ABSTRACT
INTRODUCTION A patient presents in the emergency room with an unusual set o f signs and symptoms. A new piece of life-support equipm ent is in the intensive care unit but none of the night shift personnel know how to use it to aid a crit ically ill patient. An elderly patient in a nursing hom e develops an infec tion that is resistant to all of the usual broad-spectrum antibiotics. In all of these situations, com petent 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 situa tions, they need to know what they need to learn about a particular situa tion, what particular medical procedures and resources are appropriate for the situation, how to formulate questions to seek the specific inform ation 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 & Cam pione, 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 u n d er standing. Learning experiences that support the developm ent of SDL skills are im portant in enabling the practicing physician to be a lifelong learner and a com petent problem solver.
