LCME Element 6.3 – Self-Directed and Life-Long Learning

The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences and unscheduled time to allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; appraisal of the credibility of information sources; and feedback on these skills.

Element 6.3 is one of the most challenging elements for medical schools to interpret and implement. In fact, 6.3 makes LCME’s list of most cited elements because it demands a program provide the curricular space for an open-ended, student-centered activity which also must follow a prescribed structure. Additionally, a school must have the faculty bandwidth to provide individualized feedback to each student. In other words, the nature of this activity is far from the relative ease of multiple-choice questions assessments. At the same time, the main purpose of the element is one that we can all support as educators – to elevate a learners’ abilities to self-assess their own knowledge and gaps, and then seek and use credible information. Given the rapid pace of medical advancements, Element 6.3 conveys the need for a skill set that is essential to the profession and successful practice of medicine.

Hidden Curriculum

Element 6.3 should be delivered in the preclerkship portion of your curriculum so that students are reasonably prepared for the ambiguity of clerkships. The LCME does not specify the type of course in which SDL should be embedded, nor does it specify the number of times that it must occur. Therefore, you will need to judge this for your own school and be prepared to defend your choice. Your curriculum committee should definitely weigh in on the decision and make sure that is thoroughly documented in the minutes.

Remember that the Element includes 4 distinct requirements which are:

Self-directed learning involves medical students’ :

1. Self-assessment of learning needs
2. Independent identification, analysis, and synthesis of relevant information
3. Appraisal of the credibility of information sources
4. Feedback on these skills from faculty and/or staff All 4 of these bullets need to happen in the SAME COURSE in the SAME SEQUENCE outlined in the element. You can’t spread these around like seeds in the wind. That won’t cut it. And when it says FEEDBACK – that means an individual student gets feedback.

All 4 of these bullets need to happen in the SAME COURSE in the SAME SEQUENCE outlined in the element. You can’t spread these around like seeds in the wind. That won’t cut it. And when it says FEEDBACK – that means an individual student gets feedback.

Best Practice

• Use the sequence above in your syllabus and DCI when describing how it’s done. Use the exact words, exactly.  
• Faculty should articulate the expectations associated with the activity.  They should explicitly use the sequence language when explaining the task at end.
• Word of warning: faculty should refrain from giving students the research questions and sources.
• Provide time in the curriculum to teach students how to access and appraise information sources.  University librarians are good partners for teaching students how to make the best use of resources.  Consider giving these professionals some airtime early in the preclinical curriculum, even in orientation.
• Faculty must provide feedback to each student, and the feedback should focus on the student’s selection and use of credible information to answer a self-selected question.  The LCME recently clarified that a student does not have to receive feedback every single time a student completes the steps, but sufficient feedback should be provided to develop proficiency prior to clerkships. Remember – feedback can be one-on-one (challenging for most schools), but also in a grade, or in a document provided at the conclusion with questions and responses.
• Ensure your school has a policy in place that provides sufficient unscheduled time to allow students to complete SDL.  Here is an example of a policy:  https://www.med.unc.edu/md/policies/wp-content/uploads/sites/883/2019/01/Monitoring-Student-Time-in-the-Foundation-Phase-LCME-8.8.pdf

Continuous Quality Improvement

• This is an element that seems to drift considerably after your site visit is over. This should not happen.
• Make sure you review this element at least every 2 years to ensure you are compliant
• Highly suggest that you create a form for students to use when completing the steps that actually has the sequence written right on it. And yes, you can label the form in big, bright bold letters….SELF DIRECTED LEARNING.  Make sure your Course Directors haven’t drifted away from this/changed the worksheet format as time from the LCME visit passes.
• Make sure your curriculum committee reviews the adequacy of 6.3 as part of your Pre Clerkship Phase Review and Whole Curriculum Review
• Make sure you look at the ISA questions on adequacy of time for independent study/self-directed learning etc. (these questions verbiage drift over time too). You want to incorporate these questions into an annual review/course review etc so you aren’t surprised when it’s time for your Self Study to begin.