Significant correlations included an association between respondents' opinions on the ideal number of people in a LC and prior participation in LCs; age and preference for LC focus; ideal number of LC members and LC focus; and gender identity and thoughts on LC diversity. Based on the survey results, the typical veterinary student would consider an ideal LC to (1) be selected by the students of the LC, (2) have faculty mentors, (3) have a focus on coursework with some social aspects, (4) have fewer than seven members, (5) be composed of friends, (6) meet both during and after class, and (7) be diverse.

Implementation and evaluation of a pharmacy family program to foster community and inclusion

BACKGROUND AND PURPOSE

Learning communities in the form of student-faculty families in pharmacy education provide a structure to foster community and inclusion. The purpose of this work is to describe how a new Pharmacy Family (PF) program was implemented and to evaluate the impact on students.

EDUCATIONAL ACTIVITY AND SETTING

Our PF program was developed with the goals of building community, promoting a sense of belonging, providing students with opportunities to share and receive advice, and providing a venue for surveillance of student concerns. Each family was comprised of one to two faculty/instructor leaders and three to four doctor of pharmacy students from each cohort and met longitudinally over the course of the academic year. Quantitative and qualitative survey data were collected to assess student perceptions and program satisfaction.

FINDINGS

A total of 233 students (66.2%) completed the survey and the majority (66%) were satisfied with the program. Thematic analysis of open-ended questions revealed four themes that contributed to students' satisfaction ratings: meeting content, relationships, atmosphere, and timing. Students with high satisfaction frequently noted that the program fostered connections, mentoring opportunities, and a safe space to share concerns. Students that were neutral or dissatisfied frequently commented on the timing of meetings and inability to form deeper connections.

SUMMARY

Student-faculty families can be implemented to improve community and engagement within pharmacy education. Our program was most successful in providing a venue for students to share concerns. Addressing meeting times and adjusting the structure to promote community building is warranted to achieve program goals.

Determinants of peer selection for collaborative group work of third-year bachelor students in a medical degree programme with learning communities

The social capital theory reveals the importance of peer relationships on students' learning. However, it is unclear how students select their collaborators under the influence of their previous collaborations and backgrounds. This study explores to what extent students' free selection choices for collaborators among their peers are based on previous collaboration in formally structured groups (i.e., learning communities (LCs)) and based on different students' background characteristics. A parallel program was studied where students studied in one of four LCs for two years and after that, they have to find their own group members within or across LCs to finish their bachelor thesis in the third year. In total, 1152 students' selections of their peers were analyzed. This paper presents the percentages of students choosing group members within or across LCs. It also considered the influence of students' backgrounds, like sex, nationality, and academic performances on their peerchoices by logistic regression analysis. More than half of the students chose group members within their own LC, regardless of which LC they were in. Although the majority of the students chose collaborators within their own LC, still around 40% of students were willing to collaborate with others from different LCs with whom they had never collaborated before in the formal curriculum. Students' backgrounds (i.e., sex, and academic performance) were also associated with their decisions. A high frequency of collaboration within formally structured groups enhances the students' preference of group members from the same groups, but also informal peer relationships are crucial in students' choices for collaboration. Students' sex and academic performance influence their free choice of group members while nationality does not. Students with different academic levels have a higher chance to become group members when they collaborated before in formally structured groups than those students who had not had such a collaboration experience.

Utilizing learning communities to deliver an integrated undergraduate medical education curriculum

AIM

Learning communities (LCs) have been identified as a structure to support student wellness as well as create a positive learning environment and have been increasingly adopted in undergraduate medical education (UGME). In 2016, Michigan State University College of Human Medicine made curricular changes which integrated basic, social, and clinical sciences. One of the major strategies adopted to deliver this integrated curriculum was to create LCs that served as a central scaffold for students' academic development. Our primary aim is to describe how the school utilized LC faculty to deliver this core integrated curriculum.

METHODS

Students were surveyed about their perceptions of the effectiveness of the LCs in delivering an integrated science curriculum. Student academic performance in the new curriculum was compared to that of students from the legacy curriculum as a measure of the effectiveness of the curricular changes.

