Assessing physicians' orientation toward lifelong learning.
ABSTRACT Despite the importance of lifelong learning as an element of professionalism, no psychometrically sound instrument is available for its assessment among physicians.
To assess the validity and reliability of an instrument developed to measure physicians' orientation toward lifelong learning.
Seven hundred and twenty-one physicians, of whom 444 (62%) responded.
The Jefferson Scale of Physician Lifelong Learning (JSPLL), which includes 19 items answered on a 4-point Likert scale, was used with additional questions about respondents' professional activities related to continuous learning.
Factor analysis of the JSPLL yielded 4 subscales entitled: "professional learning beliefs and motivation,"scholarly activities,"attention to learning opportunities," and "technical skills in seeking information," which are consistent with widely recognized features of lifelong learning. The validity of the scale and its subscales was supported by significant correlations with a set of criterion measures that presumably require continuous learning. The internal consistency reliability (coefficient alpha) of the JSPLL was 0.89, and the test-retest reliability was 0.91.
Empirical evidence supports the validity and reliability of the JSPLL.
- [show abstract] [hide abstract]
ABSTRACT: Self-directed learning is essential in assisting nurses to meet the challenges presented in today's health care environment. Nurse educators have an important role to play in assisting nurses to acquire the skills for self-directed learning, and to do this they need to understand the concept of self-directed learning. The aim of this review is to explore the concept of self-directed learning and its use in nurse education. A review of the literature was conducted using CINAHL, Medline and other databases and the keywords 'self-directed learning', 'student nurses', 'classroom', 'nursing education' and 'adult education'. The concept of self-directed learning is based on the principles of adult education and can take many different formats. Self-directed learning has many benefits. However, acquiring the necessary skills is dependent on a students' preference and readiness for self-directed learning and nurse educators' implementation of the concept. In implementing self-directed learning, nurse educators become facilitators of learning and require ongoing staff development. Not all students are self-directed and a variety of teaching methods should be used in curricula. A consensus definition of the concept of lifelong learning does not exist, and students and teachers may have different perspectives on it. Mature students may be more self-directing than school-leavers, and learning styles and readiness to learn need to be assessed when judging the appropriateness of using self-directed learning approaches. However, there are many potential benefits, including increased confidence, autonomy, motivation and preparation for lifelong learning.Journal of Advanced Nursing 08/2003; 43(1):62-70. · 1.53 Impact Factor
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ABSTRACT: Current assessment formats for physicians and trainees reliably test core knowledge and basic skills. However, they may underemphasize some important domains of professional medical practice, including interpersonal skills, lifelong learning, professionalism, and integration of core knowledge into clinical practice. To propose a definition of professional competence, to review current means for assessing it, and to suggest new approaches to assessment. We searched the MEDLINE database from 1966 to 2001 and reference lists of relevant articles for English-language studies of reliability or validity of measures of competence of physicians, medical students, and residents. We excluded articles of a purely descriptive nature, duplicate reports, reviews, and opinions and position statements, which yielded 195 relevant citations. Data were abstracted by 1 of us (R.M.E.). Quality criteria for inclusion were broad, given the heterogeneity of interventions, complexity of outcome measures, and paucity of randomized or longitudinal study designs. We generated an inclusive definition of competence: the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served. Aside from protecting the public and limiting access to advanced training, assessments should foster habits of learning and self-reflection and drive institutional change. Subjective, multiple-choice, and standardized patient assessments, although reliable, underemphasize important domains of professional competence: integration of knowledge and skills, context of care, information management, teamwork, health systems, and patient-physician relationships. Few assessments observe trainees in real-life situations, incorporate the perspectives of peers and patients, or use measures that predict clinical outcomes. In addition to assessments of basic skills, new formats that assess clinical reasoning, expert judgment, management of ambiguity, professionalism, time management, learning strategies, and teamwork promise a multidimensional assessment while maintaining adequate reliability and validity. Institutional support, reflection, and mentoring must accompany the development of assessment programs.JAMA The Journal of the American Medical Association 02/2002; 287(2):226-35. · 29.98 Impact Factor
