Table 8 GP Supervisor and Medical Educator perceptions of learning plans

Brings focus to learning

“that’s the best way of doing it because you’ve then got your awareness focused on, ‘Okay, what am I uncomfortable with? What am I not quite on top of? What might have changed? What haven’t I looked at for a while?’ And that’s how we stay safe and current” (RTP2, Supervisors)

“I think in recording [learning needs] they commit to it a bit” (RTP2, MEs)

Promotes learner reflection

“Well that is reflection though, what have I learnt today? I think, we’ve been trying to ask registrars, particularly when we have complicated topics like wounds for instance. And we have at a workshop somebody who’s very passionate about wounds and come and speak … and we don’t take much away from it, unless we write down stuff, so we’ve started to ask people to identify, you know, 3 or 4 things that they can take away and reflect on and write it down and use their learning plan as log for that, because otherwise there’s a lot of information and yeah if their heads like mine it just goes. So I think reflection can happen with learning logs as well as learning plans” (RTP3, MEs)

Helpful for remediation

“I have also been involved in remediating a number of registrars who’ve failed exams and when you actually make them produce a learning plan that addresses the active deficiencies that are identified, they actually improve their performance so it’s a useful tool” (RTP3, Supervisors)

Encourages independent thinking and self-directed learning

“So the idea is, that this is trying to, that’s the way I understand it, trying to get them to be thinking independently about what else do I need to do” (RTP3, MEs)

Bureaucratic exercise

“they do actually have all that in their heads but they find it frustrating sort of being pushed to do it in a written down way I find” (RTP1, MEs)

Unsuitable for some learning styles

“I never planned my learning and I still don’t, and I did okay” (RTP2, MEs)

“So I think people inherently do what works for them … it may not be a written, formal thing … it’s not useful for them write it down sometimes; it feels like a waste of their time to write it down” (RTP1, MEs)

“I think it depends how people learn; I quite like them actually. I don’t think they should be mandatory but I think for some people they’re much more useful than others” (RTP1, MEs)

Questioning the need for a learning plan document

“I agree that what we’re talking about this sort of floating learning plan that you work out on the run and update verbally, is probably much more a useful thing” (RTP1, Supervisors)

“It should be a verb not a noun, and the trouble is it’s talked about as a noun, but it’s actually a verb, it’s a process, it’s an action thing, but it gets talked about as a noun, like something that you can hold or look at. And that’s where it gets all mixed up because we get so focused on the noun and we don’t concentrate on the verb, which is how do you actually learn? And what’s your process for learning? That’s where the problem is” (RTP2, MEs)

“The thing is people may well have a plan for their learning but they just don’t structure it in that way” (RTP1, MEs)

Lack of buy-in

“Some ivory tower educational thing, probably wasn’t in medicine, it was probably…It was someone in that educational ivory tower or sitting in Canberra [Australia’s Capital City] who decided that’s a good idea” (RTP3, Supervisors)

“I don’t have a lot of evidence that compelled me as a supervisor to change my behaviour … I think that if I was more convinced that they were a useful thing rather than a tick box for getting through the training then that may be a helpful thing” (RTP1, Supervisors)

“So we try to tow the party line without really believing in it ourselves” (RTP3, MEs)

Unsuitable for adult learners

“to get a … 30-year-old and sit down and say well this is how you’re going to learn, write down every night and tick it off and tick the box, is a little bit insulting for them” (RTP3, Supervisors)

“I’m really not sure it’s necessary for experienced learners” (RTP3, Supervisors)

“It’s just such a stupid concept for high achieving adults, which is what we’re dealing with, it’s just the most ridiculous idea.” (RTP2, MEs)

Does not work in practice

“There is a whole lot of just in time stuff that I think kind of can really go missing if everything turns into a formal kind of process” (RTP1, Supervisors)

“… there’s no benefits to the registrar from doing the learning plans the way that we do it now … because of lack of time it’s for 6 months, and you’re new to a practice and you don’t really know what you want to learn about … most of the learning is, ‘I’ve seen this patient today,’ or like, ‘I heard about this thing and I don’t know much about it. How am I going to know about it a bit more?’ And that’s how most of the learning happens; it’s not you sitting down at the beginning of the term and then planning for the whole year, it’s just—that’s not what happens in real life” (RTP1, MEs)

Exposing registrar weaknesses

“Because they’re admitting there’s things that they don’t know and it’s down in hard copy, print, that ‘I don’t know this’ and it can—it’s one thing to identify a learning need in yourself but sometimes when you look at them and you think, ‘That’s really trivia, I really should have known that,’ or, ‘That’s important, I really should have known that,’ and do you really want that advertised that you had to look that up?” (RTP2, Supervisors)

“… one registrar that was struggling and about his learning plan of what he felt was missing. Initially he actually felt embarrassed to talk about those learning plans cos he felt ‘well I shouldn’t tell anyone that I’m not good with managing UTI’. And he wouldn’t even tell me, he just said that ‘I’m just very afraid of that’” (RTP3, MEs)