Self directed learning groups for GPs: a support framework for revalidationBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2692 (Published 08 May 2013) Cite this as: BMJ 2013;346:f2692
- Paula Wright, Northern deanery lead for sessional general practitioners
Self directed learning groups have been increasing in numbers and are key in education, peer support, and providing a framework for appraisal and revalidation related activities. Paula Wright looks at the benefits these groups can bring
Self directed learning groups are informal groups of general practitioners (GPs) who meet regularly for peer support and education. Generally, groups consist of five to eight GPs who meet in rotation at members’ homes to engage in a variety of learning activities.
Learning groups usually have no formal leadership and no external paid or unpaid facilitation. The term self directed refers to the fact that members determine, and usually deliver, their own learning agenda. The groups follow the tradition of young practitioner groups, which have existed for many years.
The formation of learning groups has recently been driven by appraisal and the need to formalise and provide evidence of continuing professional development and its impact1 as part of revalidation. Impact can be demonstrated by teaching and thereby changing the behaviour of colleagues.
Revalidation presents particular challenges for sessional GPs.2 This is because sessional GPs are often excluded from educational and other clinical information cascades. They may also be poorly integrated into practice teams and have no formal role in improvement of the quality of systems of care. Professional isolation is also prevalent in this group, particularly among locums, newly qualified sessional GPs, and GPs new to an area.
The requirement to submit significant event audits for appraisal and revalidation is a challenge for many sessional GPs, who may not be invited to participate in practice meetings which discuss significant events. Self directed learning groups provide an alternative forum in which to formalise reflection on significant events with colleagues. The importance of meeting requirements from the General Medical Council3 and Royal College of General Practitioners4 for supporting information to be revalidated successfully has been another driver for the formation of learning groups.
Motivation to learn is enhanced for those needing “external drivers,” as meetings provide a deadline and focus for learning about a topic to present.
Compared with learning through lectures, active group discussion results in better retention of information and is also more likely to lead to changes in clinical practice. Discussion is also particularly valuable for learning about non-clinical topics, such as NHS reorganisation, where frameworks of existing knowledge may not be as robust as those for clinical topics. The ability to recognise and voice ignorance and uncertainty are vital steps for learning, and groups create a “safe” environment to ask questions that may be thought “silly.”
Topics are chosen and presented from a GP angle, ensuring relevance and an appropriate level of detail. Talks given by hospital consultants to GPs can focus disproportionately on detailed data, pathological mechanisms, and rare causes of common problems.
Groups encourage exploration of different styles of learning and of different resources. This is particularly valuable for GPs who have not developed any new learning methods since completing their training. Some groups have a structured rota for presenting, whereas others operate a more informal “turn up and share” system based on recent cases.
GPs make many complex decisions at work in the absence of any robust evidence base derived from general practice. The ability to benchmark one’s practice against that of other GPs is extremely valuable and helps GPs to identify whether their practice is out of step with the mainstream. This may be relevant to the Bolam test, part of the definition of professional negligence.
GPs have had to learn to produce logs of their learning for appraisal, which can be challenging if this learning is based solely on reading. In a self directed learning group, continuing professional development is more easily quantified and the implications of learning for changes in practice can be explicitly discussed in a way that might not happen for more private professional development. Some groups encourage the generation of summaries, reports, or minutes which can be used as evidence of continuing professional development. The “teaching colleagues” element of self directed learning groups means that additional continuing professional development credits can be claimed for “impact.” Self directed learning groups offer opportunities for GPs to develop facilitation and chairing skills which they may not get elsewhere.
Self directed learning groups can provide an opportunity for mentoring, in the context of sharing experiences about difficult employment issues or professional or ethical dilemmas or complaints. In some groups strong professional bonds may develop into friendships.
Study groups formed during training to help pass examinations for membership of the Royal College of General Practitioners often form the basis of learning groups. However, these usually need to go through a process of identifying new goals not related to examinations and methods from a broader curriculum of the “jobbing” GP.
Though isolation has been identified as a prevalent and important factor in the experience of sessional GPs, it is recognised that even practice based GPs can be isolated and therefore self directed learning groups can offer benefits to all GPs. Groups also offer opportunities for cross fertilisation of ideas across practices.
The first meeting of the group may be key to its success. It is at this meeting that group members introduce themselves and decide on ground rules, such as the aims, meeting dates, and structures of the group and how members should contribute. Also, decisions are made on how activities will be reviewed and whether the membership will be open or closed.
