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Volume 26 (3)
Volume 26, Issue 3, Summer 2006 
J Contin Educ Health Prof 2006; 26(3):222-229
RESEARCH ARTICLE
Marianna B. Shershneva Molly Carnes Lori L. Bakken A b s t r a c t Introduction: A new paradigm in continuing medical education is characterized by emphasis on physicians’ learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice—generalist-specialist consultations—from an educational perspective. Methods: We applied the grounded-theory method with semistructured interviews. Ten primary care physicians and 9 internal medicine subspecialists were interviewed regarding their approaches to learning and teaching during generalist-specialist consultations. Results: Based on 48 formal and informal consultations reported by physicians, we developed a theory of teaching-learning transactions in generalist-specialist consultations. Discussion: As a teaching-learning transaction, the mutual learning process in generalistspecialist consultations involves 3 components: needs assessment, dialogue, and sufficiency. Providers of continuing medical education may use the proposed theoretical framework to help clinicians and health care organizations analyze and enhance educationally valuable interactions at the interface of primary and secondary care. Lessons for Practice
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