Transformative Learning in Graduate Medical Education: A Scoping Review

Abstract

Background Transformative learning (TL) is an educational theory focused on deep fundamental shifts in an individual's worldview. Such shifts are well known to occur within graduate medical education (GME). However, TL in GME has yet to be formally explored. Objective We performed a scoping review of the literature on TL within GME to identify areas where trainees currently experience or have potential to experience TL, and to explore areas where fostering TL has been used as a pedagogical tool. Methods In January 2020, we searched 7 databases to identify literature on TL in GME. Additional articles were identified by hand-searching the Journal of Graduate Medical Education. Results A total of 956 articles were identified through database search with 3 unique articles found via hand-searching. Abstracts and manuscripts were screened by 2 authors and disagreements arbitrated by a third, yielding 28 articles for our analysis. The main components of TL (disorienting dilemma, reflection, discourse, action) took various forms. TL was closely linked with professionalism training and professional identity formation. Training programs in primary care fields were most frequently referenced. Often, trainees were experiencing TL without recognition of the theory by their educators. Gaps in the graduate medical education literature exist pertaining to TL in venues such as diversity, equity, and inclusion. Conclusions Our scoping review uncovered the following themes: TL and professionalism, TL and primary care, and TL by other names. TL is likely occurring but going unrecognized in some settings.

Cinemeducation: A mixed methods study on learning through reflective thinking, perspective taking and emotional narratives

“…18,23 Through reflective thinking and a change in perspective, M23C can initiate transformative learning and train participants to become change agents. 8,78,79 Our study supports Brookfield's idea that a film combined with discussion and diverse participants can be the lens for students. 80 While only a small proportion of participants changed their innermost beliefs, M23C can contribute to changing attitudes and actions among participants.…”

A conceptual validation of transformative learning theory

“…However, over the last 20 years, it has become an interdisciplinary lens through which adult learning (i.e., change in beliefs and behavior) can be conceptualized across various disciplines and situations (Taylor and Snyder 2012). Along with extensive practical applications, research on transformative learning has grown significantly in the 30 years in adult education (e.g., Brendel and Cornett‐Murtada 2018; Gawlicz 2022), medicine or public health (e.g., Kerins et al 2020; Tallentire et al 2021; Vipler et al 2021), and general research (Hoggan and Kloubert 2020, Schnepfleitner and Ferreira 2021; Schnitzler 2020) just to mention a few. Most of the research has been qualitative in nature, and few studies have attempted to measure transformative learning, which has limited researchers’ ability to generalize transformative learning theory beyond narrow descriptive accounts and to establish the effectiveness of interventions focused on fostering change.…”

When I say… transformative learning

“…It is also outside of the formal classroom where medical learners begin socialising within a new community of practice 9 as they begin to develop their professional identities. In graduate medical education, Professional Identity Formation appears to be strongly linked to Transformative Learning Theory 10 ; Transformative Learning Theory may be a framework to make sense of the steps one takes in achieving a new professional identity 11 . In other words, as learners experience countless disorienting dilemmas during their training, it is the reflection and discourse inherent to Transformative Learning Theory that ultimately craft their new professional identities.…”

“…The coach can help create such venues, ask good questions of the learners, encouraging introspection and self‐growth. These venues may take the form of Balint groups, one‐on‐one remediation sessions, focus groups, 10 debriefing after simulation 3,14 and guided reflection on the humanities (e.g., art, literature, film) 10 . Scenarios that foster transformative learning in interprofessional settings may be even more impactful, 14 as ‘transformative learning’ and ‘interdependence in education’ were identified as two interconnected pillars that will ultimately lead to equity in health 17 …”

“…These venues may take the form of Balint groups, one-on-one remediation sessions, focus groups, 10 debriefing after simulation 3,14 and guided reflection on the humanities (e.g., art, literature, film). 10 Scenarios that foster transformative learning in interprofessional settings may be even more impactful, 14 as 'transformative learning' and 'interdependence in education' were identified as two interconnected pillars that will ultimately lead to equity in health. 17 Merriam and Baumgartner astutely point out that as of 2020, we do not have any empirical evidence comparing Learning Theory with other educational theories.…”