title: A qualitative study of resident learning in ambulatory clinic. The importance of exposure to 'breakdown' in settings that support effective response.
abstract: Qualitative analysis of a large ethnographic database from observations of a resident teaching clinic revealed three important findings. The first finding was that breakdown, a situation where an 'actor' (such as a person or the group) is not achieving expected effectiveness, was the most important category because of its frequency and explanatory power. The next finding was that exposure to breakdown was a necessary ingredient for reflective learning. The final finding was that effective response to breakdown (with concomitant reflective learning) requires six factors to be present: the patient is engaged directly; responsibility is matched to authority; tools are matched to tasks; information resources are matched to need; values are matched between co-participants; and expectations are matched with capacity. These findings have implications for planning, improvements and further studies in ambulatory teaching clinics.
authors.affiliation: Northwest Regional Faculty Development Center, VA Medical Center, Boise, ID 83702, USA. scott.smith2@med.va.gov
authors.forename: C Scott
authors.initials: CS
authors.lastname: Smith
authors.forename: Magdalena
authors.initials: M
authors.lastname: Morris
authors.forename: Chris
authors.initials: C
authors.lastname: Francovich
authors.forename: William
authors.initials: W
authors.lastname: Hill
authors.forename: Janet
authors.initials: J
authors.lastname: Gieselman
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D004503:Education, Medical, Graduate; D005194:Family Practice / Q000193:education*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007061:Idaho; D007396:Internship and Residency; D007858:Learning; D008297:Male