Learning in the social context of ambulatory care clinics.

Social learning theory describes the process by which medical students and residents become members of the professional community of physicians. According to this theory, learning is enhanced when students and residents can share with each other their partial understandings and when they can observe and emulate the thinking and actions of expert role models. The authors make several recommendations for how social learning theory may be applied to education in ambulatory care settings: (1) preceptors should pay careful attention to orienting learners and creating legitimate roles for learners appropriate to their levels of training and ability and their educational needs; (2) since students and residents learn by observing and interacting with preceptors, competent role models should be provided; (3) to be most effective, learners should be told in advance what will be modeled, observe the demonstration, discuss what occurred and why it did or did not work effectively, and, finally, be given the opportunity to practice new actions, first with guidance and later independently; (4) when debriefing about modeled interactions, preceptors should encourage self-monitoring and self-assessment; (5) preceptors should create opportunities for collaborative learning, because collaboration with peers allows learners to discover their own misconceptions and help others to develop a richer understanding of medical practice. Implementing these guidelines in ambulatory care training will enable learners and preceptors to arrive at the shared meanings and common understandings that form the foundation of the professional medical community.