Learning in (inter)action: Implicit and explicit EBM learning processes at the GP workplace

Abstract

The main goal of this thesis is to gain a better understanding of current evidence-based medicine (EBM) learning processes at the general practice (GP) workplace. EBM is defined as combining clinical expertise, the preferences of the patient and the best-available evidence when making decisions for individual patients within clinical practice. To investigate how EBM knowledge is both explicitly as implicitly learned by GP-supervisors and GP-trainees, we focus on two ways of learning in particular: observational learning and learning through dialogue during learning conversations. Video-stimulated elicitation interviews with trainees and supervisors showed that observational learning is not occurring optimally in current daily practice and also that bidirectional learning opportunities during learning conversations are not optimally utilized. Conversation Analysis showed that current conversations between supervisors and trainees often hamper bidirectional learning. This thesis ends by recommending that both workplace-based learning opportunities and formal learning moments at the training institute need to be re-examined. It is essential to see EBM learning as a social process. The interactions between supervisor and trainee create their shared knowledge and their EBM behaviour. These insights can be used to create educational designs in line with current learning processes at the workplace and help both trainees and supervisors learn how to apply EBM in practice.