Towards an Explanatory Framework of Informal and Incidental Learning in Medical Education: A Deductive Analysis of Critical Incidents from Frontline Physicians Working During the COVID-19 Pandemic

Learning Objectives: Our study aims to describe how emergency medicine physicians engage in and rely on informal and incidental learning when working through the uncertainty of clinical practice.Background: Informal learning is implicit, organic, and unstructured. Opportunities for informal learning arise in ill-structured, unstable environments where established processes may fail to provide a means of understanding situations or to develop strategies to problem-solve. We examined the Marsick and Watkins Model of Informal and Incidental Learning (IIL) as a framework to describe how physicians learn in the clinical environment, particularly when working through heightened uncertainty.Objective: Our study aims to describe how emergency medicine physicians engage in and rely on informal and incidental learning when working through the uncertainty of clinical practice.Methods: A qualitative deductive analysis of physicians’ narratives using the critical incident technique was conducted to gain an understanding of the components of IIL. Six frontline emergency medicine and six critical care physicians who worked during the height of the pandemic (March-June 2020) were interviewed. Investigators shortened narratives from recorded, transcribed interviews into cohesive, chronological stories using participants’ words. We applied codes from the IIL Model and engaged in constant comparative analysis to identify categories, patterns, and sequences of IIL.Results: Data suggest that the IIL Model and its components serve as an explanatory framework to describe physicians’ learning during uncertainty (Table 1). Consistent with previous research from the non-healthcare sector, the complexity of IIL is captured as cyclical, non-linear, non-sequential and highly intertwined with patient care.Conclusions: Data from physicians’ critical incidents clarifies understanding of IIL when working through clinical uncertainty. The Marsick and Watkins Model offers an explanatory framework for how IIL may guide educational programming that links to stages of IIL to prime students for the learning they will engage in when in clinical practice