Why Adaptive Learning is the Better Choice

What is JBJS Clinical Classroom and how does it work?
JBJS Clinical Classroom is a learning system that uses a biological model of adaptive learning technology. It observes what and how a person learns and individualizes that person’s experience with a precise focus on knowledge, skill, and confidence deficits.1

After answering each question in Clinical Classroom, learners must choose: “I know it,” “Think so,” “Unsure,” or “No idea” to describe their confidence in the answer that they selected. The adaptive algorithm looks at how the question was answered (right or wrong), the self-reported confidence level, and the time it took to answer the question. It then presents questions about content not yet mastered or about which the learner is not confident. In this way, by continually directing users away from subjects in which they are proficient and confident and toward weaker areas, it “adapts” as the user learns.

Importantly, Clinical Classroom identifies learners who are “unconsciously incompetent”—i.e., those who don’t know what they don’t know. This can direct individual learning as well as provide focus for faculty and residency directors when planning learning experiences.

How is JBJS Clinical Classroom different from question-bank study tools?
Study tools that ask hundreds of questions provide experience aimed at passing an exam, not mastery and reinforcement of the information. Question banks ask questions about subjects that the learner already knows as well those that they don’t know. Once a learner has answered 200 questions, all they have are 200 answered questions.

In contrast, Clinical Classroom quickly identifies learners’ strengths and weaknesses DURING the test-taking process so that they can continually focus on areas that they have not mastered or about which they are uncertain. Clinical Classroom allows learners to see not only missed questions but also the learning objectives that they found the most challenging, to help focus review on areas where it is needed and avoid those where it isn’t. Clinical Classroom also contains an automated “recharge” function to help learners retain previously learned content and relearn things they may have forgotten over time.

How are the questions in JBJS Clinical Classroom developed?
Experts across the orthopaedic subspecialties were recruited to develop learning objectives that require higher-order thinking, such as the ability to evaluate and diagnose a patient’s condition and select an appropriate treatment.

Writers then develop questions to test each learning objective, provide learning resources with supporting information for the questions, and list references for additional information. All questions and learning resources are peer-reviewed by several subspecialty content experts and the Editor-in-Chief of JBJS and revised as needed before being accepted for use in Clinical Classroom. Clinical Classroom is updated regularly to provide new learning objectives and questions and to revise or remove those that are no longer current.




How can JBJS Clinical Classroom better prepare learners for in-training exams, certification exams, and clinical practice?

Exam Preparation
When preparing for an exam, a learner’s time is limited. Because users of Clinical Classroom avoid spending time on content that they have mastered and can focus on areas where they need reinforcement, they may spend up to 50% less time than users of traditional e-learning methods to learn the same material1.

Clinical Classroom uses the same learning technology as NEJM Knowledge+, which prepares learners for the internal medicine and family practice board exams. Healy et al. reported on a small group of learners who used Knowledge+ to prepare for the American Board of Internal Medicine Certifying Examination (ABIM-CE) and found that, between 2014 and 2016, a significantly higher proportion passed on their first attempt compared with the national average (95% vs. 89%, z = 2.6397, p = 0.0083)2.

Another study, by Wagner et al., showed that performance on weekly quizzes may be strongly predictive of performance on resident in-service examinations and tracking data from periodic quizzes may help direct educational interventions3. With Clinical Classroom, learners can develop their own quizzes and the system will soon allow residency faculty to develop and assign quizzes to their residents.

Clinical Practice and Lifelong Learning
According to a 2017 report by the American Medical Association, “Creating a Community of Innovation,” the new focus of medical education is on “creating physicians who are self-directed, critically thinking, expert workplace learners. These learners learn how to know what they don’t know and appropriately use just-in-time knowledge resources and decision support systems to address identified gaps.”4

With the ever-changing health-care environment, physicians must adapt and learn new ways to solve different and more complex clinical problems. Use of the metacognitive approach—the ability to think about learning based on understanding what you know and what you don’t know—is gaining traction in many areas of education including health care education. The American Medical Association, as part of its Accelerating Change in Medical Education Initiative, has developed a model to create “master adaptive learners.” This model uses a metacognitive approach to encourage physicians to develop adaptive expertise that will allow them to learn and create innovative solutions in response to practice challenges5.

Clinical Classroom supports this educational paradigm shift by applying metacognition—i.e., by assessing both learners’ knowledge and their awareness of what they know (consciously competent) and what they don’t know (unconsciously incompetent). Even well-trained experienced physicians must update their knowledge and skills to diagnose and treat increasingly complex patient conditions and improve patient outcomes. Clinical Classroom provides regularly updated, evidence-based, peer-reviewed content to support the maintenance and updating of knowledge and skills required by the changing health-care environment.


JBJS Clinical Classroom offers:

Robust reporting to provide information on your activity completion, performance, and confidence level

  • AMA PRA Category 1 CreditsTM with the ability to track and print your CME transcript at any time.
  • Self-assessment examination (SAE) credits approved for Maintenance of Certification by the American Board of Orthopaedic Surgery.
  • Access to relevant articles from The Journal of Bone and Joint Surgery as well as links to citations from other peer-reviewed references.
  • Ten subspecialty modules with the ability to purchase the entire product, just one, or any combination of the 10 modules.

1. Area9 Learning. Adaptive learning: eliminating corporate e-learning fatigue. 2017.
2. Healy M, Petrusa E, Axelsson CG, Wongsirimeteeku P, Hamnvik O, O’Rourke M, Feinstein R, Steeves R, Phitayakorn R. An exploratory study of a novel adaptive e-learning board review product helping candidates prepare for certification examinations. AMEE MedEdPublish. 2018.
3. Wagner BJ, Ashurst JV, Simunich T, Cooney R. Correlation between scores on weekly quizzes and performance on the annual resident in-service examination. J Am Osteopath Assoc. 2016 Aug 1;116(8):530-4.
4. American Medical Association. Creating a community of innovation. Chicago: American Medical Association; 2017.
5. Cutrer WB, Miller B, Pusic MV, Mejicano G, Mangrulkar RS, Gruppen LD, Hawkins RE, Skochelak SE, Moore DE Jr. Fostering the development of master adaptive learners: a conceptual model to guide skill acquisition in medical education. Acad Med. 2017 Jan;92(1):70-5.



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