Learning in practice: experiences and perceptions of high-scoring physicians.

PURPOSE: To increase understanding of informal learning in practice (e.g., consulting with colleagues, reading journals) through exploring the experiences and perceptions of physicians perceived to be performing well. Objectives were to find out how physicians learned in practice and maintained their competence, and how they learned about the communication skills domain specifically.
METHOD: Of 142 family physicians participating in a formal multisource feedback (360-degree) formative assessment, 25 receiving high scores were invited to participate in interviews conducted in 2003 at Dalhousie University Faculty of Medicine. Twelve responded. Interviews were 1.5 hours each, recorded, transcribed, and analyzed by the research team using accepted qualitative procedures.
RESULTS: While formal learning appeared important to most, informal learning, especially through patients and colleagues, appeared to be fundamental. The physicians appeared to learn intentionally from practice and work experiences, and reflection appeared integral to learning and monitoring the impact of learning. Two findings were surprising: participants' conceptions of competence and perceptions that communication skills were innate rather than learned.
CONCLUSIONS: These physicians' ways of intentional learning from practice concur with current models of informal learning. However, informal learning is largely unrecognized by formal institutions. Additionally, the physicians did not in general share notions of professional competence held by educators and others in authority. These findings suggest the need to make implicit content and learning processes more explicit. Additional research areas include exploring whether physicians across the range of performance levels demonstrate similar processes of reflective learning.