A Qualitative Study of Resident Learning in Ambulatory Clinic

Qualitative analysis of a large ethnographicdatabase from observations of a residentteaching clinic revealed three importantfindings. The first finding was that breakdown,a situation where an `actor' (such as a personor the group) is not achieving expectedeffectiveness, was the most important categorybecause of its frequency and explanatory power. The next finding was that exposure to breakdownwas a necessary ingredient for reflectivelearning. The final finding was that effectiveresponse to breakdown (with concomitantreflective learning) requires six factors to bepresent: the patient is engaged directly;responsibility is matched to authority; toolsare matched to tasks; information resources arematched to need; values are matched betweenco-participants; and expectations are matchedwith capacity. These findings have implicationsfor planning, improvements and further studiesin ambulatory teaching clinics.