Professors are fond of telling graduates, \u2018\u2018This is just the beginning of your education, not the end.\u2019\u2019 Nothing in didactic form approaches the learning experience of the real world, in which there are no textbooks, no lesson plans, and no teacher to fall back on. Many early decisions are based on a teacher\u2019s transplanted wisdom. Often the transition is abrupt; the educational process up to graduation is based on a teacher-directed model of learning, for which there is no direct continuity in practice. Currently, there are multiple, instructor-led resources for long-term learning, including opportunities for continuing medical education (CME) from annual national and regional professional meetings, home study courses, audio digests, and online reviews.

This article, however, is not about formal, teacher-directed learning activities, such as lectures and CME. The reality is that instructor-led CME activity, although valuable, represents not only an arti\ufb01cial learning environment but also a relatively ine\ufb00ective one at that[1]. Active engage- ment in self-planned learning activities tends to be more e\ufb00ective than passive learning, which commonly characterizes formal CME. Most lifelong learning is problem speci\ufb01c and occurs in the context of real experience: the clinic, on an Internet search engine at night, or over the phone with a col- leaguedthose conversations that invariably begin, \u2018\u2018I got this guy..\u2019\u2019 Life- long learning involves \ufb01nding and implementing solutions to everyday problems encountered in the clinic, emergency room, and operating room and on the wards. The process by which much of this education occurs is via self-directed learning (SDL). According to Gibbons[2], a paradigm shift in instruction is \u2018\u2018teaching students to challenge themselves to pursue activi- ties that arise from their own experiences, employing their own emerging styles to \ufb01nd patterns of meaning and processes of productivity that lead

them to a high level of achievement and ful\ufb01llment. The prime imperative.is not to enhance teacher-directed learning, but to develop a more student- directed model.\u2019\u2019

Hammond and Collins[3] describe SDL as \u2018\u2018a process in which learners take the initiative, with the support and collaboration of others. For increas- ing self- and social awareness; critically analyzing and re\ufb02ecting on their sit- uations; diagnosing their learning needs with speci\ufb01c reference to competencies they have helped identify; formulating socially and personally relevant learning goals; identifying human and material resources for learn- ing; choosing and implementing appropriate learning strategies; and re\ufb02ect- ing on and evaluating their learning.\u2019\u2019 This humanistic characterization of SDL implies a sense of social awareness and responsibility, self-actualiza- tion, and the acceptance of personal responsibility for one\u2019s own learning.

The acquisition of SDL is a complex process that involves numerous skills and competencies relied on to complete challenges, such as medical school and residency. Unlike the classroom setting, in which the emphasis is on mastery of content, SDL emphasizes personal action taken to become more productive. Testing is no longer an issue, but performance certainly is. Many authors have identi\ufb01ed SDL as essential to continuing education e\ufb00orts in adults[4,5].

Not everyone is ready to accomplish SDL, however, because certain traits are essential for becoming a successful, productive person. Candy[6] synthe- sized an essential character list from more than 100 such traits (Box 1).

Generally, SDL is not limited to speci\ufb01c settings but can occur as a part of any process and include formal learning activities. Among Tough\u2019s[7] fac- tors are three common patterns in independent study: (1) a speci\ufb01ed learning need, (2) curiosity, and (3) general desire to learn. Houle[8] described three groups of adult learners: (1) goal oriented, (2) activity oriented, and (3) learn- ing oriented. Of these types, many practicing physicians clearly fall into the \ufb01rst category, because they frequently embark on a learning project to acquire new procedural skills or become familiar with new medications or updates in coding and reimbursement schedules, for example.

Possibly the most in\ufb02uential essay on SDL is \u2018\u2018The Walkabout\u2019\u2019 by Maurice Gibbons, which was published in the 1974 edition of the Phi Delta Kappan[9]. At the heart of the essay is the story of two children lost in the desert wilderness of the Australian outback. Facing certain death, the two are found and cared for by a young aborigine on his walkabout, a 6-month endurance test during which he must survive alone in the wilderness and

\u2018\u2018The movie is a haunting comment on education. What I \ufb01nd most provoc- ative is the stark contrast between the aborigine\u2019s walkabout experience and the test of adolescent\u2019s readiness for adulthood in our own society. The young native faces a severe but extremely appropriate trial, one in which he must demonstrate the knowledge and skills necessary to make him a con- tributor to the tribe rather than a drain on its meager resources. By contrast, the young North American is faced with written examinations that test skills very far removed from the actual experience he will have in real life. He sol- ves familiar theoretical problems; he does not apply what he knows in strange but real situations. His preparation is primarily for the mastery of content and skills in the disciplines and has little to do with reaching matu- rity, achieving adulthood, or developing fully as a person[9].\u2019\u2019

The walkabout model is applicable to the learning required by the prac- ticing physician. First, it should be experiential and the experience should be \u2018\u2018hands on.\u2019\u2019 Second, it should be a challenge that extends the capacities of the learner. Third, it should be a challenge speci\ufb01c to ordeven betterdde- signed by the learner. A productive learning experience depends on the learner\u2019s ability to make appropriate choices, but in most teacher-directed situations the student is not called on to make any meaningful choices. \u2018\u2018The test of the walkabout, and of life, is not what (the learner) can do under a teacher\u2019s direction, but what the teacher has enabled him to decide and to do on his own[9].\u2019\u2019 Most importantly, the trial should be an impor- tant learning experience in itself and should involve not only the demonstra- tion of the student\u2019s knowledge and skill but also self-awareness, \ufb02exibility, and personal nature.

\ue000Being methodical and disciplined
\ue000Being logical and analytical
\ue000Being re\ufb02ective and self-aware
\ue000Demonstrating curiosity, openness, and motivation
\ue000Being \ufb02exible
\ue000Being interdependent and interpersonally competent
\ue000Being persistent and responsible
\ue000Being venturesome and creative
\ue000Showing con\ufb01dence and having a positive self-concept
\ue000Being independent and self-suf\ufb01cient
\ue000Having developed information-seeking and retrieval skills
\ue000Having developed knowledge aboutdand skill atdlearning