ABSTRACT
A patient presents in the emergency room with an unusual set of signs and symptoms. A new piece of life-support equipment is in the intensive care unit but none of the night shift personnel know how to use it to aid a critically ill patient. An elderly patient in a nursing home develops an infection that is resistant to all of the usual broad-spectrum antibiotics. In all of these situations, competent physicians need to know how to go beyond what they already know to deal with new problems successfully. In order to go beyond what is known and to create new knowledge for novel situations, they need to know what they need to learn about a particular situation, what particular medical procedures and resources are appropriate for the situation, how to formulate questions to seek the specific information needed, and how the knowledge (new or old) can be applied in practice. Collectively, these abilities define what has been referred to as expertise in self-directed learning (SDL) skills or metacognitive learning abilities (see Brown, Bransford, Ferrara, & Campione, 1983; Brown & Campione, 1990). These abilities help people to grow intellectually by adapting and applying knowledge to new situations, as well as by recognizing the need to move beyond one’s current knowledge state to a new level of understanding. Learning experiences that support the development of SDL skills are important in enabling the practicing physician to be a lifelong learner and a competent problem solver.