RESULTS

The percentage of students in each class who responded to surveys ranged between 78.7% and 95.8%. Mean Likert responses (1 = strongly disagree; 5 = strongly agree) for statements 'the Faculty Fellow is effective in helping me learn the scholar group content', 'the Faculty Fellow is an effective teacher in our scholar group', and 'the Faculty Fellow is well prepared for our scholar group' ranged from 4.37 to 4.78, 4.72 to 4.76, and 4.81 to 4.86, respectively. In addition, a comparison of summative exam scores of the new curriculum's students to the legacy curriculum's students demonstrated comparable or better performances in the new curriculum.

CONCLUSIONS

Utilizing LCs to deliver an integrated science curriculum is an underutilized strategy in UGME. Surveys on student satisfaction and academic performance are encouraging. Additional outcome measures are planned to continually evaluate this innovative multifaceted integration.

Implementation and evaluation of pharmaly houses as learning communities to promote community, wellness, and advising

INTRODUCTION

Although medical education has demonstrated learning communities promote wellness and community while supporting advising and mentoring, its application in pharmacy is limited. This study explored faculty and student perceptions of pharmacy learning communities (PLC), including structure, member interactions, and curriculum topics.

METHODS

PLCs involving first-year (PY1) student advisees, third-year (PY3) peer mentors, and faculty coaches were implemented. The PLC model included Pharmaly Houses, which were compromised of multiple Pharmalies, with each Pharmaly consisting of one faculty coach, two PY3 peer mentors, and approximately 10 PY1 advisees. PLC members were invited to participate in semi-structured focus groups, and transcripts were analyzed using inductive coding.

RESULTS

Three major themes and related subthemes emerged: strengths of the PLC structure (e.g., multiple perspectives, community, networking); interactions of Pharmaly members (i.e. faculty coaches, PY3 peer mentors, PY1 advisees); and feedback on PLC curriculum topics (e.g., topic consultation, continued learning). Participants indicated the multiple perspectives provided by Pharmaly members was a strength and highlighted the PLC structure facilitated a sense of community and belonging among Pharmaly members while promoting expanded networking within the House. While the PLC expanded networks, faculty and PY1 advisees desired more one-to-one interactions. Further, students reflected on how current PLC curriculum topics (e.g., wellness) prompted continued learning, reflection, and discussion outside the House or Pharmaly meeting.

CONCLUSIONS

Participants indicated PLCs can support student access to mentoring and advising, promote wellness, and foster a sense of community and belonging. The unique peer mentoring model further promoted community.

How Do Clinical Electives during the Clerkship Year Influence Career Exploration? A Qualitative Study

Problem: Although many students begin medical school with some idea of their specialty interest, up to 80% of these students choose a different specialty by their final year. This pivot tends to happen in the clerkship year, when students are immersed in the clinical environment, gaining a practical understanding of the day-to-day work in different fields. Yet, in this year students have limited experiences with specialties. Clinical electives during the clerkship year may aid students in career development. The authors examined student career exploration through the lens of social cognitive career theory (SCCT). SCCT posits three variables that influence career development: personal goals, self-efficacy, and understanding outcome expectations. With this framework, the authors sought to understand how a program of clinical electives during the clerkship year influences students' perceptions of their career exploration. We aimed to: (1) describe an innovative clerkship elective program designed for career exploration, and (2) explore how this influenced students' career exploration using qualitative analysis. Intervention: Beginning in 2018, students at our institution were required to participate in three 2-week clinical electives during their clerkship year, called Clinical Immersive Experiences (CIExes). CIExes were categorized into four different types: apprenticeship, clinical skills building, integrative (multi-disciplinary), or subspecialty. Authors invited fourth year students to participate in interviews (January to March 2019) about how they selected electives and how these electives contributed to their career exploration. Interviews continued until reaching information sufficiency. Authors coded and analyzed transcripts using template analysis. Context: This curricular intervention took place in the context of large-scale curricular redesign. Students began clerkships partway into their second year of medical school. The family and community medicine clerkship, which was previously a 6-week core clerkship, was changed to a longitudinal format, thus freeing up 6 weeks for electives. Other core clerkships included anesthesia (2 weeks), medicine (8 weeks), neurology (4 weeks), obstetrics and gynecology (6 weeks), pediatrics (6 weeks), psychiatry (4 weeks), and surgery (8 weeks). Impact: From 15 student interviews, we identified three major themes. First, CIExes facilitated personalized career exploration. All students felt that at least one elective helped them solidify their decision about a specialty choice. Second, CIExes promoted focused learning and skills development that complemented core rotations. They noted the benefit of positive relationships with supervisors, particularly attendings, during these electives. Third, students highlighted how these electives fostered a positive learning environment and enhanced wellbeing. SCCT clarified how the CIEx program helped students advance their personal goals, self-efficacy, and outcome expectations during a pivotal time in medical school. Lessons Learned: We learned that from the student perspective, the inclusion of clinical electives in the clerkship year benefited students' career exploration by helping them develop and refine their career goals, increase self-efficacy, and test outcome expectations in a meaningful way as anticipated from SCCT. In addition, we found that CIExes created a positive learning environment that allowed deep relationships to develop in fields of interest and that supported a strong sense of wellbeing. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1891545.

