A.P. Sawatsky is assistant professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: http://orcid.org/0000-0003-4050-7984. J.T. Ratelle is assistant professor of medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota. S.L. Bonnes is assistant professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota. J.S. Egginton is senior health services analyst, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota. T.J. Beckman is professor of medicine and medical education, Division of General Internal Medicine, and associate program director, Internal Medicine Residency Program, Mayo Clinic, Rochester, Minnesota.
Acad Med. 2018 Jun;93(6):943-951. doi: 10.1097/ACM.0000000000002077.
Self-directed learning (SDL) is part of residency training, which residents desire guidance in implementing. To characterize SDL within the clinical context, this study explored residents' perceptions of faculty members' role in promoting and supporting resident SDL.
Using a constructivist grounded theory approach, the authors conducted seven focus groups with 46 internal medicine residents at the Mayo Clinic Internal Medicine Residency Program from October 2014 to January 2015. Focus group transcripts were deidentified and processed through open coding and analytic memo writing. Guided by a previously developed SDL model, data were analyzed regarding faculty member involvement in resident SDL. Themes were organized and patterns were discussed at team meetings, with constant comparison with new data. Trustworthiness was established using two member-check sessions.
The authors identified themes within the categories of faculty guidance for SDL, SDL versus other-directed learning (ODL), and faculty archetypes for supporting SDL. Clinical teachers play a key role in facilitating resident SDL and can provide guidance at each step in the SDL process. Residents discussed the distinction between SDL and ODL, highlighting the integrated nature of learning and interplay between the two approaches to learning. Residents identified themes relating to three archetypal approaches faculty implement to support resident SDL in the clinical environment (directed, collaborative, and role model SDL), with benefits and challenges of each approach.
This study underscores the importance of external guidance for resident SDL and expands on approaches faculty members can use to support SDL in the clinical context.
自我导向学习（SDL）是住院医师培训的一部分，住院医师希望在实施过程中得到指导。为了在临床环境中描述 SDL，本研究探讨了住院医师对教师在促进和支持住院医师 SDL 方面作用的看法。
本研究采用建构主义扎根理论方法，于 2014 年 10 月至 2015 年 1 月，在梅奥诊所内科住院医师培训计划中对 46 名内科住院医师进行了 7 次焦点小组讨论。对焦点小组的转录本进行去识别处理，并通过开放式编码和分析性备忘录进行处理。在先前开发的 SDL 模型的指导下，对教师参与住院医师 SDL 的数据进行了分析。在团队会议上，根据主题组织和模式进行讨论，并不断与新数据进行比较。通过两次成员检查会议来确保可信度。
作者确定了教师指导 SDL、SDL 与其他导向学习（ODL）以及支持 SDL 的教师原型等类别的主题。临床教师在促进住院医师 SDL 方面起着关键作用，可以在 SDL 过程的每个步骤提供指导。住院医师讨论了 SDL 和 ODL 之间的区别，突出了学习的综合性质以及两种学习方法之间的相互作用。住院医师确定了与教师在临床环境中支持住院医师 SDL 相关的三个典型方法的主题（定向、协作和角色扮演 SDL），并探讨了每种方法的优缺点。
本研究强调了外部指导对住院医师 SDL 的重要性，并扩展了教师在临床环境中支持 SDL 可以采用的方法。
