Window to the Unknown: Using Storytelling to Identify Learning Needs for the Intrinsic Competencies Within an Online Needs Assessment

Introduction: Needs assessments are important for developing online educational resources, but they frequently do not capture learning needs in the intrinsic physician competencies. Storytelling exercises, by promoting critical reflection and emphasizing values and context, may assist curriculum developers in identifying emergent knowledge gaps in these areas that are initially unknown to learners.

Methods: We developed an online curriculum for thrombosis and hemostasis based on an open-access online needs assessment comprised of a topic list, case scenarios, and storytelling exercise. In the storytelling exercise, learners described 1) a difficult clinical case and 2) why that case was difficult. In this qualitative descriptive study, we performed a secondary thematic analysis of this storytelling data, coded for the CanMEDS 2015 intrinsic roles. Two investigators independently coded transcripts with iterative comparison.

Results: A total of 143 respondents completed the storytelling exercise. All responses yielded a gap in medical expertise, while 25 (17.5%) described an additional intrinsic role. Learning needs in all six intrinsic roles were identified. The most commonly cited learning needs were in the leader (recognizing how resource allocation impacts health care), communicator (communicating knowledge with patients), and collaborator (unclear communication between providers) roles. These excerpts were notable for how they expressed the complexity and affective components of medicine.

Conclusions: Storytelling exercises can highlight context, attitudes, and relationships that provide depth to needs assessments. These narratives are a novel method of identifying gaps in intrinsic physician competencies that are initially unknown by learners (Johari window). These emergent intrinsic learning needs may be used to enrich learner-centered curricula.