"It's Always There, Right?" Exploring Internal Medicine Teams' Use of Basic Science Knowledge on Inpatient Rounds.

Purpose: Attendings and trainees are expected to use basic science knowledge (BSK) in clinical practice and learning. Evidence of how is scant, and more research situated in clinical learning environments (CLEs) is needed. Our study aimed to characterize use of BSK during patient care in a CLE and the actions, interactions, materials, and beliefs that influence its use, to inform efforts to connect BSK education to clinical workplace learning and patient care. Method: We conducted a constructivist grounded theory study, collecting data from eight inpatient Internal Medicine (IM) teams at one US institution from October 2022 to January 2023. Data included field notes from 27 hours observing inpatient rounds and 24 team member interviews. Iterative data analysis involved coding, memo writing, and constant comparison to develop a theory of BSK use on IM inpatient rounds. Results: We found that BSK can be activated on rounds through social interactions (among team members, with patients), and in contact with materials (e.g. the electronic health record). Our findings describe BSK as activated when team members connect to and test BSK or when they explore uncertainty; and that activation is supported by beliefs that BSK use brings value to patient care. However, team members often left BSK not activated, accompanied by beliefs about it not being a good fit for patient care activities. Actions associated with leaving BSK not activated included delegating responsibility for using it, deferring discussion, or curtailing conversations about it. Discussion: Much of the literature describes BSK use in the clinical setting as the product of individual cognition. Our findings extend this characterization, illustrating how social and material elements of the inpatient CLE influence BSK use on rounds. These elements can be leveraged to activate BSK to support integration of learning with patient care in the workplace.