Lifelong learning of physicians: contributions of different educational phases to practice performance

This pilot study was designed to find out where and when in their education physicians thought they had acquired the competencies they used in their daily practices five years after completion of their formal training. Specifically, the study sought physicians' views about the relative contributions of seven major phases of medical education (i.e., preclinical, clinical, "practice phases 1 and 2," specialty training, formal continuing education, and independent learning) to their practice performances. In 1991, the authors distributed a questionnaire to 330 physicians participating in a continuing medical education course in Germany, asking them about the relative contributions of these educational phases to their practice performances. A total of 141 (43%) returned questionnaires, of which 114 were suitable for evaluation. Specialty education was believed to have contributed most to the physicians' daily practices, with a median contribution of 20%. Practice-based independent learning, in which 38% participated in groups, contributed, with a median of 18%, and was superior to formal continuing education, with a median of 5%, and to university education, 15%. The frequency distribution of the percentages allotted to the seven phases showed great variation. Thirty-four respondents stated that they had not gained appreciably from preclinical education or formal continuing education but that the other five phases had contributed 50% to 90% of the knowledge and skills they used in their practices.