How family physicians learn a new medical procedure: Case investigations using the Personal Responsibility Orientation model

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Teaching and Leadership


Nick L. Smith


flexible sigmoidoscopy, Health education

Subject Categories

Educational Assessment, Evaluation, and Research


This research examined family physicians' perceptions of how they learned to perform flexible sigmoidoscopy, an endoscopic procedure that, increasingly, is being done by family doctors. Using a collective case study approach--that is, the description and comparison of a range of representative cases--I explored the learning experiences that had contributed to four family doctors' understanding and mastery of the procedure. I collected data through interviews, conversations, participant observation, document analyses, and an examination of the physicians' continuing medical education resources. Each physician's learning was reported as a project consisting of a series of related learning episodes. The four physicians who participated in this study reported 11 different learning episodes, for a total of 358 hours of activities targeted toward the goal of learning how to perform flexible sigmoidoscopy in the office setting. The Personal Responsibility Orientation (PRO) model of Brockett and Hiemstra (1991) provided the conceptual framework for gathering the data and for assessing the findings. My study found that new procedural skills are acquired through extensive preclinical training and clinical practice. A variety of instructional aids and activities (24 total) were employed by the physicians in learning the new medical procedure. During their multi-episodic learning projects, they benefited from preclinical and clinical experiences in which they used instructional resources in a variety of ways according to their personal preferences and their prior experiences. The physicians chose to participate in postgraduate learning experiences, the majority of which were self-directed, and they sustained the goal-directed behaviors necessary to persist and to guide their tasks to successful completion. Although the level and type of task involvement varied both across and within the learning projects, all four physicians ultimately developed cognitive understandings of the procedure, practiced their psychomotor skills preclinically and perfected them clinically, and adapted the flexible sigmoidoscopy procedure to their individual practice settings. The findings suggest that effective learning is best facilitated by providing educational formats that allow varying degrees of learner autonomy. Instructional strategies and approaches should be responsive to the needs of each learner and should help prepare learners for greater self-directedness in learning outside of institutional settings.


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