According to a 2017 report by the American Medical Association (AMA), 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 gaps1.”

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 healthcare education.

JBJS Clinical Classroom supports this educational paradigm shift by applying metacognition — 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 surgeons must update their knowledge and skills to diagnose and treat increasingly complex patient conditions and improve patient outcomes.


  • JBJS Clinical Classroom is a learning system that uses a biological model of adaptive learning. It observes what and how a person learns and individualizes the person’s experience with precise focus on knowledge, skill, and confidence deficits3.
  • Users of JBJS Clinical Classroom may spend up to 50% less time than users of traditional e-learning methods learning the same material3.
  • Clinical Classroom identifies learners who are “unconsciously incompetent” — that is, they don’t know what they don’t know. This directs individual learning and provides focus for faculty and residency directors when planning learning experiences.
  • Study tools that ask hundreds of questions provide experience aimed at passing exams versus mastery and reinforcement of information. Once a learner has answered 200 questions, all they have is 200 answered questions. By contrast, Clinical Classroom quickly identifies learners’ strengths and weaknesses during the test-taking process so that they can continually focus on areas they have not yet mastered or about which they are uncertain.
  • Clinical Classroom allows learners to review not only the probes they have missed but also which learning objectives they are finding most challenging to master. The platform also contains an automated “refresh” function to help learners retain previously learned content and to relearn things they may have forgotten over time.


JBJS recruited experts across orthopaedic subspecialties to develop learning objectives that require higher-order thinking, such as an ability to evaluate and diagnose a patient’s condition and to select an appropriate treatment. Writers then developed probes to address each learning objective, provided learning resources with supporting information for the questions, and supplied references for additional information.

All questions and learning resources are peer-reviewed by several subspecialty content experts and the JBJS Editor-in-Chief then revises as needed before integrating into JBJS Clinical Classroom. The platform is updated regularly to add new learning objectives and probes, revising any material that is no longer current.


When preparing for an exam, a learner’s time is limited. Because users of Clinical Classroom avoid spending time on content they have already 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 learning the same materials3.

Clinical Classroom uses learning technology that prepares learners for the internal medicine and family practice board exams. Healy et al. reported on a small group of learners who used the platform to prepare for the American Board of Internal Medicine certification examination (ABIM-CE) and found that, between 2014 and 2016, a significantly higher proportion passed on their first attempt compared to the national average (95% vs. 89%, z = 2.6397, p = 0.0083)4.

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 interventions5. With Clinical Classroom, learners can develop their own quizzes and the system allows residency faculty to develop and assign quizzes to their residents.