How do you know what you don’t know?

#GPFUQ 119. How do you know what you don’t know?

You won’t but you can assess your learning needs. To be able to discover all your learning needs have to try to address the St Augustine, Johari, Rumsfeld question. How can you ever know what you don’t know?  The different types of needs assessments include:

Gap or discrepancy analysis. This formal method involves comparing performance with stated intended competencies- by self-assessment, peer assessment, or objective testing -and planning education accordingly.

Reflection on action and reflection in action Reflection on action is an aspect of experiential learning and involves thinking back to some performance, with or without triggers (such as videotape or audiotape), and identifying what was done well and what could have been done better. The latter category indicates learning needs. Reflection in action involves thinking about actual performance at the time that it occurs and requires some means of recording identified strengths and weaknesses at the time.

Self-assessment by diaries, journals, log books, weekly reviews. This is an extension of reflection that involves keeping a diary or other account of experiences. However usually these tend to be written nearer the time of their review than the time of the activity being recorded.

Peer review - this involves doctors assessing each other's practice and giving feedback and perhaps advice about possible education, training, or organisational strategies to improve performance. The main types of peer review are internal, external, informal, multidisciplinary, and physician assessment. The last of these is the most formal, involving rating forms completed by nominated colleagues, and shows encouraging levels of validity, reliability, and acceptability.

Observation in more formal settings doctors can be observed performing specific tasks that can be rated by an observer, either according to known criteria or more informally. The results are discussed, and learning needs are identified. The observer can be a peer, a senior, or a disinterested person if the ratings are sufficiently objective or overlap with the observer's area of expertise (such as communication skills or management).

Critical incident review and significant event auditing Although this may be used to identify the competencies of a profession or for quality assurance, it can also be used on an individual basis to identify learning needs. The method involves individuals identifying and recording, say, one incident each week in which they feel they should have performed better, analysing the incident by its setting, exactly what occurred, and the outcome and why it was ineffective.

Practice review. A routine review of notes, charts, prescribing, letters, requests, etc, can identify learning needs, especially if the format of looking at what is satisfactory and what leaves room for improvement is followed.