Advances in Medical Education and Practice (Aug 2025)
From Reductionist Skills to Meaningful Learning: Trust and Humility in Bedside Cardiac Assessment
Abstract
James L Meisel,1 Deborah D Navedo,2,* Isaac O Opole,3,* Gail M Cohen4 ,† Sheilah A Bernard,5 Hugo Carmona,6 Ahmed H Nahas,7 Carly M Eiduson,8 Nick Papps9 1Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; 2STRATUS Center for Simulation, Brigham and Women’s Hospital, Boston, MA, USA; 3Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA; 4AMA Ed Hub. American Medical Association, Chicago, IL, USA; 5Department of Medicine/Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; 6Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA; 7New England Geriatric Research Education and Clinical Center, VA Boston Health Care System, Boston, MA, USA; Multicampus Geriatrics Fellowship, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA; Yakima Valley Farm Workers Clinic, Yakima, WA, USA; 8University of Rochester School of Medicine & Dentistry, Rochester, NY, USA; 9Synchro Agency, Canton, MA, USA*These authors contributed equally to this work†Dr. Gail March Cohen passed away on 28 March 2024Correspondence: James L Meisel, Office of Academic Programs and Health Professions Education, Mailstop 151b, VA Bedford Health Care System, 200 Springs Road, Bedford, MA, 01730, USA, Email [email protected]: Notions of trust are foundational to competency-based medical education. “Entrustability” underlies assessment; assessment is guided by integration into curricula of learners’ knowledge, skills, and attitudes. However, attitudinal notions of trust are not commonly conceptualized as integral to such frameworks. Overlap between concepts of entrustability and trust as an attitude creates opportunity to infuse trust into competency frameworks. We explored how an original bedside cardiac assessment (BCA) curriculum that supported professional attitudes, knowledge, and skills scaffolded clinical learning in a cohort of internal medicine clerkship students.Methods: The curriculum urged students to hear patients’ perspectives with humility and as key to diagnostic reasoning. Assigned short videos preceded two facilitated classes that included discussing a patient’s startling question, “Why should I trust your clinical skills?” and recognizing, in simulated clinical encounters, disparate patients’ perspectives. To better understand their experiences, we asked sixty-seven students to complete two post-class open-ended questions. We analyzed responses using content and thematic analyses.Results: Emergent codes clustered around themes in two categories: “Successful Learning” around effective learning strategies and meaningful peer encounters, skills practice, and educator encounters; and “Opportunities for Improvement”, around instructional design, learning preferences, and instruction-related improvements.Conclusion: Themes suggested effective learning and meaningful interactions. Comments affirmed the importance of attitudinal aspects of skills development; human interaction while learning; and humility, a linchpin of expertise development and patient-centered communication. All contribute to professional identity formation (PIF). Instructional design improvements were incorporated into the final version of the curriculum. Limitations included inability to examine nuances of emergent themes from the limited data set. We are studying the curriculum’s effects on BCA-related knowledge, skills, and attitudes and trust-worthiness as a learning construct. Research opportunities include impacts on humility, patient-centeredness, and PIF. We hope this exploratory work will stimulate conversations around expanded roles of notions of trust in medical education.Plain Language Summary: Why was the study done?The patient–doctor relationship is built upon trust in the doctor’s knowledge, skills, and attitudes. In this study, researchers explored medical students’ experience of participating in a curriculum that encouraged them to explore such attitudes as humility and trust (“Why should I trust your clinical skills?”) while learning to care for patients with heart problems.What did the researchers do and find?The researchers used an educational approach in which the process of learning is seen as meaningful, not as simply learning isolated facts or skills. To better understand students’ experience of participating in an early version of the curriculum, researchers asked sixty-seven students to complete open-ended questions after two sets of class activities. They then analyzed students’ responses, looking for recurring themes. The analysis suggested that the learning strategies were effective and that learning with peers; skills practice; and interacting with educators were meaningful. The analysis also revealed several opportunities to improve the curriculum itself.What do these results mean?Students reported that human interaction meaningfully contributed to successful learning. In particular, humility was key to patient-centered communication and building trust. All of this suggests the curriculum may help students develop identities as trustworthy professionals. Given a relatively small dataset, a limitation of this paper was that the researchers could not explore further nuance. The researchers anticipate that this work will stimulate conversations around expanded roles of trust in medical education.Keywords: competency-based medical education, UME-GME transition, professional identity formation, humility in medical education, confident humility, trustworthiness in health professions education, clinical teaching/bedside teaching