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ABSTRACT: To identify the values and agendas underlying reports advocating the reform of medical education and to account for their similarity and repeated promulgation. Major reports regarding undergraduate medical education reform published between 1910 and 1993 were identified through a manual bibliographic search. Nineteen of a total of 24 reports met the two inclusion criteria: they directly addressed undergraduate medical education and contained a coherent body of recommendations. Content analysis of 19 reports. All the reports articulate a specifically social vision of the medical profession, in which medical schools are seen as serving society. The reports are remarkably consistent regarding the objectives of reform and the specific reforms proposed. Core objectives of reform include the following: (1) to better serve the public interest, (2) to address physician workforce needs, (3) to cope with burgeoning medical knowledge, and (4) to increase the emphasis on generalism. Proposed reforms have tended to suggest changes in manner of teaching, content of teaching, faculty development, and organizational factors. Reforms such as increasing generalist training, increasing ambulatory care exposure, providing social science courses, teaching lifelong and self-learning skills, rewarding teaching, clarifying the school mission, and centralizing curriculum control have appeared almost continuously since 1910. The similarity of the reports' objectives and reforms results not only from a similar body of problems, but also from the reaffirmation of similar values. The reports have two implicit agendas that transcend the reform of medical education: the affirmation of the social nature of the medical profession and self-regulation of the profession. These agendas help account for the reports' similarity and their repeated promulgation.JAMA The Journal of the American Medical Association 10/1995; 274(9):706-11. · 29.98 Impact Factor
Assessing Physicians’ Orientation Toward Lifelong Learning
Mohammadreza Hojat, PhD,1Jon Veloski, MS,1Thomas J. Nasca, MD,2
James B. Erdmann, PhD,3Joseph S. Gonnella, MD1
1Center for Research in Medical Education and Health Care, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA,
USA;2Dean’s Office, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA;3Dean’s Office, Jefferson College of
Health Professions at Thomas Jefferson University, Philadelphia, PA, USA.
BACKGROUND: Despite the importance of lifelong learning as an
element of professionalism, no psychometrically sound instrument is
available for its assessment among physicians.
OBJECTIVE: To assess the validity and reliability of an instrument
developed to measure physicians’ orientation toward lifelong learning.
DESIGN: Mail survey.
PARTICIPANTS: Seven hundred and twenty-one physicians, of whom
444 (62%) responded.
MEASUREMENT: The Jefferson Scale of Physician Lifelong Learning
(JSPLL), which includes 19 items answered on a 4-point Likert scale,
was used with additional questions about respondents’ professional
activities related to continuous learning.
RESULTS: Factor analysis of the JSPLL yielded 4 subscales entitled:
‘‘professional learning beliefs and motivation,’’ ‘‘scholarly activities,’’
‘‘attention to learning opportunities,’’ and ‘‘technical skills in seeking
information,’’ which are consistent with widely recognized features of
lifelong learning. The validity of the scale and its subscales was sup-
ported by significant correlations with a set of criterion measures that
presumably require continuous learning. The internal consistency reli-
ability (coefficient a) of the JSPLL was 0.89, and the test-retest reliability
CONCLUSIONS: Empirical evidence supports the validity and reliabil-
ity of the JSPLL.
KEY WORDS: lifelong learning; physicians; psychometrics; validity;
J GEN INTERN MED 2006; 21:931–936.
education, and continues throughout a physician’s profes-
sional life.1,2The importance of preparing students to become
lifelong learners has received widespread attention by profes-
sional organizations such as the Association of American
Medical Colleges,3and the Liaison Committee on Medical
Education,4and developing lifelong learning habit has been
a consistent recommendation in virtually all proposals for
medical education reform.5Lifelong learning was among
5 competencies considered as very important by more than
75% of physicians in a national survey,6and has been
described as an important element of professionalism.7–12
One of the 9 Principles of Medical Ethics adopted by the House
edical education is a lifelong learning process that be-
gins in medical school, extends into graduate medical
of Delegates of the American Medical Association on June 17,
2001 specified that: ‘‘A physician shall continue to study,
apply, and advance scientific knowledge.. ..’’13
Despite the emphasis placed on physicians’ lifelong learn-
ing, no universally accepted definition has been proposed.14
Lifelong learning is a complex and multidimensional con-
cept,15,16as reflected in the definition suggested by the Euro-
pean Lifelong Learning Initiative: ‘‘Lifelong learning is the
development of human potential through a continuously sup-
portive process which stimulates and empowers individuals to
acquire all the knowledge, values, skills, and understanding
they will require throughout their lifetimes and to apply them
with confidence, creativity and enjoyment in all roles, circum-
stances and environments’’16(p. 592). Facets of this broad
definition, such as ‘‘human potential,’’ ‘‘supportive process,’’
‘‘creativity,’’ and ‘‘enjoyment’’ impede empirical research
because they defy measurement.
