Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, UK.
Med Teach. 2011;33(12):e670-7. doi: 10.3109/0142159X.2011.611402.
This article explores in a primary care setting how clinical learning occurs across a range of professional groups and levels of learner experience, both undergraduate and postgraduate.
To explore how clinical learning occurs in a primary care workplace from a socio-cultural perspective.
A single case study approach using interview data from 33 participants and strengthened through direct and indirect observations and documentary evidence.
Clinical learning occurs through engagement and opportunity. Engagement in learning appeared to be developed through four elements: recognition, respect, relevance and emotion. Opportunity includes the availability of patient encounters (made meaningful through the immediacy of hearing patient narratives de novo and the authenticity arising from the social context of illness) and the ability to learn with peers and professional colleagues.
These findings support and develop existing literature on learning in other clinical settings. They are consistent with socio-cultural theories of learning, but develop this literature within the context of clinical education. Engagement and learning occurred in transient learners in the absence of prolonged participation, belonging or a clear trajectory of learning. The study offers evidence from multiple learner perspectives as to how the learning environment might be enhanced in all educational settings.
本文探讨了在初级保健环境中，临床学习如何在不同专业群体和不同学习经验水平（本科和研究生）中发生。
从社会文化的角度探讨初级保健工作场所中的临床学习是如何发生的。
采用单一案例研究方法，对 33 名参与者进行访谈，并通过直接和间接观察以及文件证据进行强化。
临床学习是通过参与和机会来实现的。学习的参与似乎是通过四个要素发展起来的：认识、尊重、相关性和情感。机会包括获得患者的接触机会（通过初次听到患者的叙述和从疾病的社会背景中产生的真实性来使这些机会变得有意义），以及与同伴和专业同事一起学习的能力。
这些发现支持并发展了其他临床环境中关于学习的现有文献。它们与学习的社会文化理论一致，但在临床教育的背景下发展了这一文献。在没有长期参与、归属或明确学习轨迹的情况下，短暂的学习者也能够参与和学习。该研究从多个学习者的角度提供了证据，说明如何在所有教育环境中增强学习环境。
