Exploring deliberate practice in medicine: how do physicians learn in the workplace?

Abstract

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.

Social support in the workplace for physicians in specialization training

“…The completion of a specialist degree requires five to six years of medical practice, further studies, including both medical and management content and, at minimum, nine months of service in public health centers 1 . Learning through service occurs in medical practices, which are embedded in daily work routines, such as problem-solving, evaluation of diagnosis and treatment, understanding different opinions, and providing explanations [1]. The workplace affords good opportunities for learning, but creating a favorable learning environment requires attention.…”

Vocational thresholds: developing expertise without certainty in general practice medicine

“…This fits with other research shows that medical learning is strongly driven by, and embedded in, the work of patient care, and real medical problems are what provoke reflection among medical professionals. [7][8][9] However most of the 'medical problems' identified by GPs were actually relational challenges where there was no straightforward application of clinical knowledge.…”

Enseñar a ser médicos: un análisis de opinión de los médicos implicados en la docencia de la clínica práctica (II). Análisis cuantitativo de la opinión de médicos implicados en la docencia de clínica práctica

“…Distintos estudios previos han demostrado que el aprendizaje de la práctica clínica se encuentra directamente relacionado con el trabajo clínico cotidiano. La mayoría de las actividades de aprendizaje deberían relacionarse directamente con la atención al paciente, ya que la participación de los alumnos en su diagnóstico y tratamiento contribuye a la adquisición y el desarrollo de sus conocimientos [10,11].…”