title: Step-by-step: a model for practice-based learning.
abstract: BACKGROUND
  Innovative technology has led to high-precision radiation therapy that has dramatically altered the practice of radiation oncology. This qualitative study explored the implementation of this innovation into practice from the perspective of the practitioners in a large academic radiation medicine program and aimed to improve understanding of and facilitate the educational process of this change.
  
  
  METHODS
  Multiprofession staff participated in a series of seven focus groups and nine in-depth interviews, and the descriptive data from the transcripts were analyzed using grounded theory methodology.
  
  
  RESULTS
  Practitioners believed that there had been a major effect on many aspects of their practice. The team structure supported the adoption of change. The technology changed the way the practices worked. Learning new skills increased workload and stress but led to a new conception of the discipline and the generation of new practice-based knowledge. When the concepts were examined longitudinally, a four-step process of learning was identified. In step 1, there was anxiety as staff acquired the skills to use the technology. Step 2 involved learning to interpret new findings and images, experiencing uncertainty until new perspectives developed. Step 3 involved questioning assumptions and critical reflection, which resulted in new understanding. The final step 4 identified a process of constructing new knowledge through research, development, and dialogue within the profession.
  
  
  CONCLUSIONS
  These findings expand our understanding of how practice-based learning occurs in the context of change and can guide learning activities appropriate to each stage.
authors: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA 356043, USA. kaneg@u.washington.edu
authors: Gabrielle M
authors: GM
authors: Kane
mesh_terms: D004059:Diffusion of Innovation; D004502:Education, Medical, Continuing; D017144:Focus Groups; D006801:Humans; D033181:Information Dissemination; D018794:Problem-Based Learning / Q000379:methods*; D018787:Radiation Oncology / Q000193:education* / Q000379:methods; D011878:Radiotherapy / Q000379:methods