Once a group has been set up, it is often helpful to make a plan for the first few months. Subsequent meetings can vary in format, but it is generally useful to have a nominated person facilitating each session, helping keep to time and to an agenda if there is one. Though there may be variations from meeting to meeting, a typical meeting structure might be 15 to 20 minutes of social time, followed by 60 to 90 minutes of education, and then 20 minutes of planning and reviewing before the meeting closes.
Members will need to have a shared outlook and aspirations, and some groups think members should have the same working status. The benefits of learning groups have become apparent through appraisals and informal feedback to educators and also through formal study.5
A recent study in the Northern Deanery looked at the benefits of self directed learning groups and the factors linked to whether these groups were successful or not.56 Personal attributes of members were associated with successful groups: these included rapport and trust, self awareness, motivation, commitment from members, and willingness to share experience.
Some organisational attributes of the group were also linked to the success of groups: attributes identified included similarity of experience and status of members; geographical proximity; willingness to share experience, agreed clear aims, and ground rules; flexibility to members’ needs; and non-hierarchical structure. Other important factors for the success of a group were a sense of group ownership and autonomy from external authorities, having a set day of the month on which to meet, planning ahead, clarity of decision making, and regular review and feedback.
Finding convenient dates for all members to meet can be challenging and time consuming. For this reason many groups agree a set day of the month—for example, the first Tuesday or third Thursday. This ensures momentum, removes the need for one person to be the organiser, and provides flexibility for absences. Attendance is also reinforced by the creation of a fixed meeting date. Exceptions to the set date may be agreed in advance—for example, during school holidays.
Agreeing explicitly what each member is expected to contribute to the group will be key in maintaining commitment to the group. If members think they do not get enough back in return for their input, then motivation to participate will quickly wane. In addition, most groups meet in the evenings, in rotation at members’ homes, so it is important to keep travelling times down.
Recruitment of new members can be a challenge. The intimate nature of group meetings and the fact that they take place in members’ homes means all members must be comfortable with joiners. New members may also take time to decide whether they wish to commit to the group, and the group needs to know when to include the new member into a longer term “rota.” One solution is to ask the new member to make a firm decision after three months or three meetings.
Regular review of the group’s activities is important for keeping the group alive and its members engaged. Falling attendance can indicate frustrated and disenfranchised members. Members can take on the facilitation role in rotation each year, ensuring all members are able to participate, summarising discussions and facilitating compromise where this diverges.
It is important that the facilitator stays neutral during the discussions and clearly separates chairing from contributing their views as a member. Discussions can be structured by asking what members think is going well and what changes they would like to see.
Activities of learning groups
Presenting clinical topics, such as National Institute for Care Excellence guidelines
Sharing prescribing information
Presenting non-clinical topics, such as chaperoning
Discussing challenging cases
Reporting back from courses
Significant event audits or discussion of complaints
Journal club discussion
Discussion of job opportunities, practices, and different portfolios
Factors for success of learning groups7
Size: six to eight members is optimum for sustainability
Evaluation: should be at least annually at a review meeting
Education: groups that are purely social are less likely to continue
Date: scheduling meetings for a set day each month helps sustain momentum
Local: short distances reduce travelling time and help improve attendance rates
Infrastructure: planning of dates, venues, and content is key
Networking: support is key as it means that members are seeking peer support as well as education from their group
Ground rules: it is important to capture the group’s shared goals
Shared: the group’s members must have shared aims, roles, and commitments
I first became involved in setting up self directed learning groups seven years ago as a GP tutor and have been thrilled to see them take off in the Northern Deanery. I have undertaken a range of initiatives to help promote them.
I held combined social and educational events in collaboration with my local sessional GP group, North East Sessional GPs, which enabled interested sessional GPs to meet others in the same area with a view to forming learning groups.
I invited GPs to submit their name, email, location, role, and expectations of a learning group. This information was then compiled and circulated to respondents, with the rest of the process left to personal initiative. I repeated this exercise annually. Learning groups are subject to turnover when members or their partners take new jobs and move area. Also, newcomers to an area and newly qualified GPs are often particularly isolated and need help integrating into new networks. I have written a practical guide to learning groups,7 which is disseminated at deanery events and is available via the deanery and the North-East Sessional GPs website (www.nesg.org.uk).
I am grateful for comments from Gill Morrow and Charlotte Rothwell.
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I am chair of the North East Sessional GP Group.