The Four Stages of the Physician Learning Process

The Four Stages of the Physician Learning Process

In my last post, I described a typical day in the life of a primary care physician—the pressures of time, seeing patients, spending quality time with them, knowing the importance of education and training to better help them, and the anxiety faced with all of it.

After work, I managed to stop and get groceries on my way home but ran out of time to cook dinner, so I grabbed a quick meal (Chinese takeout, in case you were interested). With my last bite of lo mien, I am now approaching a position to learn. There are no distractions—the cat has been fed, TiVo is recording Game of Thrones—and so now is the time to learn. I am tired, but I am also determined to attempt to resolve those issues that I noted in my day’s practice.

The literature tells us that there are further stages to the learning process to instill practice change. Knowing this will assist the instructional designer in his or her efforts to ensure that each stage is performed as expediently as possible for the learner. After deciding that there are areas that would warrant future focus, what are the next steps?

Stage 1: The Change Agents of Learning

The change agents of learning occur when physicians scan their environments and become aware of some element of their practice that may require an educational intervention, as discussed in my previous post.

Stage 2: Engaging in learning

The next stage, engaging in learning, is when physicians participate in learning activities focused on gaining the knowledge and skills needed to solve the identified problem or to broaden knowledge in a particular area (Slotnick, 1999). In this stage, the learner is seeking resources and carrying out an inquiry into the problem. As I hinted at previously, it is worthwhile for the physician to learn from issues directly applicable to his or her clinical practice.

Having this on-the-job, just-in-time style of training is one such way of engaging in learning, but unfortunately it is not always the quickest route to implementation in the field. Physicians also take part in medical education (both CME and non-CME) activities outside of the workplace, such as learning through reading and reflection, e-learning activities, small-group learning, and conferences. These types of learning activities are vital, as they support the development of learning with direct reference to externally set educational standards: best practices that may have validity for their patients.

Stage 3: Trying out what was learned

After having learned what was needed to solve a problem or enhance knowledge and skills in a particular area, physicians will adopt the new idea and determine whether it is feasible to incorporate into practice, and perhaps more importantly whether this change will be beneficial (Grol, 2002). This is when they gain experience using what was learned (Slotnick, 1999, 2000), trying out this new knowledge or procedure within their own setting—that is, seeing what the results are, for them, in their practice—and gaining insight into in the field through learning and results.

Stage 4: Incorporating what was learned

The final stage of the process occurs when the physician has become very comfortable with what has been learned, and has gained enough experience to resolve the initial problem that spurred the change (Slotnick, 1999). At this stage, the change has been embedded into routines (Grol, 2002) and becomes the physician’s go-to skill or knowledge.

To conclude, the literature suggests that the process of physician learning follows these steps outlined above. Of course, there will be times when these stages take longer to complete than others. There may be times, when entering a stage, a learner realizes the proposed solution is not valid or practical, personally or in practice. In this sense, the process outlined above should be seen more as an ever-expanding loop of refining and trying out activities of learning rather than a definitive linear process.

I hope this closes the loop nicely. In my next post, I will explore some of the other areas of what drives physician change within a practice. I think you deserve that extra eggroll now.


Grol R, (2002) Changing physicians’ competence and performance: finding the balance between the individual and the organization. J Contin Educ Health Prof. 22(4):244-51.

Slotnick HB, (1999) How doctors learn: physicians’ self-directed learning episodes. Acad Med. 74(10):1106-17.

Slotnick HB, (2000) Physicians’ Learning Strategies Chest. 118;18S-23S.