For the practical purpose of developing an operational
measure of lifelong learning, based on a review of relevant
literature and panel discussions in our pilot studies,17we
defined lifelong learning as ‘‘a concept that involves a set
of self-initiated activities (behavioral aspect), and informa-
tion seeking skills (capabilities) that are activated in individu-
als with a sustained motivation to learn and the ability to
recognize their own learning needs (cognitition).’’ The 4 key
concepts in this definition that have been frequently described
in the literature18–21
are in italics to underscore their
Although afew instrumentshavebeen used to measure self-
directed learning in the general population,19,22,23they are nei-
ther specific to physicians nor designed to address lifelong learn-
ing as conceptualized in this study. To the best of our knowledge,
before the development of the Jefferson Scale of Physician
Lifelong Learning, no psychometrically sound instrument was
available to measure orientation toward lifelong learning and its
empirically derived components among physicians. This study
was designed to assess the psychometric properties of an in-
strument developed to measure physicians’ lifelong learning.
Eligible participants included 721 physicians in the Jefferson
Health System, affiliated with Thomas Jefferson University
Hospital and Jefferson Medical College in the Greater
Delaware Valley Region around Philadelphia. The final sample
included 444 physicians who responded to the survey, repre-
Manuscript received October 28, 2005
Initial editorial decision January 4, 2006
Final acceptance March 15, 2006
The authors have no conflict of interest to declare for this article or this
Address correspondence and requests for reprints to Dr. Hojat:
Center for Research in Medical Education and Health Care, Jefferson
senting a 62% response rate including 124 (28%) women,
124 (28%) physicians practicing in primary care specialties,
320 (72%) in other specialties, 378 (88%) holding an MD
degree, 35 (8%) a DO, and 18 (4%) a combined MD-PhD degree.
The Jefferson Scale of Physician Lifelong Learning (JSPLL) was
used. The JSPLL contains 19 items answered on a 4-point
Likert scale (strongly disagree=1, disagree=2, agree=3,
strongly agree=4). The higher the score on the JSPLL, the
greater the orientation toward lifelong learning. Details about
the development of its conceptual framework, the steps used to
generate its items, and the results of preliminary psychometric
analyses based on a small sample of 160 physicians were
Criterion Measures for Validity Assessments
We used 26 additional items (1 global indicator of lifelong
learning, 13 supplementary, and 12 checklist items) to assess
validity. The global indicator of lifelong learning asked
respondents to rate the extent of their orientation toward
lifelong learning on a 10-point scale (1=not committed to
lifelong learning, 10=a tireless advocate of lifelong learning).
The 13 supplementary items, answered on a 10-point scale
(1=not true about me at all, 10=completely true about me),
were used to assess the convergent validity of the JSPLL. These
items addressed the following 4 areas of criterion measures
determined by a factor analytic study: ‘‘intrinsic motivation’’ for
lifelong learning (4 items, e.g., I can easily recognize my profes-
sional strengths and weaknesses), ‘‘extrinsic
(2 items, e.g., learning cannot be initiated by itself, there should
be an external factor to initiate learning), ‘‘research interest’’
(4 items, e.g., I consider myself a researcher as well as a clini-
cian), and ‘‘information seeking skills’’ (3 items, e.g., I believe
that the skills to surf websites to find out what’s going on in
medicine is important for all physicians in order to catch up
with news and advances) (see Appendix A).
The 12 additional checklist items were used to assess the
validity of the JSPLL by the method of contrasted groups24
(p. 144). These items surveyed the respondents’ professional
activities that presumably require continuous learning (see
Table 3). Items about the respondents’ sex and specialty were
Upon the approval of the Institutional Review Board of Thomas
Jefferson University, we mailed surveys to 721 physicians.
