Crammer's corner
GP at The Fern Hill Practice, Faringdon, and RCGP Curriculum Development Fellow
E-mail: ben.riley{at}nhs.net
This issue of Crammer's Corner considers how you can identify your learning needs and use the curriculum to direct your learning activities.
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Learning what you need to learn |
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 TOP Learning what you need... Identifying learning needsPrioritizing learning needsSpiral learningLearning complex skillsUsing the curriculum to... |
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General practice is a very broad specialty and it is sometimes difficult to know where to start when faced with so many different topics and skills to master. Identifying your learning needs effectively is an important step in the learning process as it enables you to set some priorities.
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Identifying learning needs |
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TOPLearning what you need...Identifying learning needsPrioritizing learning needsSpiral learningLearning complex skillsUsing the curriculum to... |
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Day-to-day contact with patients will generate many learning needs, which can be recorded in a patient log or learning portfolio. Early on, trainees tend to focus on the need to acquire items of clinical knowledge or technical procedures. AKTs are useful for testing knowledge (AKT questions are published every month on www.rcgp-innovait.oxfordjournals.org) and can help identify areas of strength or weakness. Learning needs relating to more complex skills, such as consultation skills, can be identified by case analysis, consultation analysis (video surgeries) and shared surgeries.
GP learners can identify their individual learning needs through a large number of educational activities. Some of these are listed in Fig. 1.
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Prioritizing learning needs |
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TOPLearning what you need...Identifying learning needsPrioritizing learning needsSpiral learningLearning complex skillsUsing the curriculum to... |
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So you have identified a number of learning needs. How do you decide which ones to tackle first?
Self-assessment tools (such as confidence rating scales) are useful for prioritizing learning needs, as they can reveal areas the learner feels particularly motivated to learn. However, it is important to remember that evidence from assessment shows that doctors are not always accurate at assessing their own abilities. Self-assessments should be checked against other evidence of performance (e.g. patient satisfaction questionnaires) to ensure the findings are accurate. RCGP Scotland's nPEP (www.pep-ekit.org.uk) is an online interactive test of general practice and is a useful objective tool to help with the prioritization of learning needs.
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Spiral learning |
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TOPLearning what you need...Identifying learning needsPrioritizing learning needsSpiral learningLearning complex skillsUsing the curriculum to... |
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Spiral learning involves revisiting the same areas of the curriculum on several occasions over time. This means reviewing topics, skills and competencies more than once, each time focusing in greater depth and complexity. An analogy to this is a plane descending in a spiral as it prepares to land—as the plane circles downwards, lower and lower, the landmarks below appear in greater detail.
Each time an area a topic or skill is revisited in spiral learning, the learner:
- Reviews what was previously learned
- Reinforces the recognition of important patterns
- Gains a greater awareness of what determines their decisions
- Expands their range of management options
- Achieves a more complex understanding
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Learning complex skills |
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TOPLearning what you need...Identifying learning needsPrioritizing learning needsSpiral learningLearning complex skillsUsing the curriculum to... |
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Complex GP skills, such as communication skills, consultation techniques and dealing with ethical dilemmas, require a more sophisticated approach to learning.
It often helps to break down more complex learning needs into learning outcomes. A learning outcome is a brief description of a behaviour or an activity that you will be able to demonstrate, the context in which you will demonstrate it, the standard to which it will be performed and the timescale. An example is given in Fig. 2.
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Learning outcomes can be further broken down into the individual items of knowledge, attitude and skill that together are required to meet the outcome. Each individual item can then be addressed in turn through a number of different learning activities, before these are then brought together and put into action as a whole, in order to achieve the outcome.
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Using the curriculum to direct learning |
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TOPLearning what you need...Identifying learning needsPrioritizing learning needsSpiral learningLearning complex skillsUsing the curriculum to... |
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GP Specialty Trainees, as self-directed learners, are encouraged to take charge of their learning increasingly as training progresses. However, even the most independent and self-directed learner benefits from a degree of guidance and direction. This is often the case at the start of a training post, when the sudden deluge of learning needs can feel overwhelming. The curriculum forms the reference framework for planning educational activities to ensure all the domains of general practice are covered.
The RCGP has published an electronic self-assessment tool which is based on the curriculum (available in the Educational Resources section at www.rcgp-curriculum.org.uk). This allows learners to score themselves on their level of confidence against all of the learning outcomes that are described in the curriculum.
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