Exploring Participation as a Mechanism of Domain-Specific Learning During Otolaryngology Clinical Clerkships

Clinical clerkships are a form of workplace-based learning in which authentic participation is considered a key contributor to learning. However, it remains unclear which domains of clinical learning depend on authentic participation and which can be supported through structured instructional activities. Taking advantage of the educational changes associated with the COVID-19 pandemic as a natural educational experiment, this study examined how differences in opportunities for authentic participation were associated with domain-specific learning outcomes during otolaryngology clinical clerkships.

This comparative cross-sectional study analyzed prospectively collected educational evaluation data from 237 fourth- and fifth-year medical students who completed otolaryngology clinical clerkships between January 2021 and March 2023 (196 in-person and 41 online). Both clerkship formats shared identical educational objectives but differed in opportunities for authentic workplace participation. Learning experiences were assessed using an eight-item questionnaire representing participation-dependent and participation-independent learning domains. Group comparisons were performed using Mann-Whitney U-tests and Levene's test for homogeneity of variance.

Median scores were generally comparable between the in-person and online clerkships across most domains. However, response variability differed significantly for clinical documentation and patient status reporting (p = 0.0047), with higher variance in the online group. No significant differences were observed for clinical reasoning, professionalism, understanding of otolaryngology, or overall satisfaction.

Within the limitations of this exploratory study, our observations tentatively suggest that clinical learning may not be uniformly dependent on authentic workplace participation. Cognitive learning outcomes may be supported through structured instructional activities, whereas experiential learning may depend more strongly on opportunities for authentic participation. These findings may provide a conceptual framework for future studies and for the design of hybrid clinical clerkships that intentionally integrate structured instruction with meaningful workplace participation. Further multicenter studies using objective assessments are warranted to confirm these observations.