We assigned a numeric code to each survey to compare
respondents with nonrespondents and to match the forms in
a test-retest reliability study. The cover letter explained that
the code was assigned to enable follow-up while concealing
respondents’ personal identities. Two follow-up reminders
were sent approximately 4 weeks apart. The final sample
included 444 physicians (62% response rate), who returned
useable surveys. Approximately 3 months later, we sent a
second form to a random sample of 100 of the 444 physicians
(71 responded). The cover letter informed the physicians that
they had been chosen for a study of the scores’ stability over
time. Statistical methods included w2, Pearson correlation,
principal factor analysis with varimax rotation, t-test, analy-
sis of variance, and analysis of covariance.
We compared respondents (n=444) and nonrespondents
(n=277) to assure representativeness of the sample with res-
pect to sex, degree (MD, MD-PhD, DO), and specialty. No signi-
ficant differences were observed between respondents and
nonrespondents on sex and type of degree. However, primary
care physicians were less likely to respond (62% response rate)
than others (72% response rate) (w(1)=7.8, Po.01).
Descriptive Statistics of the JSPLL
The frequency distribution, mean, median, standard devia-
tion, range, quartiles, and reliability coefficients of the JSPLL
are reported in Table 1. The internal consistency reliability
(coefficient a) for the scale was 0.89 and the test-retest
reliability was 0.91.
Item Statistics and Item-Total Score Correlations
The mean item scores for the 19 items ranged from a high
of 3.86 (SD=0.37) for ‘‘Lifelong learning is a professional
responsibility of all physicians’’ to a low of 2.36 (SD=1.1) for
‘‘I frequently publish articles in peer-reviewed journals.’’
Item-total score correlations were all positive and statis-
tically significant (Po.01), ranging from a low of r=.37 for
‘‘Searching for the answer to a question is, in and by itself
rewarding’’ to a high of r=.72 for ‘‘I actively conduct research
as a principal investigator or co-investigator.’’ The median of
the item-total score correlations was r=.60.
The underlying components of the JSPLL were examined
by factor analysis. Four factors with eigenvalues greater than
1 accounted for 60% of the total variance. Each factor can
be considered as a subscale of the JSPLL. Rotated factor
coefficients and summary results of factor analysis are report-
ed in Table 2.
The first subscale (36%) was entitled ‘‘professional learn-
ing beliefs and motivation.’’ Nine items had coefficients greater
than 0.45 on this subscale. Coefficient a for this subscale was
0.79. The second subscale (12%) is related to a construct
involving ‘‘scholarly activities.’’ Five items had coefficients
greater than 0.45 on this subscale (coefficient a=0.89). The
third subscale (7%) was entitled ‘‘attention to learning oppor-
tunities.’’ Four items had coefficients greater than 0.45 on this
subscale (coefficient a=0.74). The final subscale, accounting
for 5% of the variance, was entitled ‘‘technical skills in seeking
information.’’ Two items had a high loading on this subscale
We calculated subscale scores by summing scores for
items with the highest factor coefficients (reported in bold in
Table 2). Correlations among the 4 subscale scores ranged
from a low of 0.36 (between ‘‘professional learning beliefs
and motivation’’ and ‘‘technical skills in information seeking’’
subscales) to a high of 0.64 (between ‘‘professional learning
beliefs and motivation’’ and ‘‘attention to learning opportuni-
Hojat et al., Physician Lifelong Learning
The convergent validity of an instrument is addressed by ex-
amining correlations between scores on the instrument and
conceptually relevant criterion measures24(p. 156). We found
a significant correlation between JSPLL total scores and the
global indicator of lifelong learning (r=.53, Po.01). Correla-
tions between JSPLL subscale scores and the global indicator
of lifelong learning ranged from a low of 0.29 (for the ‘‘technical
skills in information seeking’’ subscale) to a high of 0.50 (for
the ‘‘learning beliefs and motivation’’ subscale). Correlations
with the 4 criterion measures reported in Table 3 indicate that
the total JSPLL scores correlated significantly with all 4 crite-
rion measures. The highest correlation was obtained for
‘‘research activities’’ (r=.69) and the lowest for ‘‘extrinsic
motivation’’ (r=.15). Correlations between JSPLL subscale
scores and the 4 criterion measures ranged from a high
of 0.78 between the ‘‘scholarly activities’’ subscale and the
‘‘research activities’’ criterion measure to lows of 0.03 and
0.04 between the ‘‘extrinsic motivation’’ criterion measure
and the JSPLL of ‘‘scholarly activities’’ and ‘‘attention to learn-
ing opportunities,’’ respectively.
