Self-directed learning in post-graduate medical education: Self-judgement and supervisor judgement of competence development in Austrian nine-month basic training.

Abstract

Background: Self-directed learning in the workplace should lead to the mastery of predefined learning objectives, with subjective competence judgements steering learning and promoting acceptance of feedback. Rotations should support self-directed learning in basic training by allowing junior physicians (JPs) to apply basic clinical competencies in various internal medicine and surgical departments.

Aim: The study hypothesises that rotations support self-directed learning, as measured by self-judgements and supervisor judgements. Additionally, it describes JPs' willingness to reflect on their learning needs at the end of their basic training.

Methods: This longitudinal study comprises 147 pseudonymised logbooks completed by JPs from three Vienna healthcare group (WIGEV) clinics. The logbook accompanies JPs' training, requiring them and their supervising specialist physicians to rate their training goal completion (10-level % scale) in training months 2, 3, 5, 6, 8 and 9. In addition, in months 3, 6 and 9, the JPs document the level of competence (knowledge, experience and proficiency) they feel they have achieved for each learning objective specified by the Austrian medical association (ÖÄK).

Results: The self-judged level of training goal completion demonstrates a multi-peaked distribution with an increasing trend; the supervisors' judgement of JPs' level of training goal completion is almost parallel. The share of learning objectives where the required level of competence is seen as not yet mastered decreases throughout the training. In the 9^th month of training, approximately ¼ of the JPs indicated a need to learn in ≥10% of the learning objectives, independent of the training clinic.

Conclusions: After switching departments, JPs downgraded their rating of training goal completion. Rotation supports realistic self-judgement, as competencies must be applied and reassessed in a new context. Most JPs consider the required level of competence per learning objective to be mastered at the end of basic training, yet they remain prepared to reflect critically on their learning needs.