Abstract
Background Self-directed learning (SDL) is crucial for physicians to remain current in a rapidly evolving medical environment, and graduate medical education (GME) is increasingly incorporating academic coaching to support this lifelong learning. Despite this, there is limited evidence on how residents practically implement SDL strategies, particularly within the cognitive load theory framework. Objective To investigate how internal medicine residents participate in SDL within an academic coaching program, focusing on how strategies align with cognitive load theory. Methods This qualitative study occurred in a single internal medicine residency program with a formal, longitudinal academic coaching curriculum. In October 2023, we conducted semistructured interviews with participating residents. We purposefully selected 16 of the 27 eligible residents (59%) and conducted semistructured interviews until we reached thematic sufficiency. We reanalyzed these transcripts using thematic analysis to identify SDL behaviors and resource utilization patterns. Results Three key themes emerged: (1) personalization and structure in learning: residents developed individualized, goal-oriented learning plans; (2) diverse learning strategies with emphasis on retrieval practice: residents frequently engaged in active recall and multimodal resource integration; and (3) deliberate repetition and spaced learning for retention: residents intentionally used repetition and temporal spacing to consolidate knowledge. Conclusions Internal medicine residents employ structured, cognitively informed SDL strategies when provided with academic coaching support.