Impact of COVID-19 on Medical Education: Perspectives From Students

This article provides an overview of issues facing medical students in such key areas as communication, preclinical and clinical education, increased isolation, disruption to time-based curricula, inequities in virtual learning, racial trauma, medical student activism, increased conversations surrounding race and racism, LGBTQIA+ students, dual-degree students, and the virtual residency cycle. This article described challenges navigated by medical students during the COVID-19 pandemic, as well as triumphs resulting from the disruption and actionable recommendations in key areas. While the pandemic presented new challenges for medical students, it also uncovered or exacerbated long-standing problems. The intent is for medical schools and institutions to use these recommendations to create learning environments that do not depend on medical student resilience. The main takeaways for medical schools are to: (1) maintain an individualized and learner-centered ethos while remaining dynamic, flexible, and ready to embrace both immediate and incremental changes; (2) maintain open lines of communication; (3) implement policies and practices that support students' academic, physical, and mental well-being; (4) engage and support students who bear historically disadvantaged identities on the basis of race, ethnicity, sexual orientation, gender, or disability; and (5) support creative and collaborative partnerships between medical institutions and students to ensure the ongoing evolution of medical education to meet the needs of learners and patients.

Fireside Chats: A Novel Wellness Initiative for Medical Students in the COVID-19 Era

To supplement preexisting wellness programming for the surgery clerkship, a faculty surgeon at Vanderbilt initiated Fireside Chats (FC) in 2015. Inspired by Franklin Roosevelt’s Depression-era radio broadcasts, FC features small group sizes, off-campus excursions, and a reimagining of the mentor–mentee relationship that eschews hierarchy in favor of deep, mutualistic connections in both personal and professional domains. Here we describe the rationale and implementation of FC and present survey data that demonstrate the warm reception of FC and its efficacy in stewarding the mental health of medical students. Moreover, unlike large group activities such as “learning communities,” FC continues to meet in-person during COVID-19 and preserves social engagement opportunities that may alleviate pandemic-induced isolation and distress.

A Better Learning Community: Mixed-Methods Reveal Medical Student Preferences with Implications for Learning Community Design and Implementation

BACKGROUND

Medical school learning communities benefit students. The College of Medicine (COM) at the University of Arkansas for Medical Sciences (UAMS) provides medical students with academic, professional, and personal support through a learning community (LC) made of 7 academic houses.

OBJECTIVES

To evaluate the effectiveness of the academic house model at UAMS utilizing a mixed-methods survey. The aims were to: (1) assess student experience and satisfaction with academic houses, (2) describe the realms of advising and guidance, and (3) identify areas for improvement.

METHOD

An online survey was assigned to 723 COM students (all students enrolled, first through fourth years) at UAMS in March 2019. The survey was comprised of 25 items (10 multiple-choice, 8 on the Likert scale, and 7 open-ended questions). Data was depicted using frequency and percentages and/or thematic review of free-form responses.

RESULTS

The survey response rate was 31% (227 students). The majority of students responding (132, 58.1%) attended 2 or more face-to-face meetings with the faculty advisor within the preceding year. However, 27 (11.9%) students did not have any meetings. Approximately two-thirds of the respondents were satisfied or very satisfied with the guidance and direction provided by their advisors [very satisfied (n = 83; 36.6%); satisfied (n = 77; 33.9%)]. Themes that emerged from student generated areas for improvement include time constraints, advisor/advisee interest mismatch, and perceived inadequacy of advising content/connections.

