Kairos moments in unexpected situations: A learning opportunity for medical students

Co-written by Abdelmadjid Zinet & Rofique Ali

A final-year medical student saw a patient for a follow-up of their routine blood test. The patient had abnormal LFTs and a history of alcohol dependence. The patient became acutely unwell during the consultation and started vomiting. The student assessed him, examined his liver, and found high blood pressure and potential upper gastrointestinal bleeding signs. The student called the clinical supervisor, who evaluated the patient.? The patient needed to be transferred to the hospital. However, the patient said he wanted to go home for a drink because he suffered from withdrawal symptoms. The student felt sad, overwhelmed, and unsure of what to do.

This case illustrates some issues and dilemmas medical students may encounter in primary care settings. The patient was well when he attended the consultation room but started to vomit and looked unwell. The patient was advised that they would need to be admitted but made a decision that appeared unwise for the student.? The unexpected changes to the patient's health present kairos moments. Kairos is a Greek word that means "the right or opportune moment." In medical education, kairos moments are unexpected situations that can provide valuable learning opportunities for medical students.??

Encouraging reflection and providing feedback could help the student to understand clinical and ethical issues in this case. How do we balance patient’s autonomy to make unwise decisions against the need to provide care?

Several studies support the evidence for emotional intelligence in medical students. Research suggests a direct correlation between medical education and emotional intelligence competencies.? This means that medical education provides an ideal platform for integrating further emotional intelligence training. The study highlights the importance of emotional intelligence in medicine and emphasises the need for incorporating emotional intelligence training programs into medical curricula.?

Other theoretical perspectives

Cognitive psychology can help us to understand how students learn from complex cases. Cognitive psychologists have identified several key factors contributing to learning, including attention, motivation, and prior knowledge. When students are presented with a complex case, it is useful to capture their attention and motivate them to learn. This can be done by making the issue relevant to their interests and by providing them with opportunities to be successful. It is also essential to activate students' prior knowledge and to help them connect the new information to their existing knowledge base.

Social constructivism emphasises the importance of social interaction in learning. Social constructivists believe that learners construct their knowledge through interaction with others. When students are working on a complex case, it is crucial to provide them with opportunities to collaborate with each other and their instructors. This will help them to learn from each other and to develop a deeper understanding of the case.

Situated learning theory emphasises the importance of context in learning. Situated learning theorists believe that learning is best achieved when it is situated in real-world contexts. When students are working on a complex case, they are learning in a very real-world context. This allows them to apply their knowledge and skills to solve real-world problems.

While kairos moments can be challenging, they are also an opportunity for medical students to learn new things and to develop their clinical skills. Here are a few tips for medical educators on how to turn kairos moments into learning opportunities for students:

• Create a safe and supportive learning environment. Students need to feel comfortable asking questions and making mistakes. Establish a culture of collaboration and respect in your teaching environment.
• Encourage students to reflect on the experience. Ask students to think about what they learned from the experience, both clinically and personally. What went well? What could have been improved? What challenges did they face? How did they overcome those challenges?
• Provide students with feedback. Give students specific and constructive feedback on their performance. Be sure to highlight their strengths and areas for improvement.
• Use the experience to teach broader concepts. Use the kairos moment to teach students about medical concepts, such as clinical reasoning, decision-making, and communication.
• Connect the experience to other cases. Help students to see how the current experience relates to other cases they have seen or studied. This will help them to develop a deeper understanding of the disease process and how to manage it.
• Recognise emotional aspects of the learner's experience. Support the student through debriefing, enabling reflection and providing feedback.?

Summary?

The clinical supervisor recognised that the patient was unwell and assessed their capacity. The patient could decide to decline transfer to the hospital. In addition, the supervisor recognised this as a kairos moment and debriefed with the student.

During the debrief, the supervisor and student explored the clinical and ethical issues of the case. The supervisor also provided feedback on the student's performance. The student valued the safe environment and supportive feedback, which helped them to understand the situation and recognise their own emotions.

This scenario shows how a clinical supervisor can turn a complex case into a learning opportunity for a medical student. By recognising the kairos moment and debriefing with the student, the supervisor helped the student to develop their clinical skills and professional judgment.

Chinai, S.A., Guth, T., Lovell, E., Epter, M., 2018. Taking Advantage of the Teachable Moment: A Review of Learner-Centered Clinical Teaching Models. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health 19. https://doi.org/10.5811/westjem.2017.8.35277

Johnson, D.R., 2015. Emotional intelligence as a crucial component to medical education. Int J Med Educ 6, 179–183. https://doi.org/10.5116/ijme.5654.3044

Kumagai, A.K., Naidu, T., 2020. On Time and Tea Bags: Chronos, Kairos, and Teaching for Humanistic Practice. Acad Med 95, 512–517. https://doi.org/10.1097/ACM.0000000000003083

Sthapornnanon, N., Sakulbumrungsil, R., Theeraroungchaisri, A., & Watcharadamrongkun, S. (2009). Social constructivist learning environment in an online professional practice course. American Journal of Pharmaceutical Education, 73(1), 10. https://doi.org/10.5688/aj730110

Co-written with Abdelmadjid Zinet