Validity by the Method of Contrasted Groups
One approach to studying the validity of an instrument is to
determine whether the average scores obtained by contrasting
groups are in the expected direction.24Two groups of physi-
cians were compared on the total and the 4 subscale scores
of the JSPLL. Physicians who reported that they had been
involved during the past 5 years with a particular professional
activity presumably requiring
contrasted to those who were not involved in the activity.
The 12 professional activities, the number of physicians (in-
volved with the activity=yes, not involved=no), and the effect
sizes of the differences between the 2 groups are presented in
Results of the t-tests indicated that the differences
between the 2 groups of physicians were statistically signifi-
cant (Po.01) on all 12 professional activities. Effect sizes
around 0.25 or less can be considered small and clinically
negligible, those around 0.50 are moderate, and those
around or larger than 0.75 are clinically important.25,26Based
on these guidelines, none of the effect sizes reported in
Table 4 can be considered negligible, and most are clinically
We compared the total JSPLL scores for men (M=61.7,
SD=8.8) and women (M=59.3, SD=8.1). Although the differ-
ence was statistically significant (t(442)=2.59, Po.01), the
effect size estimate was small and negligible (d=0.28), indi-
cating that the sex difference could not be considered as
Primary care physicians (n=124) in family medicine, general
internal medicine, and general pediatrics were compared with
other specialists (n=320) on the total scores of the JSPLL. Re-
sults indicate that other specialists scored higher (M=63.0,
SD=8.2) than the primary care physicians (M=56.1, SD=7.7)
(t(442)=8.12, Po.01), effect size=.87. No change in patterns of
findings was noticed after statistical control for sex by using
analysis of covariance.
Type of Degree
We compared the JSPLL scores of 3 groups of physicians with
MD (n=378), MD-PhD (n=18), and DO (n=35) degrees by
using 1-way analysis of variance. Results showed that physi-
cians with MD-PhD degrees obtained the highest mean score
(M=66.9, SD=7.7), followed by those with an MD degree
(M=61.2, SD=8.5). The lowest mean score was obtained
by those with a DO degree (M=56.2, SD=8.6) (F(2,437)=10.1,
Po.01). The pattern of findings did not change when we used
analysis of covariance to control for the confounding effect
The findings of this study provide convincing psychometric
support for the JSPLL. Its content validity was supported by
2 pilot studies during the initial stages of test development.17
The positive item-total score correlations found in this study
confirm that each item was scored in the proper direction,
and the magnitude of correlations indicates that each item
contributed significantly to the total score.
The 4 subscales identified in this study are conceptually
relevant to the components of lifelong learning described by
others.11,19–21,27The scale appears to measure orientation
toward, and scholarly outcomes of lifelong learning. However,
we realize that 1 important outcome of physician lifelong learn-
ing that does not lend itself to measurement by physicians’
self-report is patient outcome. We believe that it is important to
Table1. Frequency Distribution of Scores, Percentile Ranks,
Descriptive Statistics, and Reliability Coefficients for the
Jefferson Scale of Physician Lifelong Learning
31 to 40
41 to 43
44 to 46
47 to 49
50 to 52
53 to 55
56 to 58
59 to 61
62 to 64
65 to 67
68 to 70
71 to 73
74 to 76
Median (50th percentile)
Coefficient a reliability
19 to 76
19 to 76
?The test-retest reliability coefficient was calculated for 71 physicians
who completed the scale for a second time within approximately a
3-month interval between testing.
