# Discovering social learning ecosystems during clinical clerkship from United States medical students’ feedback encounters: a content analysis

## TL;DR

This study explores how medical students receive feedback during their clinical training, revealing patterns shaped by the unique learning environments of different medical specialties.

## Contribution

The study introduces the concept of 'social learning ecosystems' to explain how feedback practices vary across medical specialties.

## Key findings

- Feedback patterns are influenced by the social and material aspects of clinical work in each specialty.
- Standardized feedback expectations conflict with naturalistic workplace-based learning practices.
- Nurturing specialty-specific learning ecosystems could help students develop a comprehensive clinical skillset.

## Abstract

We examined United States medical students’ self-reported feedback encounters during clerkship training to better understand in situ feedback practices. Specifically, we asked: Who do students receive feedback from, about what, when, where, and how do they use it? We explored whether curricular expectations for preceptors’ written commentary aligned with feedback as it occurs naturalistically in the workplace.

This study occurred from July 2021 to February 2022 at Southern Illinois University School of Medicine. We used qualitative survey-based experience sampling to gather students’ accounts of their feedback encounters in 8 core specialties. We analyzed the who, what, when, where, and why of 267 feedback encounters reported by 11 clerkship students over 30 weeks. Code frequencies were mapped qualitatively to explore patterns in feedback encounters.

Clerkship feedback occurs in patterns apparently related to the nature of clinical work in each specialty. These patterns may be attributable to each specialty’s “social learning ecosystem”—the distinctive learning environment shaped by the social and material aspects of a given specialty’s work, which determine who preceptors are, what students do with preceptors, and what skills or attributes matter enough to preceptors to comment on.

Comprehensive, standardized expectations for written feedback across specialties conflict with the reality of workplace-based learning. Preceptors may be better able—and more motivated—to document student performance that occurs as a natural part of everyday work. Nurturing social learning ecosystems could facilitate workplace-based learning such that, across specialties, students acquire a comprehensive clinical skillset appropriate for graduation.