Hello COMSEP!
Attached and below is our January edition of the Journal Club, including a look at the value of stress in learning, a patient-informed curriculum on disability and the use of an escape room to supplement clinical skills practice.
Do the best you are able and don’t stress—there’s always an escape!
Enjoy,
Jon, Karen and Amit
Stress the Positive
Beck J, O’Hara K, van der Schaaf M, O’Brien B. Can Stress Be Good for Learning? Pediatric Resident Perspectives on the Beneficial Influence of Stress on Learning and the Role of the SupervisorAcademic Medicine 2025; 100(12):1363-1364. https://dx.doi.org/10.1097/ACM.0000000000006069
Reviewed by: Angie Moshutz & Preetha Krishnamoorthy
What was the study question?
How do pediatric residents perceive the stressors that influence their learning, the outcomes of that learning, and the role supervisors play in determining whether stress is helpful or harmful?
How was the study done?
This qualitative study was guided by a stress-learning pathway framework. Twenty pediatric residents (PGY1–3) from one program participated in semi-structured interviews exploring stressful clinical experiences, associated learning outcomes, and supervisory behaviors. Transcripts were analyzed using template analysis, combining theory-based deductive codes with inductive codes from participant narratives. Themes and sub themes were developed.
What were the results?
All residents described at least one stressful experience that contributed to learning. Analysis identified six themes: (1) Work-related stressors can lead to valuable learning: common stressors included first-time clinical tasks, diagnostic uncertainty, and fear of evaluation; (2) Valuable learning can result from stressors: stressful experiences were associated with learning outcomes including increased confidence, preparation for independent practice, and improved teaching behaviors; (3) Supervisors were sources of stress by granting autonomy, holding trainees accountable, and setting high expectations, often promoting deeper engagement and learning; (4) Supervisors also played a critical role in modulating stress by normalizing it, recognizing individual stress thresholds, and intervening when stress impeded learning or patient safety; (5) Senior residents emerged as particularly influential supervisors, as trainees were more willing to disclose stress to near-peers than attendings; (6) Supervisors can use strategies to intentionally harness learning from stress, including tailoring challenge to individual learners, diffusing stress across teams, and conducting regular “stress check-ins”.
How can this be applied to my work in education?
Stress is an inherent part of medicine and cannot be avoided. Rather than aiming to eliminate stress from training, this study emphasizes an educational mindset that intentionally manages stress. When educators accept stress as part of clinical learning and respond thoughtfully, it can support confidence, clinical judgment, and professional growth. How stress is handled in training matters, and appropriate support can help transform unavoidable stress into a positive component of physician development.
Editor’s Comments: I liked how the authors describe finding a balance in terms of challenging learners whilst being aware of the “tipping point” after which stress no longer fosters learning. It was particularly interesting that, although these learners described benefits of stress on learning outcomes, they were still afraid to acknowledge stress to their attending physicians. The big question is -how to address this tension in the clinical learning environment? (KFo)
Including the Disability Perspective in Medical Education
Robak, K. , Prokup, J. , Banks, J. , Granovetter, M. , Hyre, N. , Muenzer, M. , Villagomez, A. , Houtrow, A. & Hurwitz, M. (2025). Inclusion in Medical Education. American Journal of Physical Medicine & Rehabilitation, 104 (9), 849-854. doi: 10.1097/PHM.0000000000002727. https://doi.org/10.1097/phm.0000000000002727
Reviewed by Pooja Vikraman
What was the study question?
Will a person-centered disability curriculum co-designed with people with disabilities increase preclinical medical students’ self-reported confidence in caring for patients with disabilities?
How was the study done?
The authors performed a needs assessment with a literature review and qualitative interviews with students and persons with disabilities. Using this information, they developed an elective for 1st and 2nd year medical students. Coursework included small-group work, pre-class assignments, reflections, panel discussions, brief lectures, and readings, incorporating deidentified quotes from interviews. Effectiveness of the curriculum was determined with comparisons of pre/post surveys assessing 11 learning objectives on a 5-point Likert scale to rate student confidence on the subject matter.
What were the results?
Eleven students completed the course from 2023-2024. Students’ self-reported confidence increased on the 5-point Likert scale among all 11 learning objectives investigated. The greatest improvements in scores were noted in sections regarding understanding of importance of advocacy, equity, and equality in addition to the ability to define models of disability and understanding of disability inclusion.
Students identified main takeaways of the course as learning about the importance of disability culture, personal identity, and advocacy. They indicated improvements in their ability to identify barriers for patients with disabilities. They also acquired new language to address these topics and practical ways to prepare for patient encounters.
Areas for improvement from students included discussions about invisible disabilities, acquired versus congenital disabilities, and aging with disability.
How can this be applied to my work in education?
Inclusion of instructors, whether faculty, trainees, or patients, with lived experiences in the topics that are covered in medical student curricula can greatly augment student understanding and empathy within the field. Lessons co-designed and/or informed by people who have had disabilities themselves can provide new perspectives that medical students may not otherwise encounter until late in their careers. Integrating this style of teaching for medical students offers a humanistic lens that can improve disability cultural competence and facilitate confidence in providers when working with these patient populations.
Editor’s Note: The most interesting part of this study was using patients to understand how best to construct the curriculum. For many years we have developed our medical curriculum without this perspective when it could better align with our goal of training patient-centered clinicians. (AP)
This EKG will self-destruct in 5 seconds…
Khera S, Wai A, Ford C, Yoo A, Joe D, Oyoyo U. Implementing an Escape Room for Clinical Skills Practice in a Paediatrics Clerkship. Clin Teach. 2025 Apr;22(2):e70033. https://dx.doi.org/10.1111/tct.70033
Reviewed by Vallent Lee
What was the study question?
Is it feasible to add a short escape room activity immediately after a facilitator-assisted simulation session to strengthen the "active experimentation" step (independent, hands-on practice) in Kolb's experiential learning cycle, and do learners' knowledge and confidence improve?.
How was the study done?
Following a facilitator-assisted simulation that taught nine clinical skills to third-year medical students, the authors implemented a 40-minute, team-based escape room. The activity reinforced those skills by requiring teams to apply them to the evolving case of an unstable toddler with seizures. Learners advanced by performing clinical tasks and solving context-linked puzzles to open locks and progress through stations. Pre-simulation, post-simulation, and post-escape room surveys assessed knowledge and self-rated confidence. This was a single-site study without a control group (all clerkship students that academic year participated).
What were the results?
Knowledge improved significantly from pre- to post-simulation and was generally maintained after the escape room. Confidence rose after the simulation and, for some skills, increased further after completing the escape room. Learners most valued the escape room's opportunities for application/practice, fun, and teamwork.
How can I apply this to my work in education?
Use an escape room as a structured independent-practice bridge after instruction or simulation: create urgency with time limits, require performance of newly taught skills, and embed tasks in case-linked puzzles. To align with self-determination theory, build in autonomy (role choice, optional pathways), competence (clear objectives, calibrated difficulty, controlled hint system), and relatedness (interdependent puzzles with a shared team goal, solvable through collaboration). End with a focused debrief to consolidate learning and skill transfer.
Editor’s Note: This is a creative and clearly engaging way to provide clinical skills practice to clerkship students. The assessments only reach Kirkpatrick level 2, and since this is a team exercise I’m not sure all students would necessarily get skills practice, but there is clear evidence of knowledge transfer (JG).