Physicians' learning strategies.

This article examines the two categories of learning strategies that physicians use in clinical practice. The strategies are similar in their overall architectures and differ (1) according to nature of the clinical problem that precipitated the need to learn, and (2) the ways in which learning resources are used.

Further experience with division of the left renal vein.

The left renal vein (LRV) has numerous tributaries including, but not limited to, the inferior phrenic, suprarenal, and gonadal veins. The resultant potential for collateral LRV outflow through these tributaries in instances of LRV division is obvious. One of us has previously reported 10 such cases of LRV division (close to its confluence with the inferior vena cava and without reanastomosis) for the purpose of facilitating proximal abdominal aortic exposure for reconstructive procedures. One of the 10 patients had moderate renal insufficiency at follow-up. We present herein an additional 19 patients who underwent LRV division predominantly for aneurysmal disease of the abdominal aorta. Sixteen patients were available for follow-up. Three patients died in the intraoperative and early postoperative periods. Multivariate analysis of variance of preoperative, postoperative, and follow-up laboratory data--serum creatinine and BUN--showed no significant change in renal function as assessed.

How doctors learn: education and learning across the medical-school-to-practice trajectory.

People have needs they address daily over the course of their lives. They address these needs through identifying and resolving problems in ways that reflect their identities. This means that education, including medical education, is an identity development process because it provides people with more and better ways to satisfy their needs. Also, education does this by providing them with the knowledge and skills they use to occupy identifiable niches in society. These niches are describable in terms of what people do and the ways in which they relate to others. Medical education, in other words, allows medical students and residents to take on physicians' identities, and their identities go a long way toward defining when, where, and how they will address their psychosocial needs. Doctors begin developing the skills and knowledge they need in medical school and continue developing them through residency and into practice. However, there are important differences among medical students, residents, and practicing physicians, and these differences have an impact on how the individuals satisfy their psychosocial needs. These differences also bear on how well they will satisfy their needs later in their careers; i.e., the things physicians-in-training do to satisfy their psychosocial needs in the course of learning to become doctors are expected to prepare them to address their psychosocial needs later in life in their roles as both healers and professionals. It is against this background of describing how education helps physicians solve problems and so address their recurring psychosocial needs that the author presents 12 conclusions concerning physicians' learning.

How doctors learn: the role of clinical problems across the medical school-to-practice continuum.

The author proposes a theory of how physicians learn that uses clinical problem solving as its central feature. His theory, which integrates insights from Maslow, Schön, Norman, and others, claims that physicians-in-training and practicing physicians learn largely by deriving insights from clinical experience. These insights allow the learner to solve future problems and thereby address the learner's basic human needs for security, affiliation, and self-esteem. Ensuring that students gain such insights means that the proper roles of the teacher are (1) to select problems for students to solve and offer guidance on how to solve them, and (2) to serve as a role model of how to reflect on the problem, its solution, and the solution's effectiveness. Three principles guide instruction within its framework for learning: (1) learners, whether physicians-in-training or practicing physicians, seek to solve problems they recognize they have; (2) learners want to be involved in their own learning; and (3) instruction must both be time-efficient and also demonstrate the range of ways in which students can apply what they learn. The author concludes by applying the theory to an aspect of undergraduate education and to the general process of continuing medical education.

How doctors learn: physicians' self-directed learning episodes.

PURPOSE: To qualitatively examine the self-directed learning activities of physicians in light of several lines of research on how doctors learn. METHOD: Under the auspices of the Royal College of Physicians and Surgeons of Canada, the author elicited from physicians narratives about past learning experiences. He analyzed the narratives (1) seeking themes among the doctors' approaches and (2) examining those themes in light of the existing literature. RESULTS: The 32 physicians interviewed described learning experiences, confirming earlier research that two varieties of problems (specific and general) precipitate learning and that learning episodes follow definite stages: scanning for problems, deciding whether to pursue the learning task, acquiring new knowledge and skill, and gaining experience with what has been learned. The latter three stages have been described previously and are expanded upon here. CONCLUSION: This study produced an integrated and elaborated theory of learning in clinical practice with implications for both the education of physicians in training and physicians' continuing professional development. In particular, the theory points to problem areas in teaching medical students and residents to learn in clinical practice, and in matching the learning needs of physicians to organized continuing medical education activities.

Communication, social support and alcohol use in first-year medical students.

Increased communication from significant others and perceived interpersonal support correlated with reduced student drinking during the first 12 weeks of medical school. Writing brief essays on any subject of personal interest which were read, annotated and quickly returned by a faculty member correlated with reduced student drinking during the final 12 weeks of the first year.

A simple technique for collecting, analyzing, and interpreting evaluative data.

Best Liked/Least Liked (BL/LL) is a straightforward technique for collecting information used in evaluation. The technique is composed of stages (data collection, data analysis, and data interpretation) that are characterized by the ease with which they are accomplished. Further, the technique admits of flexibility in both range of applicability (some achievement testing and the measuring of effect) and scope of use (it can be narrowly focused or used to collect information on unintended outcomes). The technique is described here and examples are presented of its use both narrowly and broadly focused, and in service of both achievement testing and affective measurement.

