Medical Education > Current Research Studies: Physician Lifelong Learning

Current Research Studies: Physician Lifelong Learning

This study was designed to examine the feasibility of measuring physicians’ lifelong learning with special attention to the distinction between physicians involved in patient care without teaching or research responsibilities (clinicians) and those with teaching and research involvement in addition to patient-care responsibilities (academic clinicians).  The predictors and outcomes of lifelong learning for the physicians were investigated. 

Method: 

The participants included 3,195 physicians who graduated from JMC between 1975 and 2000.  The survey was mailed to all graduates of Jefferson during the study period (5,349).  Sixty percent with deliverable mailing addresses responded.  The survey included a revised version of the Jefferson Scale of Physician Lifelong Learning (JSPLL-R) plus questions about work status, practice setting, and activities related to the practice of medicine, research, and continuous learning.  Data were merged with data from the Jefferson Longitudinal Study of Medical Education.  On the basis of time devoted to patient care, research, and teaching, two groups of physicians were identified: (1) “clinicians” (n = 1,127), those who reported more  than 28 hours (or 4 days) per week in patient care, with no involvement in teaching and research, and (2) “academic clinicians” (n = 1,612), physicians who reported more  than 7 hours (or 1 day) per week involved in patient care and the rest of their time in teaching and research.  The remaining physicians were included in the “other physicians” category. 

Results: 

Findings regarding the psychometrics of the JSPLL-R showed that in a factor analytic study of the full scale (19 items), four factors were identified and designated as “learning beliefs and motivation,” “attention to learning opportunities,” “technical skills in information seeking,” and “scholarly activities.”  A subscale (which excluded 5 items involving the “scholarly activities” factor) was also generated for the “clinicians” who were not involved in teaching and research.  We assumed that this subscale would be more appropriate for measuring lifelong learning in the “clinicians” group than would the full scale used for the “academic clinicians.”  Psychometric evidence supported the JSPLL-R’s construct and criterion-related validities, its internal consistency and test-retest reliabilities.  The results supported the feasibility of using the two scales to assess the lifelong learning in the two groups of physicians. 

The following results were obtained regarding the predictors of lifelong learning before medical school, during medical school, and in residency.  In these analyses, we applied multiple regression analysis for the entire sample as well as for the “clinicians” and “academic clinicians.”  In these statistical analyses, because of the large sample size, we placed emphasis on clinical rather than statistical significance.

• Before medical school:  None of the variables before matriculation (age, gender, SAT-Quantitative scores, undergraduate GPAs, and medical school admissions interview ratings) could predict physician lifelong learning at clinically significant levels, with the exception of the SAT-Verbal scores, which could marginally predict the JSPLL-R’s full scale scores for the “academic clinicians.”
• During medical school:  For the “clinicians,” the second-year GPAs could predict the full scale and subscale scores of the JSPLL-R.  For the “academic clinicians,” the global ratings of clinical competence in the third-year major clerkships (internal medicine, family medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery), plus scores on Step 1 of medical licensing examinations were significant predictors of the full scale scores on the JSPLL-R.
• In residency: Ratings on “medical knowledge and clinical capability” made by directors of residency programs and scores on Step 3 of the medical licensing examinations could predict the full scale scores of the JSPLL-R for the “academic clinicians.”

The following results were obtained regarding the outcomes of lifelong learning. 

• For the “academic clinicians,” more time devoted to teaching, research, administration, and continuing medical education could predict higher scores on the JSPLL-R. 
• For the “clinicians,” time devoted to continuing medical education predicted lifelong learning scores. 
• We also found that high scorers among the “academic clinicians” on the full scale of the JSPLL-R were twice as likely as low scorers to publish papers in professional journals, present papers before national meetings, conduct research, receive research or training grants, and to serve as a peer reviewer for a professional journal. 
• For the “clinicians,” presenting patient education or research findings on radio or television, in a newspaper, or before a community group increased the likelihood of obtaining high scores by 2.6 times on the subscale of the JSPLL-R.

The following results were obtained by comparing physicians who graduated from combined degree programs (MD-PhD, BS-MD), the Physician Shortage Area, and the Delaware-Jefferson program.  Those with MD-PhD degrees scored higher on both the full scale and subscale of the JSPLL-R.  No group differences were observed among graduates from the other educational programs.  Additional group comparisons were made using scores on the JSPLL-R. 

Gender differences on the lifelong learning scores proved to be negligible. Physicians in internal medicine scored higher than those in family medicine and emergency medicine on the full scale of the JSPLL-R, and those in surgery and surgical specialties scored higher than other physicians in hospital-based specialties (anesthesiology, pathology/radiology), pediatrics, psychiatry, emergency medicine, and family medicine on the full scale.  The pattern of differences on the subscale scores were as follows: physicians in internal medicine scored higher than their counterparts in family medicine, emergency medicine, pediatrics, and psychiatry.  Also, surgeons scored higher than physicians in obstetrics/gynecology, ophthalmology, hospital-based specialties (anesthesiology, pathology, and radiology), family medicine, and emergency medicine.
Additional analysis involved the relationship between board certification status and lifelong learning scores.  Finally, the implications of the overall findings for medical education are discussed, and suggestions regarding future research are presented.

Final report submitted to the National Board of Medical Examiners’ Stemmler Medical Educational Research Fund (Invitational Grand Number: 0405-IG34)  This study was  funded in part by an invitational grand from the National Board of Medical Examiners (NBME) Edward J. Stemmler, MD Medical Education Research Fund. The study, its findings, and interpretations of the outcomes do not necessarily reflect NBME policy, and NBME support provides no official endorsement.