title: Changing clinical practice: significant events that influence trainees' learning.
abstract: BACKGROUND
  Changing behaviour as a result of learning from clinical practice is an important part of improving the quality of healthcare. The aims of this study were to investigate the educational influences that produce change in specialist trainees' clinical practice and to identify any differences in the types of learning recalled between trainees in primary and secondary care.
  
  
  METHODS
  All 105 general practice trainees (GPSTs) and 100 first-year specialist trainees (STs) in one deanery were given the opportunity to take part in the study. There were three data collection phases: three focus groups followed by a questionnaire and 13 semi-structured interviews. The questionnaire was distributed to all first-year STs and GPSTs. Of these, 64 STs (32% of total sample) and 45 GPSTs (22.5% of total sample) completed the questionnaire.
  
  
  RESULTS
  Broad themes outlining the key influences on behavioural change were practice-based learning and the adherence to guidelines. These themes were identified from the focus groups and questionnaire and explored during interviews. Both primary and secondary care trainees reported similar educational influences.
  
  
  CONCLUSIONS
  There is no difference in the types of learning event that primary and secondary care trainees recall when describing changes in their clinical practice. Formal learning opportunities were valued when relevant to everyday clinical experiences. Guidelines were reference points in everyday practice and also a focus for discussion in formal education settings. Positive and negative clinical events were recognised to be key experiences that aided professional development and learning. These results support the use of work-place-based learning as a means of facilitating clinical change and development in specialty training in primary and secondary care.
authors.affiliation: Edge Hill University/Mersey Deanery, Ormskirk L39 4QP, UK. brownjm@edgehill.ac.uk
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Brown
authors.forename: Monica
authors.initials: M
authors.lastname: Patel
authors.forename: John
authors.initials: J
authors.lastname: Howard
authors.forename: Gemma
authors.initials: G
authors.lastname: Cherry
authors.forename: N J
authors.initials: NJ
authors.lastname: Shaw
mesh_terms: D001291:Attitude of Health Personnel; D015510:Clinical Medicine / Q000193:education* / Q000639:trends; D058005:General Practitioners; D019983:Guideline Adherence; D006801:Humans; D011320:Primary Health Care / Q000379:methods / Q000639:trends*; D018794:Problem-Based Learning / Q000379:methods / Q000639:trends*; D011361:Professional Competence; D013038:Specialization / Q000639:trends*; D013337:Students, Medical