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Applying evidence in practice through small-group learning: a qualitative exploration of success

Background A particular approach to continuing professional development for general practitioners originated in Canada. The Canadian approach uses a modification of problem-based learning that is based on evidence-based medicine with facilitated small groups. Evidence-based modules are developed for discussion in a small group, where the group exists over an extended period of time. An evaluation of a pilot of the ‘practice-based small group learning’ (PBSG) approach in Scotland demonstrated enhanced participant knowledge and skills in evidence-based practice and small-group working. However, it is not known why PBSG was successful. Understanding this will help inform any further research and development of the approach for general practitioners and other professional groups.Aim The aim of this study was to explore the perceptions and experiences of PBSG participants to gain an understanding of how PBSG learningachieves its success.Method A qualitative study of PBSG learning using one-to-one interviews.Results The small group format is an important factor in the success of the approach, along with the crucial role of the facilitator. Other factors include: the strong need among general practitioners to update their skills and compare their practice with that of peers; the inclusive nature of the small-group environment; the importance of creating a learning environment that is the right balance between being not too cosy but not too threatening; a recognition of the learning power of the group members instead of invited experts; the lack of trust among partners in practice and the lack of confidence of participants in their own skills as a facilitator. The findings highlight the importance of a learning environment conducive to learning and change, one that is based on honesty, openness and a willingness to acknowledge ignorance as a precursor to learning.


David Cunningham , Diane R Kelly , Peter McCalister , Joe Cassidy , Ronald MacVicar

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