A model of self-directed learning in internal medicine residency: a qualitative study using grounded theory.
BACKGROUND
Existing theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors. Previous medical education research has largely focused on the process of SDL. We explored the experience with and perception of SDL among internal medicine residents to gain understanding of the personal and contextual factors of SDL in graduate medical education.


METHODS
Using a constructivist grounded theory approach, we conducted 7 focus group interviews with 46 internal medicine residents at an academic medical center. We processed the data by using open coding and writing analytic memos. Team members organized open codes to create axial codes, which were applied to all transcripts. Guided by a previous model of SDL, we developed a theoretical model that was revised through constant comparison with new data as they were collected, and we refined the theory until it had adequate explanatory power and was appropriately grounded in the experiences of residents.


RESULTS
We developed a theoretical model of SDL to explain the process, personal, and contextual factors affecting SDL during residency training. The process of SDL began with a trigger that uncovered a knowledge gap. Residents progressed to formulating learning objectives, using resources, applying knowledge, and evaluating learning. Personal factors included motivations, individual characteristics, and the change in approach to SDL over time. Contextual factors included the need for external guidance, the influence of residency program structure and culture, and the presence of contextual barriers.


CONCLUSIONS
We developed a theoretical model of SDL in medical education that can be used to promote and assess resident SDL through understanding the process, person, and context of SDL.
Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. sawatsky.adam@mayo.edu.
Adam P
AP
Sawatsky
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA.
John T
JT
Ratelle
Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Sara L
SL
Bonnes
Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Jason S
JS
Egginton
Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Thomas J
TJ
Beckman
D000046:Academic Medical Centers; D004503:Education, Medical, Graduate / Q000379:methods / Q000592:standards*; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D007858:Learning; D008297:Male; D008910:Minnesota; D017145:Models, Educational; D036301:Qualitative Research
Adult learning theory; Graduate medical education; Self-directed learning