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Struggling to be self-directed: residents' paradoxical beliefs about learning. Nothnagle M, Anandarajah G, Goldman RE, Reis S. Academic Medicine 2011;86:1539-1544.

Reviewed by Paola Palma Sisto

Self-directed learning (SDL) skills are critical for physician lifelong learning. Medical training has not traditionally emphasized the development of these skills. Trainees' perceptions on the learning culture in medical training and on using SDL skills have not been studied.

What was the study question?
What are family medicine residents' views about SDL skills?

How was the study done?
Authors conducted individual semi structured interviews with 13 graduating family medicine resident at Brown University. Four researchers analyzed the data using standard qualitative methods. Major themes were identified.

What were the results?
The themes are: resident beliefs about learning, the learning culture in their residency, and developmental progress in learning. The authors were intrigued by four paradoxes that arose from the analysis: 1) although residents understand the value of SDL, they did not practice it and felt unprepared to manage their own learning, especially in the clinical setting; 2) residents still valued the traditional, teacher-centered approach to the learning culture; 3) residents perceive patient care and learning as competing rather than a stimulus for SDL; 4) residents would like external guidance to direct their own SDL.

What are the implications of these findings?
Residents at this university residency program feel inadequately prepared to use SDL skills and wanted more external guidance. Emphasizing this skill development is critical to increase their confidence in their own skills. This can be extrapolated to the medical student as well, encouraging educators to foster this skill development in the undergraduate years.

Editor's note: This well designed and well done study highlights important tensions about self-directed learning among trainees. Teaching - and modeling - these skills in the undergraduate years may make self-directed learning seem more natural during residency. (SLB)

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