Slotnick H B
Department of Neuroscience, School of Medicine and Health Sciences, University of North Dakota, Grand Forks 58202-9037, USA.
Acad Med. 1999 Oct;74(10):1106-17. doi: 10.1097/00001888-199910000-00014.
To qualitatively examine the self-directed learning activities of physicians in light of several lines of research on how doctors learn.
Under the auspices of the Royal College of Physicians and Surgeons of Canada, the author elicited from physicians narratives about past learning experiences. He analyzed the narratives (1) seeking themes among the doctors' approaches and (2) examining those themes in light of the existing literature.
The 32 physicians interviewed described learning experiences, confirming earlier research that two varieties of problems (specific and general) precipitate learning and that learning episodes follow definite stages: scanning for problems, deciding whether to pursue the learning task, acquiring new knowledge and skill, and gaining experience with what has been learned. The latter three stages have been described previously and are expanded upon here.
This study produced an integrated and elaborated theory of learning in clinical practice with implications for both the education of physicians in training and physicians' continuing professional development. In particular, the theory points to problem areas in teaching medical students and residents to learn in clinical practice, and in matching the learning needs of physicians to organized continuing medical education activities.
根据关于医生学习方式的多项研究，对医生的自主学习活动进行定性研究。
在加拿大皇家内科医师与外科医师学院的支持下，作者从医生那里收集了关于过去学习经历的叙述。他对这些叙述进行了分析：（1）在医生的学习方法中寻找主题；（2）根据现有文献审视这些主题。
接受访谈的32位医生描述了他们的学习经历，证实了早期的研究，即两种类型的问题（具体问题和一般问题）会引发学习，且学习过程遵循明确的阶段：发现问题、决定是否着手学习任务、获取新知识和技能，以及对所学内容积累经验。后三个阶段此前已有描述，本文在此基础上进行了拓展。
本研究得出了一个关于临床实践学习的综合且详尽的理论，这对实习医生的教育和医生的持续专业发展均有启示。特别是，该理论指出了在教授医学生和住院医生临床实践学习方面以及使医生的学习需求与有组织的继续医学教育活动相匹配方面存在的问题领域。
