Codesigning Learning-By-Concordance Modules for Continuing Medical Education: Insights from Team Dynamics

Educators perceive the development of case-based Learning-by-Concordance (LbC) clinical reasoning tools for continuing medical education as time consuming due to the complex pedagogical concepts and formats involved. Because designing effective LbC tools requires teamwork, we observed a team comprising seasoned physicians and educational experts during the codesigning of two modules to identify the key factors that facilitate this process.

For this exploratory study, we gathered observational data from instructional codesign sessions, capturing participant utterances during the sessions and in immediate follow-up group discussions. We further enriched this dataset with separate, stand-alone focus groups. Applying a thematic analysis guided by the input-mediator-output-input model, we evaluated all data to examine three specific team processes: role attribution, maintenance interventions, and decision making.

The participant group comprised eight individuals: four clinical educators, two LbC specialists, and two researchers. The first LbC module required 10 sessions, whereas the second required only four. Through thematic analysis, we identified three themes: (1) A conceptual tension was needed to be resolved to further codesign; (2) directive leadership effectively drove the codesign process; and (3) the codesign process advanced through nonlinear, punctuated phases of activity.

The production time discrepancy between the two modules highlights both the challenges and benefits of collaborative instructional design. It demonstrates how codesign can be operationalized within continuing medical education while remaining closely aligned with clinicians' real-world practice needs. Ultimately, supporting the development of clinical reasoning skills for complex, uncertain scenarios demands the structured yet flexible codesign framework detailed in our findings.