The need for needs assessment in continuing medical education
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7446.999 (Published 22 April 2004) Cite this as: BMJ 2004;328:999
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Norman et al rightly state that learning needs assessment is either
omitted or poorly carried out in relation to the learning needs of medical
professionals and they present a timely case for innovative strategies
(1). They claim that self assessment and self learning approaches are
unlikely to be successful based on evidence from studies of graduates on
problem based learning education programmes. One difficulty with applying
this to doctors in established practice is that it is often erroneously
assumed that doctors will have the necessary knowledge, skills, and
behaviours to support their self-directed learning. Even if this were the
case many providers of educational activities may not have a sufficient
level of knowledge and skill to enable them to plan, design and deliver
quality CPD activities.
The authors also state that objective measures of need are preferable
to more subjective ones as doctors cannot reliably assess their own needs.
While this has been demonstrated it does not take into account the
educational concept of Johari’s Window (2) – (where a quarter of an
individual’s needs would be known to themselves and not others, a quarter
to self and others, a quarter to others and not self, and a quarter to no-
one). If the traditional CME to which the authors refer relied on wants,
it could be argued that educational activity based on the needs one knows
about would be a realistic step forward, with more objective measures a
subsequent step. For many people, moving from CME to CPD involves a
culture change and requires a set of skills and knowledge about learning
that many do not have and may not realise they do not have. There is a
risk in using an objective measure at too early a stage. If an individual
does not perceive they have a need they may not be ready to learn.
If the ‘ultimate goal of a continuing medical education is to improve
outcomes for patients by changing a doctor’s practice behaviours’ there
was no mention of the relevance of teamwork which is likely to have more
impact on patient care than the behaviour of individual doctors. In the
west of Scotland we have been promoting a self-directed approach to CPD,
both individual and multi-professional, for the past few years and in
recognition of the importance of needs assessment have developed a needs
assessment tool (QUEST - Quality Education and Service delivery through
Teamwork) for the practice team to identify their non-clinical learning
needs in relation to their role. The process involves self-completion of
a questionnaire, completion of the questionnaire by a colleague and then a
discussion between the two to identify and prioritise the individual’s
learning needs and develop a personal learning plan.
Feedback from recent experience of this approach has shown that users
welcome the opportunity to take part in a more challenging exploration of
their learning needs.
References
1 Norman G R, Shannon S I, Marrin M L. The need for needs assessment
in continuing medical education. BMJ 2004; 328: 999-1001
2 Luft J. Of human interaction. 1969. Palo Alto, Ca. National
Press
Competing interests:
None declared
Competing interests: No competing interests
Sir,
In a recent BMJ issue, GR Norman et al. (1) elaborate on innovative
strategies to identify learning needs. Such identification could take
advantage of health services coaching, a function meant to bridge the gap
between health care delivery and management. Coaching adds to traditional
continuing medical education approaches (2):
- a possibility to assess individual and group learning needs, based
on continuous observation and discussion of medical practice and health
care;
- psychological support to professionals and teams;
- organisational changes co-ordinated with in-service training,
debated with decision makers and practitioners.
Coaches build upon methodologies such as education-oriented
supervision (not control), ‘inter-vision’ (peer review of difficult cases
management), action research, medical audit, user interviews, Balint
groups and managerial interventions. Coaching assumes regular visits of an
experimented health professional to health centres and hospital wards and
subtle attendance to clinical activities. Meeting learning needs may
require rotations in clinical services where doctors or nurses can acquire
additional manual and behavioural skills (often left out of continuous
learning scope). Long lasting relationships between coach and staff permit
to establish the needed mutual trust. Coaches are best external to the
organisation when appropriate competence is lacking or when a conflict of
interest may arise concerning career prospects. Alternatively,
experimented health professionals can devote part of their activity to
support colleagues. They can be prepared for the function, e.g.
accompanying experimented coaches and being exposed to available courses
in health care management and systemic psychology, which is pivotal to
support teamwork. Though available resources need to be used with
opportunism, the introduction of coaching requires a special budget for
non-clinical activities.
Coaching has been carried out in developing countries’ pilot projects
(3) and is commonly practised in the Belgian mental health sector. It is
now tested in Belgian multidisciplinary teams (4). In this country, since
1994, external public health experts aim at endowing networks of
specialists, general practitioners and nurses, with the responsibility for
improving quality of care, co-ordination between tiers, and for setting up
integrated local health systems inspired by the concept of the health
district. The participants meet monthly to define priority problems to be
studied and solved. Several actors of the project should be able, in the
future, to coach themselves local health systems’ groups elsewhere in the
country. This project experience suggests that action research design,
versatility, culture sensitivity, and creativity should characterise
attempts to promote coaching in health services.
1. Norman GR, Shannon SI, Marrin ML. The need for needs assessment
in continuing medical education. BMJ 2004; 328: 999-1001
2. Sekerka LE and Chao J. Peer coaching as a technique to foster
professional development in clinical ambulatory settings. J Contin Educ
Health Prof. 2003; 23(1):30-37
3. Unger JP, Daveloose P, Bâ A ,Toure Sene NN, Mercenier P. Senegal
Makes a Move towards the Goals of Alma Ata by Stimulating its Health
Districts. World Health Forum 1989; 10 3/4: 456-463
4. Unger JP, Criel B, Dugas S, Van der Vennet J, Roland M. The local
health systems (LHS) project in Belgium. Presentation at the 11th annual
EUPHA meeting. Globalisation and Health in Europe: Harmonising Public
Health Practices. 20-22 November 2003, Rome, Italy. Abstract, European
Journal of Public Health 2003; 13 (Suppl.): 26.
Competing interests:
None declared
Competing interests: No competing interests
Providers of continuing medical education (CME)
Norman et al. discuss the importance of needs assessment in
continuing medical education (CME). They look for a way between the
anarchy of self assessment and the "Big Brother" approaches, and
hypothesize a different role for providers (academic units) in CME. As a
possible scenario, we imagine that a provider should act as a
certification society that assesses learning needs and, as a tutor that
provides individualized educational programs of active learning. Providers
of CME may have different strategies to identify personal and specific
learning needs and to deliver knowledge according to different course
formats. On their side doctors should choose their own provider also on
the basis of preferred methods to assess their education needs and to help
to develop personalised educational plans. In this scenario providers
should refer directly to Ministry of Health, and act as intermediate
partner since they may indicate the policies and priorities of National
Health System to individual practitioners.
Competing interests:
None declared
Competing interests: No competing interests