Learning Needs Assessment

Every GP and trainee should be engaged in an ongoing process of learning needs assessment (LNA). Doing so saves you time and energy and could save lives or legal costs! The process should help you direct your energies towards the study areas that will be most relevant and productive rather than (as sometimes occurs) the areas you happen to enjoy. Learning needs assessment can be roughly divided into intermittent and continuous methods. It can alternatively be divided into reflective processes and external feedback. It is essential that you use all 4 combinations.

The 4 quadrants of LNA  Unknown Unknowns  LNA resources 


The 4 quadrants of Learning Need Assessment

The divisions between quadrants are blurred but the important thing is to be aware of the quadrants and address each. Keep records for the future! Janet Grant’s excellent paper (BMJ 2002, 324, 156-159) lists over 40 different sources for needs assessment. Below are just a few.

Some Examples of LNA tools by quadrant Intermittent

Continuous/
frequent
Reflective

Confidence Rating Scales
Appraisal
Significant Event Analysis
Reviewing the GP curriculum
Personal reading (Journals etc)

PUNS & DENs Book
Reflection on good/difficult consultations
Reflection on emotions in practice
Reflection on relationships with colleagues or patients
Clinical outcomes
External

Multiple Choice Papers
Appraisal
Significant Event Analysis
Patient Questionnaires
Feedback from other disciplines

Random Case Analysis
Directly Observed Procedures
Colleague Feedback on Cases

 

Unknown Unknowns

How do you know what you don't know? This may seem a strange question, but it lies at the core of learning needs assessment. We may be well aware of some gaps in our clinical knowledge, and paradoxically this is fairly safe - we know when to call for help or advice. However, there may be areas where we don't realise that our knowledge is out of date, or even non-existent. When you last puzzling patient presented with a set of symptoms, were there diagnoses you didn't consider because you simply didn't know they were relevant? These unrecognised gaps, sometimes called "unknown unknowns" or "unconscious incompetency" are the scary ones. Without external input, you may never know. or may find out in unpleasant circumstances.

GP Appraisal or Starting New Training Posts - Some Useful Resources

The tools mentioned here are aimed at registrars but are excellent for established GPs too. Take the results along and impress your appraiser!

For trainees, each hospital post and the registrar year should feature some form of LNA early in the placement. Going along to your appraisal or tutorial with some LNA preparation already done will make the process much more fruitful. The GP curriculum itself is a little dense but useful to dip into. For hospital posts, NHS Education Scotland have published an excellent booklet The Curriculum in Hospital suggesting areas from the GP curriculum to be addressed during the common VTS hospital posts. For registrars, this can be enlightening when posts they have not done are reviewed.

Registrars may like to use the nPEP assessment tool to identify gaps in their knowledge. For AiT members of the RCGP the first use is free.

Reflective tools include the Wolverhamton Grid and Manchester Rating Scale.

The Honey and Mumford questionnaire helps to evaluate your individual learning style and optimise your learning. 40- and 80-question versions are available to purchase and complete on-line for £10.