Intended for healthcare professionals

Clinical Review

Keeping up: learning in the workplace

BMJ 2005; 331 doi: (Published 10 November 2005) Cite this as: BMJ 2005;331:1129
  1. Jeremy C Wyatt, professor of health informatics,
  2. Frank Sullivan, NHS Tayside professor of research and development in general practice and primary care
  1. University of Dundee


    The amount of biomedical knowledge doubles every 20 years, and new classes of drug (such as phosphodiesterase 4 inhibitors) become available when lectures at medical school are over. Therefore, a practice risks fossilising after doctors finish professional training. Many continuing medical education or continuing professional development activities help doctors carry on learning and improving their skills. These activities include courses, conferences, mailed educational materials, weekly grand rounds, journal clubs, and using internet sites. In many countries, evidence of this process is needed for doctors to continue to practice. Although these activities may increase knowledge, their impact on clinical practice is variable

    The aim of traditional medical education is to commit knowledge to memory and then use this knowledge in the workplace. The way knowledge is learnt influences its recall and application to work. One tactic to improve the process is to ensure that learning happens in the clinical workplace. Lessons are learnt faster and recalled more reliably when they originate in everyday experience.

    Learning in the workplace means spending a minute here or three minutes there to find answers prompted by the clinical questions and learning opportunities that come up in every working day, rather than doing continuing medical education for an intensive two hours a week, or a few days a year. Workplace learning is hard to achieve. It emphasises problem solving and learning skills—such as how to find relevant answers fast—not learning facts.

    Barriers and solutions

    Nobody can find a satisfactory answer to every clinical question or information need, especially as there are about two needs for every three clinical encounters. Many important clinical questions have no satisfactory answer—for example, what is the cause of motor neurone disease? Other questions are simply interesting rather than information needs. A range of practical difficulties face doctors who follow the approach of learning in …

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