Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH (Members only) FULL-TEXT		Volume 22 (3) Volume 22, Issue 3, Summer 2002 J Contin Educ Health Prof 2002; 22(3):131-141 THEORETICAL FOUNDATIONS Role of experience and context in learning to diagnose Lyme disease Bakken LL A b s t r a c t INTRODUCTION: A recent review of research in continuing medical education suggests that scholarship should be integrated with practice so that practical problems can be addressed with theoretically derived yet applicable solutions. This project develops a theory describing how physicians learn and formulate decisions in the context of diagnosing Lyme disease in order that educational programs can be designed to improve accuracy in diagnosis of this disease. METHODS: A qualitative study using grounded theory methodology was performed to explore the learning process of physicians when diagnosing Lyme disease. Nine physicians were interviewed, and the interview transcripts were coded into categories to form a theory about how physicians learn in practice. RESULTS: Patient-physician interactions initiate the learning process by setting a context for which physicians frame a problem according to familiarity. Repetitive, similar, and counter-experiences, combined with cognitive knowledge, contribute to that framework and influence how the problem is framed along a continuum of familiarity. Furthermore, these experiences serve as information that influences diagnostic decisions and physicians' behaviors. DISCUSSION: For teaching and learning, cases and examples should include sufficient variety, repetition, and counterexperiences that allow a physician to appropriately recognize and categorize a patient's signs and symptoms into a disease category. Resources for information should be readily available and current. Preceptors and physician colleagues should provide timely feedback on diagnostic accuracy, and case studies should be presented with contextual elements that facilitate the diagnosis of Lyme disease. Lessons for Practice To replicate the diagnostic environment and facilitate the diagnosis of Lyme disease, case studies with rich contextual descriptions, including the clinical setting, family lifestyles, and patient history, should be presented. Preceptors should compare Lyme disease cases explicitly with non-Lyme disease and Lyme disease-like cases. Learning resources should be readily available and current. Physicians should be presented with multiple and varied cases. Preceptors and physicians' colleagues should provide timely feedback on the accuracy of a diagnosis. MeSH Terms: Clinical Competence; Decision Making; Education, Medical, Continuing; Lyme Disease; Physician-Patient Relations Publication Type: Evaluation Studies
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