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

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 qualitative 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.