Medical professionals need to keep on learning as part of their everyday work to deliver high-quality health care. Although the importance of physicians’ learning is widely recognized, few studies have investigated how they learn in the workplace. Based on insights from deliberate practice research, this study examined the activities physicians engage in during their work that might further their professional development. As deliberate practice requires a focused effort to improve performance, the study also examined the goals underlying this behaviour. Semi-structured interviews were conducted with 50 internal medicine physicians: 19 residents, 18 internists working at a university hospital, and 13 working at a non-university hospital. The results showed that learning in medical practice was very much embedded in clinical work. Most relevant learning activities were directly related to patient care rather than motivated by competence improvement goals. Advice and feedback were sought when necessary to provide this care. Performance standards were tied to patients’ conditions. The patients encountered and the discussions with colleagues about patients were valued most for professional development, while teaching and updating activities were also valued in this respect. In conclusion, physicians’ learning is largely guided by practical experience rather than deliberately sought. When professionals interact in diagnosing and treating patients to achieve high-quality care, their experiences contribute to expertise development. However, much could be gained from managing learning opportunities more explicitly. We offer suggestions for increasing the focus on learning in medical practice and further research.

Professional development plans (PDPs) have recently been introduced in Dutch schools to support teachers' professional development. However, teachers' beliefs regarding the use of PDPs have not been systematically researched, whereas research on the use of PDPs indicates that the implementation is not always successful and depends on how use is perceived by users. Some teachers may doubt the usefulness and purpose of a PDP, and this might influence their reactions to its introduction. Using Fishbein and Ajzen's theory of planned behaviour, the current study explored teachers' characteristics (such as age and years of experience in education) and their beliefs about intention to use a PDP. Clusters of teachers with similar characteristics and beliefs were identified to permit the design of interventions specific to each cluster. Semi-structured interviews were conducted to reveal these beliefs and characteristics for a sample of 41 teachers working in schools where using a PDP was mandatory. The results showed that most teachers had a positive attitude towards using a PDP. However, because using a PDP was mandatory, they felt pressured to produce one. Moreover, it was not a priority. This was because of their high workload. The present study contributes to the literature by adding knowledge of teachers' beliefs about the use of PDPs. This knowledge may help the PDP to become a more effective device in promoting teachers' professional development.❒ Sandra Janssen, Educational consultant/teacher,

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Los momentos difíciles como incidentes críticos en diálogo. Identidad profesional de los profesores de FP técnica