Identifying and remediating specific deficiencies of entering medical students.

For many reasons some entering medical students have specific deficiencies in substantive areas. This study describes a methodology used successfully in the areas of anatomy terminology, behavioral science concepts, and applied mathematics both to identify students with these deficiencies and to provide the required remediation. The methodology involves empirical identification of what students need to know, the use of specially constructed criterion-referenced tests, and "stand-alone" instructional materials. Benefits of the methodology include assurance that all students have certain minimal skills and competencies, specification for faculty of the students' skills and knowledge, and a reported increase in student confidence in the areas covered.

Multivariate interpretation of laboratory tests used in monitoring patients.

This study demonstrates an approach to the problem of minimizing false-negative and false-positive laboratory findings. In this approach, we consider the fact that results of laboratory tests are correlated, utilize within-person test results to interpret current results, and minimize the impact of multivariate conservatism by examining test results in small groups. The procedure requires panels of tests to be divided into related subpanels, testing each subpanel independently, and using the Bonferroni inequality to determine whether any of the observed values for a given subpanel is "out-of-range." The procedure is demonstrated, and its limitations are observed and discussed.

Dimensions of medical students' perceptions of instruction.

Factor analysis of medical student ratings of basic science instruction yielded three dimensions of student perception of instruction: faculty-student rapport, outside work, and aspects of student comprehension. While these factors are similar to those identified in other studies, they differ in respects probably reflecting differences between medical students and other students and differences in questionnaire design.

Changes in learning-resource use across physicians' learning episodes.

INTRODUCTION: This study explores the numbers of learning resources physicians use at each stage in self-directed learning episodes addressing general problems. MATERIALS AND METHODS: A survey of a statewide random sample of doctors estimated the number of resources used at each stage in solving various general problems. RESULTS: The 50% response rate for faculty allowed generalization of findings to the population of these physicians; the rate for nonfaculty physicians was too low to allow generalization. Faculty findings showed (1) broader resource use in learning about diseases than diagnosis or therapeutics (2) comparable numbers of resources used in deciding whether to take on the learning problem and learning the required skills and knowledge, (3) greater numbers of resources selected to evaluate the problem and to learn the required skills and knowledge than to gain experience with the newly learned skills and knowledge, and (4) support for assertions that doctors value learning resources that are accessible, applicable, familiar, and time effective. DISCUSSION: The findings were interpreted in light of theory describing physicians' self-directed learning episodes, and implications are presented for physicians-in-training, physicians, and medical librarians.

Predictors of success in undergraduate human physiology.

This study tested the hypothesis that measurable attributes in students' backgrounds are related to their successful completion of an undergraduate human physiology course. Demographic, general academic performance, and science achievement data were obtained from student records for students enrolled during the 1995-1996 academic year, and additional demographic data were obtained from students enrolled during the 1996-1998 academic years. A hierarchical logistic regression analysis explored the relationship fo these variables to the percentage of students passing the human physiology course. Predicted passing versus failing showed a sensitivity of 85.5% and specificity of 69.7%. Two independent validations of the logistical regression equation correctly predicted the performance of subsequent groups of students 75.9% and 77.6% of the time.

The epidemiology of physician learning.

Because medicine and education share a striking number of attributes, the authors explored epidemiology-a tool useful in medicine-as a perspective on the education of physicians. More specifically, the parallel between medicine and education was examined, key features of epidemiology were identified, and these were used in exploring attributes of the continuing education of physicians. This exploration involved both a regional study of primary care physicians for adults and a national study of a single specialty.

A preliminary study of the relationship between central auditory processing disorder and attention deficit disorder.

Fifteen boys aged six to ten who met the criteria for attention deficit disorder (ADD) were compared with ten boys who did not have ADD in a double-blind, placebo-controlled, single-crossover study of methylphenidate. To assess the degree of overlap between ADD and central auditory processing disorder (CAPD), all subjects were assessed on parent and teacher behavior rating scales, as well as a battery of CAPD tests at baseline and after three and six weeks of treatment. Twelve of the 15 subjects with ADD and none of the subjects without ADD met the criteria for CAPD. The subjects with ADD also responded to stimulant treatment on the measures of both ADD and CAPD. The overlap in the symptomatology of these disorders, the finding that the criteria for both disorders were met in 12 of 15 cases and the sensitivity of both ADD and CAPD measures to treatment with methylphenidate suggest that ADD and CAPD are closely related disorders. The implications of these results are three-fold. First, sustained attention is a critical feature of performance on CAPD tests and the current diagnostic criteria for CAPD make a clinical separation of the two disorders problematic. Second, stimulants appear to be a useful treatment for the symptoms of both ADD and CAPD. Third, CAPD tests may be a useful measure of ADD symptomatology and response to stimulants.