Using the cognitive apprenticeship model to identify learning strategies that learners view as effective in ward rounds

Background: Cognitive apprenticeship model (CAM) is an instructional model for situated learning. There is limited data available on application of the CAM in clinical settings. The aim of the study was to identify learning strategies using CAM, which in the opinion of learners are effective in ward rounds. Methods: Participants were residents and medical students who rotated through internal medicine at Aga Khan University Hospital, Karachi. We sought learners' opinion on a structured questionnaire based on four principal dimensions of cognitive apprenticeship. A previously determined set of 10 defined competencies were compared with CAM's six teaching/learning (T/L) methods (modelling, coaching, scaffolding, articulation, reflection and exploration) as well. Mean and SD were calculated. Mann-Whitney test was used to compare scores. Results: Of 195 participants, there were 100 men (51.3%) and 95 women (48.7%). Perceived learning for six T/L methods, ranged from 3.7 to 3.9 (max=5). Coaching and scaffolding had the highest scores. Statistically significant difference between the student and resident groups was noted. Medical students perceived coaching and scaffolding (4.1 and 4.05) and residents rated coaching, articulation and exploration as most effective (3.9 and 3.8). Majority (82.1%) reported a positive learning environment in wards. Conclusions: CAM enabled to identify two T/L methods (scaffolding and coaching) that are important for learning in ward round. Limited differences in perceived effectiveness of the T/L methods indicate that variety can be used to sustain interest in learners. Positive learning environment, team diversity and tasks of increasing complexity contribute to learning.