CONCLUSIONS

This study confirms the effectiveness of the LC model for advising and mentoring in the COM at UAMS. Uniquely, this study identifies not only learners' satisfaction with their LC but also highlights areas for improvement which are widely generalizable and important to consider for institutions with or planning to start an LC.

The learning community faculty experience: how longitudinal relationships with learners enhance work meaning

INTRODUCTION

Work meaning has gained attention as an important contributor to physician job engagement and well-being but little is known about how faculty participation in medical school learning communities might influence this phenomena. Our study goals were to determine how physician faculty members may derive meaning from serving as mentors for longitudinal learning communities of medical students, to understand how that meaning may impact other areas of their work, and relate our findings to existing literature and theoretical frameworks.

METHODS

The research team conducted, recorded, transcribed, and coded 25 semi-structured telephone interviews of faculty mentors from four US medical schools with curricular learning communities. The team used an iterative interview coding process to generate final themes and relate these themes to existing literature.

RESULTS

The authors identified five themes of meaning faculty derive from participation as learning community mentors: "I am a better professional," "I am more connected," "I am rejuvenated," "I am contributing," and "I am honored." A sixth theme, "I am harmed," encompassed the negative aspects of the learning community faculty experience. The authors found that their identified themes related closely to the theoretical framework for pathways to meaningful work proposed by Rosso et al.

DISCUSSION

The alignment of the themes we identified on the experience of learning community faculty to existing literature on work meaning corroborates the theoretical framework and deepens understanding of beneficial and harmful learning community effects on faculty. As learning communities become increasingly common within medical schools, this understanding may be important for leaders in academic medicine considering potential indirect benefits of this educational model.

The influence of mixing international and domestic students on competency learning in small groups in undergraduate medical education

BACKGROUND

Medical curricula are increasingly internationalized, with international students being mixed with domestic students in small group learning. Small group learning is known to foster competency learning in undergraduate medical education, specifically Communication, Collaboration, Leadership, and Professionalism. However, it is unclear what happens with the learning of competencies when international students are introduced in small groups. This study explores if students in international small groups master the competencies Collaboration, Leadership and Professionalism at the same level as students in domestic groups in an undergraduate medical curriculum.

METHOD

In total, 1215 Students of three academic year cohorts participated in the study. They were divided into four learning communities (LCs), per year cohort, in which tutor groups were the main instructional format. The tutorials of two learning communities were taught in English, with a mix of international and Dutch students. The tutorials of the other two learning communities were taught in Dutch with almost all domestic students. Trained tutors assessed three competencies (Collaboration, Leadership, Professionalism) twice per semester, as 'Not-on-track', 'On-track', or 'Fast-on-track'. By using Chi-square tests, we compared students' competencies performance twice per semester between the four LCs in the first two undergraduate years.

RESULTS

The passing rate ('On-track' plus 'Fast-on-track') for the minimum level of competencies did not differ between the mixed and domestic groups. However, students in the mixed groups received more excellent performance evaluations ('Fast-on-track') than the students in the homogenous groups of Dutch students. This higher performance was true for both international and Dutch students of the mixed groups. Prior knowledge, age, gender, and nationality did not explain this phenomenon. The effect could also not be explained by a bias of the tutors.

CONCLUSION

When students are educated in mixed groups of international and Dutch students, they can obtain the same basic competency levels, no matter what mix of students is made. However, students in the mixed international groups outperformed the students in the homogenous Dutch groups in achieving excellent performance scores. Future research should explore if these findings can be explained from differences in motivation, perceived grading or social network interactions.

Evaluation of a Preclerkship Learning Community Model for Delivering Clinical Skills Curriculum

BACKGROUND

Medical schools are increasingly using learning communities (LCs) for clinical skills curriculum delivery despite little research on LCs employed for this purpose. We evaluated an LC model compared with a non-LC model for preclerkship clinical skills curriculum using Kirkpatrick's hierarchy as an evaluation framework.

METHODS

The first LC cohort's (N = 101; matriculating Fall 2013) reaction to the LC model was assessed with self-reported surveys. Change in skills and learning transfer to clerkships was measured with objective structured clinical examinations (OSCEs) at the end of years 2 and 3 and first and last clerkship preceptor evaluations; the LC cohort and the prior cohort (N = 86; matriculating Fall 2012) that received clinical skills instruction in a non-LC format were compared with Mann-Whitney U tests.

