How to assess your learning needs
If you are a reflective practitioner then it is likely that you assess your learning needs already—albeit unconsciously. So how should you do it formally? At this stage the average practitioner who wants to find out more may be flummoxed. The Good CPD Guide lists over 40 different methods of assessment. They range from keeping a diary of knowledge gaps, to assessing your practice risks, to formal patient satisfaction surveys. You can use them to assess your own needs or those of your practice. But most busy clinicians will want to choose from a more limited list of tools to assess their learning needs. Here is a sample of tools that you may want to try out.
If you work in a team you can do a formal 360 appraisal: this involves asking your colleagues to give feedback on your strengths and weaknesses. The colleagues can be doctors or can be interdisciplinary members of your team.9 They can give feedback on your knowledge skills or attitudes or even your abilities as a team player. Those giving feedback should remember that it should be balanced, descriptive, objective and constructive. It is not helpful to say ‘you are useless and you always will be and you said horrible things about me’. It is helpful to say ‘you are good with patients but you don’t always keep good notes and you should work on this’.
Critical incident reviews
The primary purpose of these reviews is to find out what went wrong, how and why it went wrong and how to prevent errors from being repeated. But they can also be used as an educational tool. A real incident that occurred to your team is likely to concentrate minds much more effectively than a dry research paper. The review could look at things that went wrong (for example, a patient being given a drug to which they were allergic) but could equally look at events that had a positive outcome (for example how the team worked effectively to cure a patient with meningitis). Such reviews should be structured. First, you should identify what incident you should look at and then give everyone time to prepare his or her thoughts prior to the meeting. Then you should conduct the review in as fair a way as possible. The purpose of the review is not to blame individuals but to find out what the team can learn from what went wrong.
This involves keeping a diary of learning needs that crop up during your working day. You might jot down something in a consultation or write a note about an issue from a practice meeting. By looking back at your diary you can identify your knowledge gaps. They may be just individual gaps but if you look more closely you may start to identify systematic gaps (for example, you may discover that 40% of your learning needs discovered in this way are about diabetes). Doctors who keep a diary generate more specific learning objectives than those who do not.
This could involve using data that already exist or doing a formal patient satisfaction questionnaire. The latter requires you to have confidence in yourself and in your colleagues and to be robust enough to accept criticism.
Alternatively, you could ask your colleagues to observe your performance and to give feedback on what you could do better. Observing how you practise by recording your consultations on video is a powerful tool that can help you identify your learning needs. It is particularly good at looking at how you communicate and how patient centred you are in your consultations.13 Video analysis is already used extensively to assess competence in exams and in summative assessment of GP registrars.
There are a variety of methods to help you uncover the gaps in your knowledge—different methods will suit different people. It is best to use more than one method and a combination of subjective and objective methods often gives a better overall picture of your knowledge gaps.