Mapping the cognitive environment of a residency: An exploratory study of a maternal and child health rotation

Background: Studying a learning environment's cognitive demands may help to explain why some residents perform poorly. Purpose: This exploratory study was designed to construct a model of the cognitive environment of a family medicine rotation in maternal and child health. Methods: Mapping the cognitive environment was accomplished by interviewing 10 of 12 first-year residents, followed by construction of a model of the cognitive environment based on resident interviews, observation of residents, faculty discussions, and development of a cognitive environment survey to verify the model. Results: Seven aspects of the cognitive environment were identified as placing strong cognitive demands on learners: instability of environment, multiplicity of events, subjectivity of clinical events, level of stress, locus of control, cognitive nature of cases, and nonclinical responsibilities. Conclusion: The model and survey hold promise as a way to identify those features of a clinical rotation that place cognitive demands on learners.