RESULTS

The LC model for preclerkship clinical skills curriculum was rated as excellent or good by 96% of respondents in Semesters 1 to 3 (N = 95). Across multiple performance domains, 96% to 99% of students were satisfied to very satisfied with their LC faculty preceptors (N varied by item). For the end of preclerkship OSCE, the LC cohort scored higher than the non-LC cohort in history gathering (P = .003, d = 0.50), physical examination (P = .019, d = 0.32), and encounter documentation (P ⩽ .001, d = 0.47); the non-LC cohort scored higher than the LC cohort in communication (P = .001, d = 0.43). For the end of year 3 OSCE, the LC cohort scored higher than the non-LC cohort in history gathering (P = .006, d = 0.50) and encounter note documentation (P = .027, d = 0.24); there was no difference in physical examination or communication scores between cohorts. There was no detectable difference between LC and non-LC student performance on the preceptor evaluation forms at either the beginning or end of the clerkship curriculum.

CONCLUSIONS

We observed limited performance improvements for LC compared with non-LC students on the end of the preclerkship OSCE but not on the clerkship preceptor evaluations. Additional studies of LC models for clinical skills curriculum delivery are needed to further elucidate their impact on the professional development of medical students.

Cloaking as a Community: Re-imagining the White Coat Ceremony With a Medical School Learning Community

The Johns Hopkins School of Medicine's Learning Community-White Coat Ceremony (LC-WCC) is held each spring as a learning community (LC) event. Learning communities (LCs) connect people to learn and work across boundaries to achieve a shared goal. The LC-WCC invites first-year students to collaborate with school leaders, define the class professional values, and innovate with community members. Class-elected student leaders recruit peers to join committees to plan and lead several aspects of the ceremony, including a class-nominated speaker, a personal statements presentation, a patient inclusion presentation, a class-authored statement of values, and artistic performances. Student cloaking is performed by LC advisors in their LC small groups. A 2015 post-LC-WCC survey asking students to compare experiences of a traditional Stethoscope Ceremony (SC) with the LC-WCC found that the latter significantly increased students' sense of accomplishment (38% vs 68%, P < .001), sense of connection to the school (59% vs 82%, P < .001), to classmates (71% vs 93%, P < .001), and to the event (42% vs 76%, P < .001). Cloaking as a community is an effective way for a medical school LC to instill a greater sense of community and student leadership in this milestone celebration of humanistic values in medicine.

Defining Learning Communities in Undergraduate Medical Education: A National Study

BACKGROUND

Learning communities (LCs) are intentionally designed groups that are actively engaged in learning with and from each other. While gaining prominence in US medical schools, LCs show significant variability in their characteristics across institutions, creating uncertainty about how best to measure their effects.

OBJECTIVE

The aim of this study is to describe the characteristics of medical school LCs by primary purpose, structures, and processes and lay the groundwork for future outcome studies and benchmarking for best practices.

METHODS

Medical school LC directors from programs affiliated with the Learning Communities Institute (LCI) were sent an online survey of program demographics and activities, and asked to upload a program description or summary of the LC's purpose, goals, and how it functions. Descriptive statistics were computed for survey responses and a qualitative content analysis was performed on program descriptions by 3 authors to identify and categorize emergent themes.

RESULTS

Of 28 medical school LCs surveyed, 96% (27) responded, and 25 (89%) provided program descriptions for qualitative content analysis. All programs reported longitudinal relationships between students and faculty. Most frequently cited objectives were advising or mentoring (100%), professional development (96%), courses (96%), social activities (85%), and wellness (82%). Primary purpose themes were supporting students' professional development, fostering a sense of community, and creating a sense of wholeness. Structures included a community framework, subdivisions into smaller units, and governance by faculty and students. Process themes included longitudinal relationships, integrating faculty roles, and connecting students across class years.

CONCLUSIONS

Medical school LCs represent a collection of high-impact educational practices characterized by community and small-group structures, relational continuity, and collaborative learning as a means to guide and holistically support students in their learning and development as physicians. In describing 27 medical school LCs, this study proposes a unifying framework to facilitate future educational outcomes studies across institutions.

Becoming Doctors: Examining Student Narratives to Understand the Process of Professional Identity Formation Within a Learning Community

BACKGROUND

Professional identity formation is a key aim of medical education, yet empiric data on how this forms are limited.

