Learning from clinical work: the roles of learning cues and credibility judgements

CONTEXT: How learners interpret their clinical experiences to create meaningful learning has not been well studied. We explored experiences considered by doctors to be influential in their learning in order to better understand this process. METHODS: Using a grounded theory approach, we interviewed 22 academic doctors who had been in practice for <= 5 years. Participants were asked to reflect on experiences they considered to have been influential during their training. Constant comparative analysis for emerging themes was conducted iteratively with data collection. RESULTS: A model of clinical learning emerged in which the clinical work itself is central. As they observe and participate in clinical work, learners can attend to a variety of sources of information that facilitate the inter-pretation of the experience and the construction of knowledge from it. These 'learning cues' include feedback, role models, clinical outcomes, patient or family responses, and comparisons with peers. The integration of a cue depends on the learner's judgement of its credibility. Certain cues, such as clinical outcomes or feedback from patients, are seen as innately credible, whereas other cues, particularly feedback from supervisors, are subjected to critical judgement. CONCLUSIONS: Learners make complex judgements regarding the credibility of information about clinical performance. Credibility judgements influence the learning that arises from the clinical experience. Further understanding of how such judgements are made could guide educators in providing credible information to learners.