2 HOW to Learn

It is a tragic fact that most of us know how to be taught;
we haven’t learned how to learn
Knowles

You will have come to realise over time how you learn most effectively. The trick is to find the ‘key levers of change’, according to the Pareto theory; the 20% of factors that have 80% of the effect.

We all want to learn in different ways, have different timescales and priorities and varying needs for learning. Building in ‘Life Long learning’ or adult based ‘learn-as-you- go’ principles into regular practice makes learning more effortless and effective, but sometimes, taking time out to concentrate on one area is also most helpful. The following sections should help you to do both. Please let us know of more examples of good practice or suggestions.

We suggest there are 4 Levels of learning:-

LEVEL 1 - Practice-Based Reflective Learning

Practice based reflective learning, or ‘learn as you go’, has a deep impact on the development of skills and knowledge, and is more likely to change practice. We learn best from our experience of looking after patients; we learn most from our mistakes. In many areas specialist palliative care teams (community and hospice based) provide ongoing support to primary health care teams, including educational support. This can include enabling reflective practice during a primary health care team meeting, facilitating ‘traffic light’ or significant event analysis sessions, or teaching on a specific subject that arises directly from patient care eg the management of neuropathic pain or hypercalcaemia.

There are 2 main areas of practice-based reflective learning

a) Clinical patient-based issues
b) Organisational process-based issues

a) Clinical patient-based issues

This reflective learning involves the discussion of patients on the Supportive Care register during a practice’s Primary Health Team Meeting, sharing of clinical expertise and might also include advice from the local Clinical Nurse Specialist/ Macmillan Nurse. Following a summary of factual information and assessment of their needs and plans, there could be some discussion about future management for each patient, side effects of treatments, points to watch out for, other sources of help etc. For example, when discussing a 64 year old man with Ca Colon, other ideas to manage his rectal pain, tenesmus, break-though pain, night sweats etc and sources of help for complimentary therapy and anaesthetic procedures.

Schon (1983) talked about “reflection in practice”, i.e. thinking through what you are doing at the time, and “reflection on action” , i.e. thinking about what you have done after you have completed it. Both of these are important if learning is to take place.

b) Organisational process-based issues

It is useful to consider sometimes why the same issues are preventing best care from being delivered to your patients and what can be done about them. For example, if lack of access to equipment is a real factor in precipitating admission to hospital, or poor access to out of hours drugs, or lack of communication within or between teams, then by recognising the importance of these factors, measuring their effects, pooling findings with other practices , a good case could be made to your local PCT commissioners (or soon to be, practice based commissioners), to respond appropriately eg by delivering a responsive equipment service, access to out of hours drugs , white board for teams etc . It is only by clarifying the problems can we begin to address them, and now we have a vehicle to collate palliative care needs for our patients, we can now go beyond anecdotes and measure the areas of need in order to address them. This then can be locally audited within or between practices. We can then have the satisfaction of seeing in very practical ways the influence of this work in commissioning locally driven way improvements.

Examples include:

• Significant Event Analysis
  • SEA/’traffic lights’ form Six month Review meetings / Audit meetings
    Developing ongoing audit within the practice to inform the practice teams of potential learning or development needs

• Feedback from practice, PCT or national analysis related to questionnaires (see Evaluation Section or contact National GSF Centre for details).

  For example - in the last 6 months one practice may have had 20 deaths, 8 in their preferred place of choice and of the other 12, 6 had issues with carer breakdown and difficulty accessing night sitters during the final days etc. Hence a call to improve access to night sitters and carers support information given to the practice would be useful, with a review the following 6 months.

• After Death Analysis
  We are hoping to pilot a simple After Death Analysis tool to use to check up that these structures and processes are actually effective in delivering good care to patients. This involves checking notes from a sample of the last 5-10 deaths in a practice against a checklist - anyone interested please contact the National GSF Centre for more details.

LEVEL 2 - Using External Educational Resources eg books, videos, journals, power point presentations etc

These can be introduced as part of your Practice/Personal Development Plan, as part of a team review meeting, as a separate teaching session or in your own study time.

We include some examples below, although we are aware that there is a lack of teaching resources in the form of power point presentations, videos etc that can be used in practice. We hope to develop a greater ‘library ‘ of resources to be shared in future so please contact the National GSF Centre if you could contribute to this area with any suitable presentations or resources.

Examples:

• National electronic library for health palliative and supportive care information
• Help the Hospices CLIP- Current Learning in Palliative Care is a collection of 15 minute tutorials available on the Help the Hospices website. They vary from introductory to advanced and cover a wide variety of subjects around palliative care. The tutorials are conducive to personal study or group work and are fully downloadable. This is an excellent, free resource that is easy to use by any level of health professional.
• Palliative Care Learning for UK Doctors – This is a free learning package with an hour long accredited session on Palliative care for Continuing Professional Development. It is available to UK Doctors with a GMC number.
• The following links to video clips which include breaking bad news training scenarios. These have been developed by Hospice Friendly Hospital Programme. LEVEL 3 - Locally Provided Education eg lectures, study days, courses

This local class room based learning varies between localities. Please contact your local hospice or specialist palliative care providers for information.

This could include hospice study days, palliative care interest groups, journal groups, community nurse educational programmes in palliative care, ad hoc training sessions, protected learning time events etc

LEVEL 4 - National educational courses

These are nationally available courses or distance learning courses, usually based in a university, for those able to devote more time to this area. They usually involve attendance for some lectures and also work at home to undertake certain agreed tasks eg portfolio learning on a patients case, essays, audit projects etc.

Please see ‘Where to learn’ section.

1 WHAT to Learn
3 WHERE to Learn