METHODS

Our study is a qualitative analysis of student reflections written during the final session of our Becoming a Physician curriculum. After reading their medical school admission essay and their class oath, students wrote about a "time, or times during your third year when you felt like a doctor." The reflections were qualitatively analyzed by the evaluation team, looking for themes found in the reflections.

RESULTS

Narrative themes separated into 4 distinct categories, specifically that performing physician tasks can make one feel like a doctor, demonstrating caring is a fundamental task of doctors, integrating personal ideals with professional values promotes professional identity formation, and the theme of never feeling like a doctor. Subsets of these broad categories provide further insight into individual and integrative tasks. Patients, patient families, and students through their own reflection prompted learners to feel like doctors in 74% of narratives, whereas physicians or the care team did so in 26% of our narratives.

CONCLUSION

Students are able to reflect on times during their principal clinical year where they feel like doctors, taking a step toward forming a professional identity. Having faculty prompt and support such reflection can help faculty understand the student experience of their principal clinical year and promote professional identity formation.

Predictors of Student Engagement in Learning Communities

INTRODUCTION

Little is known about what factors predict student engagement in learning communities (LCs). At our institution, we recently converted from an informal, unfunded program with volunteer mentors and no participation requirement to a formal, funded program with a structured curriculum, dedicated mentors, and required attendance. We sought to identify factors that predict student engagement in this new program.

METHODS

Medical students from all 4 years were invited to complete a survey that included self-rating of their level of engagement with their LC. We hypothesized that student engagement would be (1) higher in the new, formal program compared with the informal program; (2) lower among older students; and (3) higher among students who value collective activities for stress management.

RESULTS

In total, 75% of students completed the survey. Students who participated in the formal LC program reported significantly higher engagement than those who experienced the informal version. Older, out-of-state, and underrepresented in medicine (URiM) students reported lower levels of engagement compared with younger, in-state, and non-URiM students, but gender and campus assignment were not associated with level of engagement. Students who valued participation in extracurricular activities, service work, and time with friends or family all had higher levels of engagement in LCs compared with those who valued more solitary activities.

DISCUSSION

The formal, structured LC program was associated with higher levels of engagement than the informal program, and engagement was maintained throughout the 4-year curriculum. Subgroups of students reported lower engagement in LCs, and future research is needed to better understand and address this variability in engagement. This study is limited by the fact that students are only surveyed once annually, at a single institution, and our measure of engagement is brief and dependent on student self-report. In addition, it is not possible to discern from this study which components of the formal LC program were most strongly associated with high engagement.

Associations between learning community engagement and burnout, quality of life, and empathy among medical students

OBJECTIVES

To inform evidence-based design and implementation of medical school learning communities (LCs) by investigating which LC components medical students at one school with a multi-component LC were most valued and which were associated with desirable outcomes.

METHODS

In this cross-sectional study, all Johns Hopkins School of Medicine (JHSOM) students were surveyed in Spring 2016 regarding perceived value of LC components (peers, faculty advisors, Clinical Foundations of Medicine (CFM) clinical skills course, quarterly reflective discussion sessions, social activities, and LC rooms) with learning environment (LE) perceptions, quality of life, burnout, and empathy assessed as outcomes. Multivariate logistic regressions analyzed associations between LC components and outcomes.

RESULTS

Overall 368/480 (77%) students responded.  CFM was highly valued by 286 (80%) students, advisors by 277 (75%).  All LC components were significantly associated with favorable overall LE perceptions, but associations with LE subdomains varied.  CFM was the only LC component to have significant associations with greater empathic concern (OR 2.1, 95% CI=1.2-3.7) and perspective-taking (OR 1.8, 95% CI=1.0-3.1), less emotional exhaustion (OR 0.4, 95% CI=0.2-0.6) and depersonalization (OR 0.3, 95% CI=0.1-0.5), and good quality of life (OR 3.7, 95% CI=1.9-7.1).  Every other LC component, except LC rooms, was associated with greater empathy or enhanced well-being.

CONCLUSIONS

Components within an LC are valued differently and vary in their relationships with student outcomes.  Future LC research may isolate the effects of and explore interactions among different LC components, leading to more purposeful LC design and allocation of resources.