Design of Learner-Created Electronic Flashcards in Undergraduate Medical Education: Implications for Knowledge and Skill Development

Abstract EFs are an increasingly popular active learning tool among medical learners. Many learners use EFs created by other learners—the content and quality of which may go unchecked by experts and educators. Of central concern is whether learner-created flashcards adequately support competency and skill development in addition to facilitating knowledge acquisition. Our mixed-methods study applied an inductively and deductively developed framework for EF design to a random sample of 1,179 flashcards from popular learner-created EF decks for undergraduate medical education (UME). We categorized each flashcard across four different dimensions: Content Area (e.g., flashcard is relevant to clinical vs. basic science fields), Clinical Reasoning Domain (e.g., flashcard supports reasoning like diagnosis), Knowledge Domain (e.g., flashcard tests procedural vs. informational knowledge), and Cognitive Process (e.g., flashcard involves recalling vs. applying knowledge). EFs in our sample tested a wide variety of knowledge in a variety of ways beyond simple factual recall. We report learner-created EFs can likely elicit higher-order thinking skills and test clinically relevant knowledge which may support clinical reasoning and procedural skill development. However, while Step 2 decks contained more clinically relevant and complex flashcards than Step 1 or preclinical decks, overall clinical relevance and complexity in learner-created EFs was limited. EFs have the potential to support learners in both knowledge acquisition and development of critical skills and competencies. However, learner-created EF decks may benefit from oversight by expert-educators to ensure their content and quality aligns with educational goals. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded by the University of Michigan Rackham Research Grant and the University of Michigan Capstone for Impact Grant. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors.