Identifying Learning Needs

WHERE YOU CAN IDENTIFY LEARNING NEEDS

The Clinicians Own experience in direct patient care

PUNs and DENs, Blind spots, Clinically-generated unknowns & difficulties arising in practice (Problem Based Learning (PBL) and Self Directed Learning (SDL), Other disciplines, Competence standards, Introducing innovations in practice eg screening for CHD, Knowledgeable patients “ I found this on the internet doctor and is it true that….”, Mistakes, Patients' complaints and feedback, Post-mortems and the clinico-pathological conferences (CPC), Reflection on practical experience

From the Primary Health Care team

The following may generate ideas that you previously never thought about:

In-house Clinical meetings, Practice (business) meetings, Practice (educational) meetings, Other Clinical Colleagues, Mentoring

Non-clinical activities

Academic activities, Half-day release participation (for Registrars), Visits to other practices

Journal articles, Conferences & International visits, Medico-legal cases, Press and media, Professional conversations, Research

Specific needs assessment

Random case analysis, Problem case analysis, Video assessment of performance, Formative assessment package, Observation - joint surgery, Self-assessment - confidence scales (see below), Objective tests of knowledge and skill e.g. PEP CD package; Summative assessment MCQ, MRCGP, Diploma’s etc, Significant Event Audit, Gap analysis, Revalidation systems, Self-assessment

Formal quality management and risk assessment

The following are objective ways of identifying some of your learning needs

Audit, Morbidity patterns, PACT data, Patient adverse events, Patient satisfaction surveys, Risk assessment

Peer review

Several methods of peer review:

External peer review, Informal peer review of the individual doctor, Internal peer review, Multidisciplinary peer review, Physician assessment

NW Thames Confidence Grid

Usually found as a grid with tick boxes. Can be used as a simple check list (and a curriculum)

Check it out….a copy can be found on the site You might want to use it with your trainer (if you’re a registrar) and help you to prepare a learning plan during your stent in general practice.

Source : an excellent site for trainers but in my opinion, for registrars too.

HOW TO ELICIT NEEDS FROM THE TRAINEE

Method I: Interview

Advantages:

Reveals feelings, causes, and possible solutions of problems as well as facts. Affords maximum opportunity for free expression of opinion and giving of suggestions.

Limitations:

Is time-consuming, so can reach relatively few people. Results may be difficult to quantify. Can make subject feel 'on the spot'.

Tips

Pretest and revise interview questions as needed.

Be sure interviewer can and does listen, doesn't judge responses - they may need training.

Do not use to interpret, sell or educate.

Method 2: Questionnaire

Advantages:

Can reach many people in a short time. Is relatively inexpensive. Gives opportunity of expression without fear of embarrassment. Yields data easily summarised and reported.

Limitations:

Little provision for free expression of unanticipated responses. May be difficult to construct. It has limited effectiveness in getting at the causes of problems and possible solutions.

Tips

Pretest and revise questions and form as needed.

Offer and safeguard anonymity.

Use only if prepared to

(1)report findings, both favourable and unfavourable, and

(2)do something about them.

Method 3: Tests

Advantages:

Are useful as diagnostic tools to identify specific areas of deficiencies. Especially selecting potential trainees. Results are easy to compare and report.

Limitations:

Tests validated for many specific situations often not available; tests validated elsewhere may prove invalid in new situations. Results give clues, are not conclusive, tests give second-best evidence in relation to job performance.

Tips

Know what test measures; be sure it is worth measuring

Apply results only to factors for which test is good.

Don't use tests to take blame for difficult or unpopular decisions which management supervisors should take.

Method 4: Group Problem Analysis

Advantages:

Same as for interview, plus: permits synthesis of different viewpoints; promotes general understanding and agreement; builds support for needed training, and is in itself good training.

Limitations:

Is time-consuming and initially expensive. Senior staff may feel too busy to participate, want work done for them. The results may be difficult to quantify.

Tips

Do not promise or expect quick results.

Start with problems known to the of concern to group.

Identify all problems of significant concern to group.

Let group make own analysis, set own priorities.

Method 5: Job Analysis, Critical Incidence Analysis and Performance Review

Advantages:

Produces specific and precise information about performance. Is directly tied to actual work and to on-job performance. Breaks work into segments manageable both for train lug and for appraisal purposes.

Limitations:

Time-consuming. Difficult for people not specifically trained in job analysis techniques. Supervisors often dislike reviewing inadequacies in juniors and colleagues with them personally. Reveals training needs of individuals but not those based on needs of organisation. Some may find it threatening.

Tips

Brush up on job analysis techniques, arrange special training for those who are to do it.

Be sure analysis is of current tasks, and current performance.

Review with 'client' both: (1) analysis of job, and (2) appraisal of performance.

Do provide support and remedial training.

Method 6: Records and Reports Study

Advantages:

Provides excellent clues to trouble spots. Provides best objective evidence of results of problems. Are usually of concern to and easily understood by those involved.

Limitations:

Do not show causes of problems, or possible solutions. May not provide enough case materials (e.g. grievances) to be meaningful. May not reflect current situation, recent changes.

Tips

Use as checks and clues, in combination with other methods.

Source: T M Hayes, UWCM Cardiff, 1/90

Adapted from Rosof & Saslaw, 'Needs Assessment' in Continuing Medical Education; a Primer. Praeger, New York 1986.

TEACHING TASKS

Define the priority objectives for learning

Identify the learner's agenda

Assess the learner’s needs

Negotiate and agree the content and priorities for learning

Select and use appropriate learning methods and resources that develop the trainee's :

  • competence
  • critical thinking
  • self-awareness

Provide an environment and example that reinforces the learning

Agree plans for future learning

Use time efficiently

Establish and maintain a relationship that enables the other tasks to be achieved

Evaluate the extent to which the above tasks have been achieved