Judgement
An attribute of personal expertise that goes beyond that competence which any
fully trained doctor could be reliably expected to demonstrate.
It can also be seen as a dimension of lifelong learning linked mainly to the
improvement of decision-making through learning from experience over a long
period, rather than the learning of new practices or keeping up to date with
research
Postgraduate trainees are employed as working health professionals, so their
current competence is always an issue, as well as the competence they will be
expected to demonstrate when their specialist training has been completed.
Defining competence in terms of the expectations of the holder of a particular
post helps to avoid confusion.
The central problem of postgraduate education is how best to combine work
within a doctor's current competence, itself a source of learning, with the
provision and use of learning opportunities to extend that competence.
There is a need for an agreed framework for the development of competence
during each training programme, which puts learning outcomes on the priority
list alongside service duties.
Areas in which competence is seriously underconceptualised
include communications, teamwork and management in healthcare settings.
Learning in Clinical Settings
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Many features of the educational policy seem to be
appropriate, but they are not being implemented in many hospitals. There is
insufficient supervision and feedback. Educational goals are subordinated to
service demands. While many house officers receive good clinical teaching, a
minority do not and assurance of educational quality is weak. Learning goals
are only specified at a very general level, so there is little clarity about
priorities, especially at the PRHO stage.
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This issue has to be tackled at local level where there is
limited management of the educational process and clinical tutors have little
time and no authority over clinical teaching. Deans do what they can; but
quality assurance of postgraduate education lags well behind that for clinical
practice; and the UK research base at this level is minuscule.
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The learning of procedures in medical posts has been
criticised for being too haphazard: there is often little continuity of
experience and guidance is often provided by doctors who are themselves not
very experienced.
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The appropriateness for GPs of so much general hospital
training has been questioned. Though research on this issue would be
difficult, we think more research evidence could and should be gathered.
The key issues emerging from North American research are:
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the time allocated for trainer-trainee interaction and
making the best use of that time; |
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methods of providing feedback; |
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qualities of teachers rated as `good' by trainees and their
colleagues.
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One gets the impression that American residents receive
considerably more clinical teaching than their British counterparts, but there
is no British data to enable a proper comparison. The variation in the amount
of training received by British trainees is reported as considerable, raising
issues of quality assurance and trainee entitlement.
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