A Simple Tool to Evoke Physiciansʼ Real Training Needs

Abstract

Commonly used methods for identifying the training needs of general practitioners do not enable the real needs felt during interviews with patients during office visits to be detected. In this study, the authors evaluate how physicians' use of a personal-office-visit diary affects the level of specificity of their expressed training needs. In 1999, the authors carried out a controlled intervention trial using a random sample of 1,038 general practitioners from a region of France, randomized to intervention and control groups. The practitioners in the intervention group were asked to identify their training needs using a personal-office-visit diary. The level of specificity for their expressed needs was compared with that of the expressed needs of the practitioners in the control group. The use of the diary was associated with a significantly higher level of specificity in the training needs identified by the general practitioners who participated. Independent of the intervention, practitioners under 40 years of age, those in urban practice, and those who were members of a continuing medical education (CME) association expressed their training needs with higher specificity. The personal-office-visit diary would seem to be a simple, inexpensive, and useful tool for more specifically identifying training needs, which could help establish more appropriate and better-targeted training programs. However, it should be assessed further by those involved in CME for general practitioners.

What are the most effective strategies for improving quality and safety of health care?

“…Evidence strongly suggests that clinicians have a limited ability to accurately self‐assess competence or performance, 39 as opposed to multifaceted clinical skill appraisals that include direct observation of clinical consultations by external assessors 40 . Performance can be enhanced by targeted learning packages based on the needs assessment of individual clinicians, 41 including use of individual practice audits and patient diaries 42,43 …”

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“… Gap or discrepancy analysis: comparing performance and competencies by self‐assessment or peer assessment, or objective testing. Individuals reflecting on their performance during or after a defined event. Self‐assessment by diaries, journals, log books, etc. Doctors who keep a diary of learning issues might be able to generate more specific learning objectives than those who do not 9 Peer review: whereby doctors assess and provide feedback to each other. Observation of doctors performing tasks that can be rated by an observer. Critical incident review and/or significant event auditing. Practice review, for example, review of notes, records, prescribing, letters, referrals, investigation requests, etc. …”

“…Self‐assessment by diaries, journals, log books, etc. Doctors who keep a diary of learning issues might be able to generate more specific learning objectives than those who do not 9 …”

“…Clinicians often undertake education in areas of existing competence, whereas avoiding topics in which they are deficient 5 . Systems which permit practitioners to monitor and coordinate their own competence might be inappropriately optimistic 9 . All endeavours at voluntary re‐certification initiated by the American Board of Medical Specialties have been unsuccessful, and have been replaced by compulsory CPD requirements 10 …”

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“…Perol et al showed that doctors who kept an office visit diary of learning issues were able to generate more specific learning objectives than those who did not 12. The importance of this observation relates to the observation by Bergus et al that the structure of clinical questions is key to obtaining useful answers from consultants 13.…”