Learning in practice

Postal survey of approaches to learning among Ontario physicians: implications for continuing medical education

M Dianne Delva, associate professor, ^a John R Kirby, professor, ^b Christopher K Knapper, director, ^c R V Birtwhistle, professor. ^d

^a Department of Family Medicine, Queen's University, Kingston, Ontario, Canada K7l 5E9, ^b Faculty of Education, Queen's University, ^c Instructional Development Centre, Queen's University, ^d Department of Family Medicine, Queen's University

Correspondence to: M D Delva mdd2{at}post.queensu.ca

Objectives: To understand the approaches to learning of practising physicians in their workplace and to assess the relation of these approaches to their motivation for, preferred methods of, and perceived barriers to continuing medical education.
Design: Postal survey of 800 Ontario physicians.
Participants: 373 physicians who responded.
Main outcome measures: Correlations of approaches to learning and perceptions of workplace climate with methods, motives, and barriers to continuing medical education.
Results: Perceived heavy workload was significantly associated with the surface disorganised (r=0.463, P<0.01) and surface rational approach (r=0.135, P<0.05) to learning. The deep approach to learning was significantly correlated with a perception of choice-independence and a supportive-receptive climate at work (r=0.341 and 0.237, P<0.01). Physicians who adopt a deep approach to learning seem to be internally motivated to learn, whereas external motivation is associated with surface approaches to learning. Heavy workload and a surface disorganised approach to learning were correlated with every listed barrier to continuing medical education. The deep approach to learning was associated with independent learning activities and no barriers.
Conclusions: Perception of the workplace climate affects physicians' approaches to learning at work and their motivation for and perceived barriers to continuing medical education. Younger, rural, family physicians may be most vulnerable to feeling overworked and adopting less effective approaches to learning. Further work is required to determine if changing the workplace environment will help physicians learn more effectively.

What is already known on this topic Throughout their careers physicians face enormous challenges in managing the growth of medical knowledge Students who perceive choice, independence, and good teaching at university take a deep, integrative approach to learning whereas those who feel overworked or overwhelmed tend to learn by rote What this study adds Feeling overwhelmed at work is associated with a disorganised and superficial approach to learning and perception of many barriers to continuing medical education Physicians who believe they have choice, independence, and support in their work take a deep approach to learning, are internally motivated, and use independent learning methods Younger, rural, and family physicians are most likely to feel overworked