Mission Seemingly Impossible: Student Satisfaction with Time for Self-Directed Learning

Background. Medical schools accredited by the Liaison Committee on Medical Education (LCME) are often required to demonstrate improvement on accreditation elements in a relatively short amount of time. In October 2021, the LCME cited our institution as Unsatisfactory for the self-directed learning (SDL) element after 21.3% of second-year medical (M2) students reported dissatisfaction with unscheduled time for SDL. The LCME required us to demonstrate improvement in a status update due December 2022. In this paper, we describe a rapid continuous quality improvement (CQI) approach that successfully increased student satisfaction and achieved full compliance within 1 year. Methods. We employed a rapid CQI approach to (a) investigate reasons for dissatisfaction, (b) implement targeted interventions, and (c) monitor success of implementation. We held a focus group in March 2022 to understand student dissatisfaction and used rapid qualitative evaluation techniques to analyze the discussion. Results. We determined the chief root cause of the dissatisfaction to be M2 students’ lack of appreciation for the importance of practicing SDL skills as they increased their studying for United States Medical Licensing Examination (USMLE) Step 1. The curriculum committee asked curricular leaders to implement curricular changes in August 2022 to better highlight the relevance of SDL skills to clerkship performance and demonstrate to M2 students the value of practicing these skills. Curricular leaders made further changes to help students develop more efficient information literacy skills. Results of an October 2022 survey showed M2 satisfaction with the adequacy of unscheduled time for SDL improved to 94.3%. Conclusions. A focus group clarified student perceptions. Small changes to the SDL curriculum improved student satisfaction. Students may have been especially responsive to messaging that efficient SDL skills are a critical component of clerkship performance.