Gagliardi Anna R, Wright Frances C, Victor J Charles, Brouwers Melissa C, Silver Ivan L
Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.
J Contin Educ Health Prof. 2009 Fall;29(4):269-75. doi: 10.1002/chp.20046.
To explore the relationship between self-directed learning (SDL) needs, patterns, barriers, and outcomes among nonacademic general surgeons.
Participants dictated details of SDL episodes associated with cancer patient management from October 2007 to March 2008. Transcripts were coded thematically. Frequencies were calculated for elements of each SDL stage. Statistical significance among subgroups was established with the use of the Pearson chi-square test, adjusted for clustering by surgeon. Participants were interviewed by telephone, and transcripts were analyzed by qualitative methods.
Of 21 consenting surgeons, 15 submitted 115 cases, and 108 were analyzed. Most involved breast (40.7%), colon (18.5%), or rectal cancer (13.0%); 2 or more clinical tasks (41.7%); and 2 or more questions (89.8%). Information was sought from the Internet (48.1%), colleagues (24.2%), or both (6.8%). Information was partially, or not relevant for 21.3% of cases. Evidence was new for 66.7%, and confirmed knowledge for 10.7% of cases. Learning helped surgeons formulate new (34.2%), or confirm original (16.5%) management plans, or determine that referral was appropriate (39.2%). Use of codified sources was associated with information retrieval (P < .05), and identifying new evidence leading to a change in management from that initially proposed (P < or = .001).
Numerous individual and systemic barriers may prevent practicing physicians from undertaking SDL, but provision of structured guidance prompted SDL and resulted in several beneficial outcomes. Further research is needed to validate these findings, and investigate who should support SDL, and how.
探讨非学术型普通外科医生自主学习（SDL）的需求、模式、障碍及结果之间的关系。
参与者口述了2007年10月至2008年3月期间与癌症患者管理相关的SDL事件细节。对转录本进行主题编码。计算每个SDL阶段各要素的频率。使用Pearson卡方检验确定亚组间的统计学显著性，并针对外科医生进行聚类调整。通过电话采访参与者，并采用定性方法分析转录本。
在21名同意参与的外科医生中，15名提交了115个病例，其中108个病例进行了分析。大多数病例涉及乳腺癌（40.7%）、结肠癌（18.5%）或直肠癌（13.0%）；2项或更多临床任务（41.7%）；以及2个或更多问题（89.8%）。信息来源为互联网（48.1%）、同事（24.2%）或两者兼有（6.8%）。21.3%的病例所获取的信息部分相关或不相关。66.7%的病例中证据是新的，10.7%的病例中证据证实了已有知识。学习帮助外科医生制定新的（34.2%）或确认原来的（16.5%）管理计划，或确定转诊是合适的（39.2%）。使用编码资源与信息检索相关（P < .05），并识别出导致管理方式与最初提议不同的新证据（P < 或 = .001）。
众多个人和系统层面的障碍可能会阻碍执业医师进行SDL，但提供结构化指导可促使SDL并带来一些有益结果。需要进一步研究以验证这些发现，并调查谁应支持SDL以及如何支持。
