title: A model of teaching-learning transactions in generalist-specialist consultations.
abstract: BACKGROUND
  A new paradigm in continuing medical education is characterized by emphasis on physicians' learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice--generalist-specialist consultations--from an educational perspective.
  
  
  METHODS
  We applied the grounded-theory method with semistructured interviews. Ten primary care physicians and 9 internal medicine subspecialists were interviewed regarding their approaches to learning and teaching during generalist-specialist consultations.
  
  
  RESULTS
  Based on 48 formal and informal consultations reported by physicians, we developed a theory of teaching-learning transactions in generalist-specialist consultations.
  
  
  CONCLUSIONS
  As a teaching-learning transaction, the mutual learning process in generalist-specialist consultations involves 3 components: needs assessment, dialogue, and sufficiency. Providers of continuing medical education may use the proposed theoretical framework to help clinicians and health care organizations analyze and enhance educationally valuable interactions at the interface of primary and secondary care.
authors.affiliation: Office of Continuing Professional Development in Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI 53705, USA. mbshershneva@wisc.edu
authors.forename: Marianna B
authors.initials: MB
authors.lastname: Shershneva
authors.forename: Molly
authors.initials: M
authors.lastname: Carnes
authors.forename: Lori L
authors.initials: LL
authors.lastname: Bakken
mesh_terms: D004502:Education, Medical, Continuing / Q000458:organization & administration*; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008511:Medicine; D013038:Specialization; D013663:Teaching / Q000379:methods*