Self-directed learning in Orthopaedic trainees and contextualisation of knowledge gaps, an exploratory study.

Background: Self-Directed Learning (SDL) is a subjective concept with no universally agreed definition. The aim of this project was to obtain the perspectives of Orthopaedic trainee registrars on SDL.

Methods: Seven Orthopaedic trainees in the Southwest Peninsula region were recruited in person by the primary author as an Orthopaedic trainee on the same programme as the participants. A one-hour Microsoft teams video interview was arranged at a mutually convenient time exploring several topics including learning resources, experiential learning, learning strategies, training programme requirements and assessment. The interviews were audio recorded and transcribed verbatim. Transcripts were coded using Corbin's and Strauss's published coding method and analysed to develop a model of SDL in this training context.

Results: Six learning stages were identified from the coded transcripts and these stages were like Knowles's stages of SDL. Participants felt less autonomous during the identification of knowledge gaps, goal setting and evaluation of learning stages. Participants perceived to have more control over the selection of strategies, and learning stages of SDL. The factors which influenced autonomy at various stages of SDL included supervisors, experiential learning opportunities, service provision competing with learning opportunities, training programme requirements and the power dynamic between trainees and supervisors. Self-advocacy by the trainees for experiential learning opportunities and for their progression was an additional action relevant to SDL that was evident. Online learning resources such as Orthobullets.com, YouTube videos, external revision courses, collaboration and webinars encouraged more autonomy with SDL.

Conclusions: Although the United kingdom's Trauma and Orthopaedic curriculum is described as trainee led and SDL is encouraged, in practice Orthopaedic trainees felt limited autonomy with the various stages of SDL due to external factors including their level of experience and the training environment. Trainees' experiences around self-advocacy highlighted the importance of a collaborative and supportive learning culture emphasising dialogue, receiving high quality feedback, and openness for successful progression.