In the face of rapid growth in medical information and the rate of technological change, physicians keep up to date by continually seeking opportunities to learn and change on the job. Most learning initiated by physicians is self-directed and motivated by a desire to "do a better job." Although physicians often intend to maintain or enhance their competence or performance by participating in learning activities, the outcomes of individual learning events do not always meet expectations. The learning process doctors use to address the problems they identify and the outcomes that result from that learning are unclear. This paper is not a critique of theories of adult learning, but seeks to provide a practical interpretation of practice-based learning outcomes and suggest strategies to validate these outcomes in regard to their relevance to the physician's practice environment. In addition, the authors provide their sense of which competencies physician-learners require in order to achieve these outcomes of learning.Practice-based learning is the process whereby physicians use their practice environment and experiences to identify opportunities for learning. These processes are set in motion by practice needs and take the context of practice into account. They require the physician-learner to acquire skills and knowledge to address the problem and to evaluate the impact of the outcomes of learning on practice. Outcome refers to any result, consequence, or effect that occurs as a result of the learning process.Research has produced several models explaining how physicians learn and adopt innovations into their practice.1,3-5 Jennett et al. noted that learning tends to follow one of two formats, formal and semi-structured.2 Geertsma et al. and Putnam and Campbell both noted that learning proceeded through a series of stages.3,4 Fox et al.