Effects of an Experiential Learning Curriculum on Systems-Thinking

Abstract

Introduction: Though health systems science (HSS) is referred to as the third pillar of medical education along with the pillars of basic science and clinical care, the effects of learning theories used to teach components of HSS including quality improvement/ patient safety (QI/PS), are poorly understood. Experiential learning theory is often referenced in QI/ PS education but its effects on QI/PS education are not well-described.

Objective: To examine the effects of teaching QI using experiential learning theory on resident systems-thinking.

Methods: Data was gathered from 30 resident participants in a 3-h QI workshop designed using experiential learning theory. Using a mixed-methods design, aspects of learner systems-thinking were analyzed both before and after the workshop. Learners were asked about their confidence in systems-thinking behaviors, and their QI plans were evaluated qualitatively for themes as well as quantitatively via the QIKAT-R.

Results: There was a significant increase in self-reported confidence in systems-thinking behaviors post-workshop. Odds ratio of the QI aim statement focusing on the systems-level of the problem after the workshop was 41.4 with a 95% CI of 8.9142 to 192.2721, p-value .0001. Thematic analysis of QI plans revealed a change in residents' thinking about healthcare problems. They shifted from attributing problems to individual actors to thinking about the problem as lying in the interaction between systems.

Conclusion: Experiential learning theory can be an effective framework for QI to transform learners into systems-thinkers.

Keywords: Quality improvement; experiential learning; medical education; systems thinking.

Figure 1.

Kolb's experiential learning cycle.

Figure 2.

Application of experiential learning theory to learning activities.

Figure 3.

Measuring the elements of system thinking.

Figure 4.

Using the experimental learning cycle to create system's thinking.