1. Learning strategies How do we learn and how can we learn more effectively

2. Aims / objectives To encourage you think about how you learn and to identify ways you may be able to learn more effectively in the future Introduce some models of learning Identify some resources from which you can learn

3. What do you need to be a good GP?

4. The VTS Learning Objectives Have a sound, practical knowledge of clinical medicine Understand the basic principles of health and health care for populations Have a broad understanding of medical ethics Use time effectively Are able to tolerate uncertainty Value diversity Are prepared for adaptation to change throughout their career Have good communication skills Practise patient-centred medicine Are able to organise an efficient and caring practice Are able to work effectively in multidisciplinary teams Practise preventive medicine Practise evidence-based medicine Regularly audit their own performance Are able to plan their continuing education and professional development Are able to balance the demands of personal and professional life Apply these in context

5. What types of learning? Acquiring knowledge Practical skills / competencies Values

6. Millers pyramid Does Shows how Knows how Knows

7. Acquiring knowledge Lectures Tutorials Books Journals Electronic info. – DTB, MeRec, Mentor, PILs, Medline, on line journals, Bandollier. Others?

8. Skills Clinical skills Practical skills Communication / consultation skills Problem solving skills Evaluating and doing research and audit Others? And what about values / attitudes?

9. Experiential learning Kolb (1984) describes an experiential learning cycle: concrete experience observations and reflection formation of abstract concepts and generalizations testing implications of concepts in new situations. So whilst learning from concrete experience forms part of the theory of experiential learning, a process reflection is also central.

10. Reflective practitioner Schön (1983) developed the concept of the Reflective Practitioner. The professional practitioner reflects on their knowledge whilst engaging in activity. This enables them to adapt to the potentially unique context or problem with which they are faced. Coles (1994) concludes that: Professional education should provide people with the opportunity to reflect on their practice and to identify the theories embedded in their routine work.

11. Feedback Feedback from others is important in helping to learn. Who do we get feedback from? How can you help others to give you feedback? What sorts of feedback are effective?

12. Learning from each other Feedback Facilitating reflection Sharing knowledge Teaching skills Different perspectives Sharing resources

13. Adult learning Learning stuff that is important to you Can be applied in the real world i.e.context is important Your responsibility to learn rather than the teachers responsibility to tell you what you need to know Learning that is self-directed (SDL) Learning is continuous and ongoing and must adapt to new situations (lifelong learning) Is knowledge only temporary?

14. Constructivism Three Cs Construction- Knowledge builds on what is already known. Context is important when learning and also when applying learning in practice Collaboration – knowledge is socially negotiated, i.e varies in different contexts / cultures, collaboration helps to explore different perspectives.

15. Some tools to help learning whilst working Write down and find out later: Patient Unmet Needs (PUNs) – This bloke needs a hip replacement and the waiting list is 12months, is there anything I can do? Doctor Eduactional Needs (DENs) e.g. I dont know whether I should start this bloke on a statin. PCA – looks at what you know you dont know RCA – looks at things you might think were not problems Critical Incident Analysis – looks at things that have gone wrong, or nearly went wrong, or went well

16. Summary There is a vast amount to learn in order to be a good GP Factual knowledge is a small, but important part of this and is perhaps relatively simple to acquire. Learning can and should occur in lots of different ways, in different circumstances and with lots of different resources Most of what you learn will not be from your elders and betters but from yourselves, your peers, your patients and yourselves? Understanding what type of learning need you are trying to address can help identify the best way to achieve it.