SHM Converge Scientific Abstract ePoster Gallery-Caught in a Spiral: How Misaligned Expectations Undermine Learning on Wards

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This study used constructivist grounded theory to explain why medical students on clerkship often rely on third-party learning tools instead of patient-centered learning. Researchers analyzed 46 interviews, including student focus groups and resident/attending interviews, using iterative constant comparison, memoing, triangulation, and a consensus codebook.

The analysis produced the <strong>“Spiral of Misaligned Expectations.”</strong> Students enter clerkship with a performance-focused identity shaped by grades, exams, and assessment pressure. This conflicts with educators’ emphasis on clinical growth and patient care. Because students feel less agency in their education, they adopt strategic learning adaptations such as question banks, chart review, and electronic medical records rather than direct patient encounters. At the same time, residents and attendings often believe their own approach is the best or most practical, which intensifies conflict. Frustration and cognitive overload then reinforce the cycle, further pulling students away from patient-based learning.

The authors argue that breaking this spiral requires <strong>multiple coordinated interventions</strong>, not a single fix. These include:
- <strong>Cognitive reframing</strong> to help students see patient care as a source of learning
- <strong>Deliberate educational support</strong> with clear expectations and guidance
- <strong>Experiential learning moments</strong> that allow students to recognize the value of learning from patients

Overall, the model highlights how misaligned goals and expectations among students, residents, and educators create ongoing discord in clerkship education. Recognizing this spiral may help teams realign roles, reduce conflict, and strengthen patient-centered learning on the wards.

Asset Subtitle

Justin Q. Wang

Meta Tag

Author List Amar Kohli, Ashley Youngs, Caroline Olt, Justin Q. Wang, Nicole Luche

Category Research

Concept Misalignment

Concept Spiral of Misaligned Expectations

Concept Clerkship

Concept Assessment

Concept Strategic Learning

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Justin Q. Wang

Track Education

Keywords

constructivist grounded theory

medical students

clerkship education

third-party learning tools

patient-centered learning

spiral of misaligned expectations

performance-focused identity

educational support

experiential learning

clinical growth

Misalignment

Spiral of Misaligned Expectations

Clerkship

Assessment

Strategic Learning