Decker Prize for 1999 awarded for study of factors influencing the stimulus to learning recorded by physicians keeping a learning portfolio

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While studies in continuing education have identified the information sources most frequently used by physicians for learning, little is known of what stimulates physicians to engage in learning activities that lead to a commitment to adopt a new practice. This study reports on the recorded stimulus for learning of 8576 items of learning submitted by 652 physicians who voluntarily enrolled in the Maintenance of Competence program (MOCOMP®) of the Royal College of Physicians and Surgeons of Canada and used a paper or electronic diary (PCDiary®) to record self-directed learning activities. The most frequent stimuli for initiating learning were reading the medical literature and managing patients. The only demographic variable that significantly influenced the item stimulus profile of these physicians was the number of years since graduation (p =.0001). Physicians less than 10 years from graduation more frequently recorded learning items stimulated by an audit of practice and less frequently by a discussion with peers compared with physicians in practice more than 10 years. Physicians in practice for more than 30 years initiated learning activities primarily based on their interaction with patients. There was no significant relationship between the item stimulus profile and the physicians' specialty type (p =.47), size of the community where their practice is located (p =.24), or their type of university association (p =.17). This study provides evidence related to differences between the activities physicians perceived had stimulated learning and the likelihood that the learning would lead them to make a commitment to change practice. The stimulus code “reviewing the management of more than one patient” was 47% more likely (odds ratio = 1.47, 95% CI, 1.27, 1.71, p <.001) and “audits of a clinical or laboratory practice” 31% more likely (odds ratio = 1.31, 95% CI, 1.04, 1.66, p =.024) to result in a commitment to make a change in practice than reading the medical literature, the most frequently assigned stimulus for learning. The implications of these findings related to models of physician learning and studies of change in continuing medical education are discussed.

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