Hojat et al., Physician Lifelong Learning
incorporate this element in the assessment of physician
lifelong learning by obtaining relevant information from
peers, patients or clinical charts for a more comprehensive
assessment. Despite this limitation, the identification of the 4
subscales suggests that lifelong learning is a multidimensional
concept.28They are also consistent with the competencies of
self-directed learning such as skills for information retrieval,
motivation and self-initiation, attention to learning opportuni-
ties and scholarly activities,20and identification of learning
validity of the scale. The notion that professionals must have
a high degree of intrinsic motivation for learning to maintain
competence29,30is reflected in the ‘‘professional beliefs and
motivation’’ subscale, and a desire to learn and to initiate self-
study, described as facets of lifelong learning,29is reflected in
for the construct
the ‘‘professional learning beliefs and motivation’’ and ‘‘atten-
tion to learning opportunity’’ subscales. The ‘‘technical skills
in information seeking’’ subscale is consistent with the notion
that information technology, advanced telecommunications,
and the Internet are major vehicles for pursuing lifelong learn-
ing.30,31This finding is also in agreement with the guidelines
proposed in the Medical School Objectives Project to ensure
that medical school graduates demonstrate the ability to
retrieve information from electronic databases and other
resources for solving problems relevant to the patient3(p. 7).
The 4 subscales are similar to the factors found in our
preliminary study with 160 physicians.17For example, the
‘‘professional beliefs and motivation’’ subscale in the present
study corresponds to the 2 factors of ‘‘motivation’’ and ‘‘self-
initiated learning’’ of the preliminary study. The ‘‘scholarly
Table2. Rotated Factor Matrix of the Jefferson Scale of Physician Lifelong Learning
1. Rapid changes in medical science require constant updating of knowledge and development of new
I recognize my need to constantly acquire new professional knowledge
Lifelong learning is a professional responsibility of all physicians
I believe that I would fall behind if I stopped learning about new developments in my profession
One important mission of undergraduate medical education is to develop the habit of lifelong learning
I enjoy reading articles in which issues of my professional interest are discussed
I always make time for self-directed learning, even when I have a busy practice schedule and other
professional and family obligations
Searching for an answer to a question is, in and by itself rewarding
I review professional journals every week
I actively conduct research as a principal investigator or a co-investigator
I give on average at least one presentation at professional meetings in every given year
I frequently publish articles in peer-reviewed journals
I routinely exchange e-mail messages with my colleagues
I routinely attend grand rounds offered in my field regardless of whether a certificate for
attendance is offered
I routinely attend annual meetings of professional medical organization
I attend professional development programs regardless of whether CME credit is offered
I take any opportunity to gain new knowledge/skills that are important to my profession
My preferred approach in finding an answer to a question is to search the appropriate
I search computer databases (e.g., MEDLINE) to find out about new developments in my field
Items are listed by the order of magnitude of the factor coefficients within each factor. Values greater than 0.45 are in bold. Items were answered on a
4-point Likert-type scale (1=strongly disagree, 4=strongly agree).
Factor 1: A construct involving ‘‘Professional learning beliefs and motivation.’’
Factor 2: A construct involving ‘‘Scholarly activities.’’
Factor 3: A construct involving ‘‘Attention to learning opportunities.’’
Factor 4: A construct involving ‘‘Technical skills in information seeking.’’
Table3. Correlations Between Subscale Scores of the Jefferson Scale of Physician Lifelong Learning (JSPLL) and Criterion Measures
Criterion MeasuresSubscales of the JSPLL
Learning Beliefs &
Attention to Learning
Technical Skills in Information
Global indicator of lifelong
Intrinsic motivation factor
Research activities factor
Computer skills factor
Extrinsic motivation factor
All of the correlations above .15 are statistically significant (Po.01).
Hojat et al., Physician Lifelong Learning
activities’’ subscale corresponds to the ‘‘research endeavor’’
factor, the ‘‘attention to learning opportunity’’ subscale corre-
sponds to the ‘‘need recognition’’ factor, and the ‘‘technical
skills in seeking information’’ subscale corresponds to the
‘‘technical skills’’ factor extracted in the preliminary study.
The pattern of correlations between the subscale scores
and the 4 criterion measures suggests that each subscale of
the JSPLL yields the highest correlation with the most con-
ceptually relevant area of the criterion measure, providing
support for the convergent validity of the subscales. The find-
ings by the method of contrasted groups (Table 4) suggest that
scores of the JSPLL yield statistical and practical significant
link to behavioral manifestation of continuous learning (e.g.,
inventions, research activities, and appearance on public
media), thus providing additional support for the validity of
The difference between the mean scores for primary care
physicians and for other specialists could be explained by our
previous findings32showing that specialists were more likely
than generalists to be involved in research and that they pro-
duced more publications, activities that are linked to contin-
uous learning. Comparisons of the 2 groups in the present
study confirmed that specialists reported more involvement
with the professional activities listed in Table 4. The difference
between the mean scores in favor of those with MD-PhD
degrees could be explained in part by considering the research
training of this group that increased the likelihood of involve-
ment with continuous learning activities. This speculation was
confirmed by observing that those with MD-PhD degrees
reported more involvement with the professional activities
listed in Table 4 than the other physicians.
