LEARNING IN THE SOCIAL-CONTEXT OF AMBULATORY CARE CLINICS

Social learning theory describes the process by which medical students and residents become members of the professional community of physici ans. According to this theory, learning is enhanced when students and residents can share with each other their partial understandings and w hen they can observe and emulate the thinking and actions of expert ro le models. The authors make several recommendations for how social lea rning theory may be applied to education in ambulatory care settings: (1) preceptors should pay careful attention to orienting learners and creating legitimate roles for learners appropriate to their levels of training and ability and their educational needs; (2) since students a nd residents learn by observing and interacting with preceptors, compe tent role models should be provided; (3) to be most effective, learner s should be told in advance what will be modeled, observe the demonstr ation, discuss what occurred and why it did or did not work effectivel y, and, finally, be given the opportunity to practice new actions, fir st with guidance and later independently; (4) when debriefing about mo deled interactions, preceptors should encourage self-monitoring and se lf-assessment; (5) preceptors should create opportunities for collabor ative learning, because collaboration with peers allows learners to di scover their own misconceptions and help others to develop a richer un derstanding of medical practice. Implementing these guidelines in ambu latory care training will enable learners and preceptors to arrive at the shared meanings and common understandings that form the foundation of the professional medical community.