How GPs learn: teaching ≠ learning
The purpose of the specialist training programme in general practice (and the GP ST3 year in particular) is that the trainee learns to be a better GP than would have been the case without the training.
What is learning? Learning has happened when people can demonstrate that they know something that they didn’t know before (insights and realisations as well as facts) and/or when they can do something they couldn’t do before (skills). Unfortunately, teaching can occur without any learning taking place just as learning can take place in the absence of teaching.
There are a number of key principles that make learning more effective for adults, which have been identified from many years of research. These principles of ‘adult learning’ are particularly relevant for GPs not only in the trainee year, but also for ongoing continuous professional development. If they are applied in practice, learning will be more effective:
1. GPs learn from experience
Learning in most adults is generally more effective when it is based on real experience rather than abstract theory alone. For a GP, learning from experience involves reflecting on (i.e. ‘thinking about’) events that occur in daily practice, considering why these feel significant, addressing any learning needs that arise and formulating a new approach that can be adopted in the future. Then, the next time a similar situation recurs, the GP’s response will be different; this leads to another new experience, a further opportunity for reflection, and so on. This reflective learning cycle can repeat ad infinitum and each time it occurs something new can be learned. This is the cycle of experiential and reflective learning (after Kolb, 1984):
2. GPs like to direct their own learning
Most adults like to feel in charge of their lives and the same applies to their learning, although there are times when we want to be told what learning activities to do rather than find out for ourselves. This is particularly the case when a learner is under stress or adjusting to a new learning environment. Speciality trainees who are just starting out in general practice often request a considerable amount of direction from their trainers and course organisers initially, although they tend to take more and more control of their learning as their experience and confidence grows. This principle is referred to as self-directed learning (Brookfield, 1986).
3. GPs learn what they need to learn
For many GPs, their readiness to learn is often strongly related to how relevant they perceive a learning activity to be to the tasks they perform in their day-to-day role. In other words, learning based on the curriculum needs to feel relevant to learning how to be a GP, passing the new MRCGP assessments, or getting through appraisal and revalidation, or many learners will lose interest. This principle is known as needs-based learning.
4. GPs learn how to solve problems
Yes, you’ve guessed it – problem-based learning (Knowles, 1984). Those of you who trained in Manchester will be very familiar with this concept. Traditionally, lessons at school are categorised into subjects. In medicine these are generally referred to as ‘specialities’. Unfortunately in the real world of GP-land patients do not often present with their complaints neatly categorised. A competent GP must learn to apply his or her medical expertise effectively to daily situations, based on the underlying theoretical medical knowledge and theory he or she has previously acquired.