Keeping Up to Date

Trying to keep up to date often feels like a daunting challenge with a relentless tide of new information to absorb. A careful evaluation of needs and priorities and using a personal development plan (PDP) are therefore essential to keep up to date but also to avoid information overload.

General Medical Council Guidance on Keeping Up to Date

Continuing professional development should be an organised and continuing process but must be responsive to learning requirements based on patients' needs, self-evaluation and evaluation by others - eg, partners, appraisal process. It is important to keep up to date in all aspects of being a doctor, partner and employer and to include skills (clinical, consultation, interpersonal, leadership, etc), as well as knowledge in any development plan.

The advent of revalidation in 2012 placed further emphasis on the importance of keeping up to date and on providing evidence of doing so. Doctors are obliged to maintain a folder or portfolio of information drawn from their practice to show how they are meeting the required standards. This is demonstrated at an annual appraisal. The portfolio places emphasis on how the various sections relate to the categories in Good Medical Practice.^[2] See separate articles Revalidation - Current State of Play and GP Appraisals for more details.

Furthermore, GMC guidance on keeping up to date includes:^[3]

• Responsibility for identifying your own needs and then planning how to address them.
• A requirement to reflect regularly on standards of your medical practice.
• Remaining competent and up to date across the scope of your medical roles.
• Maintenance and improvement of standards of your own practice and that of the team in which you work.
• Shaping your continuing professional development (CPD) by not only your own needs but by those of the people who use the service.
• A requirement to reflect on outcomes of learning and to keep a record of both reflection and impact to practice.

Evaluating learning needs

Self-evaluation

• Reflection: take time to consider strengths, weaknesses and learning needs. Consider setting aside dedicated time (eg, 10-20 minutes at the end of each day, to consider issues arising that day) rather than letting them build up, become daunting and possibly end up being forgotten. Reflection following learning events has also become an important part of the evidence required for revalidation. Reflect on what has been learned, what will change practice and whether any further action needs to be taken (further learning, audit, etc) as a result.
• Audit.
• Self-challenges and tests such as those on the Royal College of General Practitioners (RCGP) website.^[4]
• Videos of consultations: not just for GP registrars; these provide an excellent method of evaluating and improving consultation skills.
• Significant event analysis within the practice team.
• Referral analysis: consider those referrals that may not have been required with improved knowledge/skills.
• Case Reviews.

Evaluation by others

• Discussion with other members of the primary healthcare team.
• Multi-source feedback. Patient and colleague feedback surveys are now an essential part of revalidation. One of each should be carried out in each five-year revalidation cycle. Appraisal toolkits have the standard GMC surveys embedded within them.
• Sessional GPs should attempt to become involved in clinical meetings and try to follow up patients, particularly in those practices they go to frequently, and also to join local sessional GP groups.^[5]
• GP appraisals.

Patients' needs

• 'Patient's unmet needs' (PUNs) and 'doctor's educational needs' (DENs): keep a log of those patient needs that could have been better managed with improved knowledge/skills.
• Reviewing patient records.
• Analysis of complaints - should be discussed at clinical meetings and reflected upon to look for any learning needs or impact to practice/protocols.

Methods of keeping up to date

The best method to use for keeping up to date will depend on the learning need as well as individual preference and available time. It is recommended that a variety of learning methods should be used.^[3]There should be a mix of formal and informal learning and some should be peer-based. The many options include:

• Discussions with and learning from partners and other members of the practice team. This will include informal chats over coffee as well as practice and clinical meetings.
• Local and national courses, study days and conferences. Keep an open mind in sponsored meetings and be aware of potential bias.
• Distance e-learning methods. Many such modules exist on websites, including BMJ Learning, Doctors.net, the RCGP, Pulse Learning, OmniaMed and the National Skills Academy (NSA) Health e-learning. Many other internet resources are useful sources of information such as patient.info, GP Notebook and NHS Choices.
• Reading. This includes journals, books and guidelines. Nowadays online journals usually include the option of searching archived material, rather than relying on a relevant article appearing at an appropriate time. Guidelines from the National Institute for Health and Care Excellence (NICE) or the Scottish Intercollegiate Guidelines Network (SIGN) may be more easily digested by taking turns with peers to present the essentials of relevant new guidelines at clinical meetings or in peer support groups.
• Textbooks. In the past an important learning tool but may not be as relevant or helpful as other more interactive and more practical methods.
• Practical skill training courses. Basic life support skills are expected to be updated annually via practical hands-on training with resuscitation dummies. Minor surgery requirements were tightened in 2011 and the RCGP considers GP minor surgery to be at a crossroads, with many GPs no longer providing the service.^{[6, 7]}
• Attending hospital clinics/short-term clinical assistant posts. May be time-consuming and not necessarily meet the required learning needs. However, this may provide valuable time spent with a specialist if it involves a special interest.