Will a Personal Development Plan keep making you a better doctor?

#GPFUQ 118. Will a Personal Development Plan keep making you a better doctor? Probably not. PDPs were designed to reinforce adult type self-directed learning where the learner identifies their own educational needs, formulates a plan to address those needs, reflects on the learning achieved or confirmed, and identifies further needs. But PDPs are being used differently now. Annual PDPs are a requirement for NHS appraisal and GMC revalidation. What went wrong? The process of the learner identifying ‘important learning needs’ has disappeared and been replaced with a bureaucracy of documentation. Arguably a means to an end has become an end in itself.

The main aim of a PDP is to ‘identify and address your learning needs’

1. The General Medical Council says: PDP will help you identify and address your needs and those of others. It will also help employers identify, coordinate and resource the learning and development needs for all staff.

2. The Royal College of GPs says: PDP consists of a number of ‘SMART’ (Specific, Measurable, Achievable, Realistic and Time-bound) objectives,  although some may, of necessity, be less measurable and time-bound than others.

The PDP must contain the following key elements for each objective:

• a statement of the development need

• an explanation of how the development need will be addressed (the action to be taken and the resources required); objectives are more likely to be achieved if consideration is given to several ways of meeting them

• the date by which the objective will be achieved

• the intended outcome(s) from the objective.

3. The British Medical Association says: PDP should contain a list of personal objectives with an indication of the period of time in which items should be completed and how completion should be recognised. The PDP represents the main developmental output for the doctor.

4. BMJ Learning says: PDP is a demonstration of your personal responsibility for continuous improvement in your professional roles

5. The NHS revalidation Support Team says: PDP is an agreement, between the appraisee and appraiser, on the learning and development needs of the appraisee, identified at the appraisal interview, with an outcome-based learning plan for the subsequent year.

6 The Higher Education Authority (HEA) says: PDP is 'a structured and supported process undertaken by an individual to reflect upon their own learning, performance and/or achievement and to plan for their personal, educational and career development'.

7. Wikipedia says: PDP is the process of creating an action plan based on awareness, values, reflection, goal-setting and planning for personal development within the context of a career, education, relationship or for self-improvement.

A review of the history of PDPs in the UK doesn’t reveal any evidence base (in terms any better outcome such as learning and career development) for writing a PDP once a year. Personal Learning plans (PLP) developed in Higher Education in the 1970’s from the idea of having learning pathways agreed between the learner and the institution. In the 1980s PLPs were used to develop key skills in undergraduates and then spread to encourage more flexibility and autonomy in learning. The Higher education institutions used them to integrate new curriculum demands like communication, problem solving, teamwork and personal development. They asked their learners to identify ways in which they could develop these skills, identify their needs and find ways to develop and demonstrate them.  Around the same time the phrase `the reflective practitioner' was coined by Schon (1983) and the notion of reflection in professional life became a key feature in professional development. PLPs are consistent with new 1980’s educational approaches like `deep' learning’ and ‘adult learning’. In the 1990s, work-based appraisal systems spread along with the need to demonstrate continuing professional development to maintain membership of professional bodies like accounting and banking. Personal learning targets set by the learner were used as evidence in portfolio-based learning and assessment.

In medicine in response to concerns about the quality assurance of doctors performance, the GMC set a target that all doctors should undergo a process of regular appraisal, and be involved in a process of periodic revalidation. In 2002 Personal Development Plans PDPs became part of compulsory annual NHS appraisals and would be a requirement for GMC revalidation. After ten years of delays GMC revalidation finally started in 2012.

This completed the transformation of Personal Learning Plans from a short-term, learner-centred, reflective tool based on identified learning needs to the Personal Development Plan that is a never-ending cycle of mandatory, directed documentation used to address any appraisal-driven whim. How can this make better doctors?