The support for the validity of the JSPLL and its subscales
provided in this study, and the magnitude of the internal con-
sistency and test-retest reliabilities of the scale and subscales
confirm that the scale and its subscales are psychometrically
sound. To the best of our knowledge, the JSPLL is the first
instrument developed specifically to measure physicians’ ori-
entation toward lifelong learning. This brief, self-administered
instrument has potential utility and numerous implications in
medical education research.
Although the psychometric evidence reported in support of
the JSPLL is convincing, further research is needed with
a representative national sample of physicians in different
specialties (e.g., from the American Medical Association’s
Physician Masterfile) for further psychometric analyses and
for the construction of norm tables with score distribution
and percentile ranks for subgroups of physicians. Also, it is
important to determine whether the factor structure of the
JSPLL can be maintained for physicians in different specialties
and practice settings.
The social desirability response style may jeopardize the
validity of the scores in self-report instruments. We attempted
to address the issue by using a single item, ‘‘I am known by my
patients as a physician who loves poetry,’’ as a proxy measure
for social desirability response style. Although we found no
relationship between responses to this item and scores of the
JSPLL, the issue of the possible influence of social desirability
bias on test scores deserves further research attention.
Additional research is also needed to examine the validity
of the JSPLL scores as predictors of board certification,
citation rate for publications, clinical outcomes, patients’
satisfaction, and malpractice claims. Supported by an invita-
tional grant from the NBME Stemmler Medical Educational
Research Fund, we are continuing our research to generate
2 subtests of the JSPLL. One will be applicable to physicians
who are full-time clinicians and are not involved in research
and teaching activities. The other will be applicable to acade-
mician-clinician physicians involved in teaching or research
as well as clinical activities. To enhance our understanding
Table4. Effect Sizeswof Group Differences on the Scores of the Jefferson Scale of Physician Lifelong Learning by Professional Activities,
Comparing Physicians Who Were Involved with the Activity and Those Who Were Not Involved
Professional ActivitiesInvolvementEffect Sizes
1. Published article(s) in professional journals
2. Presented paper(s) before national meetings
3. Collaborated in the conduct of research
studies or clinical trials
4. Received a grant for research or training
5. Received professional awards or honors
6. Held office in national professional organizations
7. Served on professional committees (hospital, society)
8. Served as an editor, or on the editorial board of a
9. Served as a reviewer for a professional journal
10. Shared in developing medical/surgical procedures,
instruments, drugs or techniques described in the literature
11. Presented patient education/research findings in public
media, or community groups
12. Been involved in teaching medical students or residents
413 26 0.54??
wEffect sizes were calculated based on this formula: (Meanyes?Meanno)/pooled SD.
Hojat et al., Physician Lifelong Learning
of physician lifelong learning, we also plan to examine the an-
tecedents and consequences of lifelong learning for physicians
who are full-time clinicians and their academic counterparts.
We would like to thank Bethany Brooks for her editorial assist-
ance. This study was funded in part by a grant from the National
Board of Medical Examiners (NBME) Edward J. Stemmler, MD
Medical Education Research Fund. The study, its findings, and
interpretations of the outcomes do not necessarily reflect NBME
policy, and NBME support provides no official endorsement.
1. Association of American Medical Colleges (AAMC). Contemporary
issues in medicine—medical informatics and population health: report II
of the Medical School Objectives Project. Acad Med. 1999;74:130–41.
2. Gonnella JS, Callahan C, Louis DZ, Hojat M, Erdmann JB. Medical
education and health services research: the linkage. Med Teacher.
3. Association of American Medical Colleges (AAMC). Learning objec-
tives for medical student education. Guidelines for medical schools: Re-
port 1 of the medical school objective project. Available at: http://
www.aamc.org/meded/msop/msop1.pdf. Accessed January 25, 2006.
4. Liaison Committee on Medical Education (LCME). Function and
Structure of a Medical School. Washington, DC: LCME; 2000.
