Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Acad Med. 2010 Dec;85(12):1874-9. doi: 10.1097/ACM.0b013e3181fa02a4.
Self-directed learning (SDL) skills are essential for the formation and ongoing competence of today's physicians who work in the context of expanding scientific knowledge and changing health care systems. In 2007-2008, the authors developed a program to promote SDL in the Brown University Family Medicine Residency. Through an iterative process, the project team juggled learning theories (i.e., Knowles' SDL model, Collins' cognitive apprenticeship model, and Quirk's expertise development model) with curricular goals, instructional options, and local constraints to design a practical and theoretically robust intervention.The intervention that emerged from this process features a faculty physician serving as a learning coach who meets individually each month with all second-year residents to assist them in generating learning goals, reflecting on their learning experiences, and practicing evidence-based medicine (EBM) skills. An electronic portfolio serves as a documentation tool that supports reflection; residents record their goals and reflections in the portfolio, which also contains their formative assessments, procedure logs, and special projects. To address the hidden curriculum, the program designers took special care to avoid increasing faculty and resident workload and created a forum for discussion and group reflection. Program evaluation combines qualitative and quantitative methods, such as surveys of and interviews with residents and faculty, to assess changes in residents' SDL and EBM skills and in the program's educational culture. The authors use Kern and colleagues' six-step model for curriculum development to describe both the unfolding of this complex project and the choices that resulted in the current program design.
自主学习 (SDL) 技能对于当今在不断扩展的科学知识和不断变化的医疗保健系统背景下工作的医生的形成和持续能力至关重要。2007-2008 年，作者开发了一个在布朗大学家庭医学住院医师培训中促进 SDL 的计划。通过迭代过程，项目团队兼顾了学习理论（即 Knowles 的 SDL 模型、Collins 的认知学徒制模型和 Quirk 的专业知识发展模型）与课程目标、教学选择和当地限制，以设计一个实用且理论上可靠的干预措施。从这个过程中产生的干预措施的特点是一名担任学习教练的主治医生，他每月与所有第二年的住院医师单独会面，以帮助他们制定学习目标、反思学习经验并实践循证医学 (EBM) 技能。电子档案夹用作支持反思的文档工具；住院医师在档案夹中记录他们的目标和反思，其中还包含他们的形成性评估、程序日志和特殊项目。为了解决隐性课程问题，项目设计者特别注意避免增加教师和住院医师的工作量，并为讨论和小组反思创建了一个论坛。该计划的评估结合了定性和定量方法，例如对住院医师和教师进行调查和访谈，以评估住院医师 SDL 和 EBM 技能以及该计划的教育文化的变化。作者使用 Kern 及其同事的六步课程开发模型来描述这个复杂项目的展开过程以及导致当前计划设计的选择。
