Smith Susan J, Kakarala Radhika R, Talluri Siva K, Sud Parul, Parboosingh J
J Grad Med Educ. 2011 Sep;3(3):425-8. doi: 10.4300/JGME-03-03-30.
We implemented a curriculum using self-directed learning plans (SDLPs) based on clinical questions arising from the residents' practice, and we report on perceptions and attitudes from residents in internal medicine regarding the use of SDLPs conceived at point of care.
Internal medicine residents at a single community hospital in the Midwest were surveyed in 2006 regarding SDLPs. We report their perceived effectiveness in identifying knowledge gaps, the processes used to fill those gaps, and the resident outcomes using descriptive statistics.
A total of 26 out of 37 residents (70%) responded. Most (24 of 26; 92%) perceived SDLPs helped them to identify and fill knowledge gaps and that their skills in framing questions (23 of 26; 88%), identifying resources (21 of 26; 81%), and critically appraising the evidence (20 of 26; 77%) improved through regular use. They also felt these plans led to a meaningful change in their practice or provided further direction for learning (17 of 26; 65%). Most (21 of 26; 81%) reported their intent to include point-of-care learning in their continuing education after residency. We found no significant differences in the responses of first-year compared with second- or third-year residents.
Questions arising during patient care are strong motivators for physician self-directed learning. The residents' responses indicated that they accepted the SDLPs and intend to use them in practice. Embedding the discussion of the SDLPs in preclinic conferences has ensured sustainability during the past 5 years and has enabled us to demonstrate teaching of practice-based learning and improvement.
我们基于住院医师实践中出现的临床问题，实施了一项使用自我导向学习计划（SDLPs）的课程，并报告内科住院医师对即时医疗中构思的SDLPs使用的看法和态度。
2006年，对中西部一家社区医院的内科住院医师进行了关于SDLPs的调查。我们使用描述性统计方法报告他们在识别知识差距方面感知到的有效性、填补这些差距所采用的过程以及住院医师的成果。
37名住院医师中有26名（70%）做出了回应。大多数（26名中的24名；92%）认为SDLPs帮助他们识别和填补了知识差距，并且通过经常使用，他们在构建问题（26名中的23名；88%）、识别资源（26名中的21名；81%）和批判性评估证据（26名中的20名；77%）方面的技能得到了提高。他们还认为这些计划导致了他们实践中的有意义改变或为学习提供了进一步的方向（26名中的17名；65%）。大多数（26名中的21名；81%）报告他们打算在住院医师培训结束后的继续教育中纳入即时医疗学习。我们发现一年级住院医师与二年级或三年级住院医师的回答没有显著差异。
患者护理过程中出现的问题是医生自我导向学习的强大动力。住院医师的回答表明他们接受了SDLPs并打算在实践中使用它们。在临床前会议中纳入对SDLPs的讨论，在过去5年中确保了其可持续性，并使我们能够展示基于实践的学习与改进的教学。