5. Christakis NA. The similarity and frequency of proposals to reform US
medical education: constant concerns. JAMA. 1995;274:706–11.
6. Finocchio LJ, Bailiff PJ, Grant RW, O’Neil EH. Professional compe-
tence in the changing health care system: physicians’ view on the
importance and adequacy of formal training in medical education. Acad
7. Arnold L. Assessing professional behavior: yesterday, today, and tomor-
row. Acad Med. 2002;77:28–37.
8. Duff P. Professionalism in medicine: an A-Z primer. Obstet Gynecol.
9. Epstein RM, Hundert EM. Defining and assessing professional compe-
tence. JAMA. 2002;287:226–35.
10. Miflin BM, Campbell CB, Price DA. A lesson from the introduction of a
problem-based, graduate entry course: the effects of different views of
self-direction. Med Educ. 1999;33:801–7.
11. Nelson AR. Medicine: business or professionalism, art or science? Am
J Obstet Gynecol. 1998;174:755–8.
12. Nierman DM. Professionalism and the teaching of clinical medicine:
perspectives of teachers and students. Mt Sinai J Med. 2002;69:410–1.
13. American Medical Association (AMA). Principles of medical ethics.
Accessed January 25, 2006.
14. O’Shea E. Self-directed learning in nurse education: a review of litera-
ture. J Adv Nurs. 2003;43:62–70.
15. McKenzie P. How to make lifelong learning a reality: implications for the
planning of educational provision in Austria. In: Aspin D, Chapman J,
Hatton M, Sawano Y, eds. International Handbook of Lifelong Learning.
Dordecht, the Netherlands: Kluwer; 2001:367–78.
16. Longworth N. Learning communities for a learning century. In:
Aspin D., Chapman J., Hatton M., Sawano Y., eds. International
Handbook of Lifelong Learning. Dordecht, the Netherlands: Kluwer;
17. Hojat M, Nasca TJ, Erdmann JB, Frisby AJ, Veloski JJ, Gonnella JS.
An operational measure of physician lifelong learning: its development,
components, and preliminary psychometric data. Med Teacher. 2003;25:
18. Aspin D, Chapman J, Hatton M, Sawano Y. International Handbook of
Lifelong Learning. Dordecht, the Netherlands: Kluwer; 2001.
19. Bligh J. The S-SDLRS: a short questionnaire about self-directed learn-
ing. Postgrad Educ General Pract. 1993;4:121–5.
20. Candy PC. Self-Direction for Life-Long Learning: A Comprehen-
sive Guide to Theory and Practice. San Francisco, CA: Jossey-Bass;
21. Knowles M. Self-Directed Learning: A Guide for Learners and Teachers.
New York: Association Press; 1975.
22. Guglielmino LM. Development of the self-directed learning readiness
scale [Doctoral dissertation, University of Minnesota, 1977]. Dissert
Abstr Int. 1977;38:6467A.
23. Oddi LF. Development and validation of an instrument to identify
self-directed continuing learners. Adult Educ Q. 1986;36:97–107.
24. Anastasi A. Psychological Testing. New York: Macmillan; 1976.
25. Cohen J. Statistical Power Analysis for Behavioral Sciences. Hillsdale,
NJ: Erlbaum; 1987.
26. Hojat M, Xu G. A visitor’s guide to effect sizes: statistical significance
versus practical (clinical) importance of research findings. Adv Health Sci
27. Jennet PA, Swanson RW. Lifelong, self-directed learning: why physi-
cians and educators should be interested? J Continuing Educ Health
28. Bolhuis S. Toward process-oriented teaching for self-directed lifelong
learning: a multidimensional perspective. Learning Instruction. 2003;
29. Long HB, Agyekum SK. Guglielmino’s self-directed learning readiness
scale: a validation study. Higher Educ. 1983;12:77–87.
30. Carlton KH. Redefining continuing education delivery. Computers Nurs.
31. McCarthy M. Computer and internet: tools for lifelong learning. J Renal
32. Hojat M, Gonnella JS, Erdmann JB, Veloski JJ, Xu G. Primary care
and non-primary care physicians: a longitudinal study of their similar-
ities. Acad Med. 1995;70:S17–28.
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Hojat et al., Physician Lifelong Learning