Abstract
BackgroundExisting theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors. Previous medical education research has largely focused on the process of SDL. We explored the experience with and perception of SDL among internal medicine residents to gain understanding of the personal and contextual factors of SDL in graduate medical education.MethodsUsing a constructivist grounded theory approach, we conducted 7 focus group interviews with 46 internal medicine residents at an academic medical center. We processed the data by using open coding and writing analytic memos. Team members organized open codes to create axial codes, which were applied to all transcripts. Guided by a previous model of SDL, we developed a theoretical model that was revised through constant comparison with new data as they were collected, and we refined the theory until it had adequate explanatory power and was appropriately grounded in the experiences of residents.ResultsWe developed a theoretical model of SDL to explain the process, personal, and contextual factors affecting SDL during residency training. The process of SDL began with a trigger that uncovered a knowledge gap. Residents progressed to formulating learning objectives, using resources, applying knowledge, and evaluating learning. Personal factors included motivations, individual characteristics, and the change in approach to SDL over time. Contextual factors included the need for external guidance, the influence of residency program structure and culture, and the presence of contextual barriers.ConclusionsWe developed a theoretical model of SDL in medical education that can be used to promote and assess resident SDL through understanding the process, person, and context of SDL.
Highlights
Existing theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors
The Accreditation Council for Graduate Medical Education [2] requires that “residents and faculty members must demonstrate an understanding of their personal role in...attention to lifelong learning,” by developing skills and habits “to continuously improve patient care based on constant self-evaluation.”
They define person as the “characteristics of the individual,” such as “critical reflection, enthusiasm, life experience, motivation, and self-concept,” whereas process includes skills and abilities to carry out SDL [11]. This model added to their previous model the importance of context, which they defined as encompassing the “environmental and sociopolitical climate, such as culture, power, learning environment, political milieu...” [11]. This theoretical model highlights the complexity of SDL, incorporating the personal and contextual factors that affect the process of SDL
Summary
Existing theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors. The Accreditation Council for Graduate Medical Education [2] requires that “residents and faculty members must demonstrate an understanding of their personal role in...attention to lifelong learning,” by developing skills and habits “to continuously improve patient care based on constant self-evaluation.”. Knowles incorporated SDL into his adult learning theory by emphasizing “the learners’ self-concept of being responsible for their own decisions” and stating that “the most potent motivations [for learning] are internal pressures,” which contribute to “the transition from dependent to self-directing learners” [5]. Sawatsky et al BMC Medical Education (2017) 17:31 strategies, and evaluating learning outcomes.” One review of SDL in medical education scholarship identified that many studies lacked a definition for SDL, highlighting that there is limited understanding of SDL and that clearer definitions and theories of SDL are needed to advance SDL research in medical education [7]
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