15 Chan DH, Leclair K, Kaczorowski J. Problem-based small-group learning via the internet among community family physicians: a randomised controlled trial. MD Comput 1999;16:54-8. 16 Heale J, Davis D, Norman G, Woodward C, Neufeld V, Dodd P. A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. (Accepted 20 September 2001)Learning needs assessment: assessing the need Janet GrantLearning needs assessment has a fundamental role in education and training, but care is needed to prevent it becoming a straitjacket It might seem self evident that the need to learn should underpin any educational system. Indeed, the literature suggests that, at least in relation to continuing professional development, learning is more likely to lead to change in practice when needs assessment has been conducted, the education is linked to practice, personal incentive drives the educational effort, and there is some reinforcement of the learning. 1 Learning needs assessment is thus crucial in the educational process, but perhaps more of this already occurs in medical education than we suspect. The key lesson might be for those who design new systems of education and training: for example, the postgraduate education allowance system in general practice was felt to fail the profession because it did not include needs assessment and so led to ad hoc education to fulfil the time requirements of the system rather than the needs of individual doctors or the profession as a whole. On the other hand, basing learning in a profession entirely on the assessment of needs is a dangerous and limiting tactic. So a balance must be struck. Learning needs assessment in medicineIn 1998 both individual and organisational needs assessment became part of government policy in relation to the continuing professional development and personal development plans of all healthcare professionals.2 Thus, it has a role in the clinical governance of the service 3 and is therefore much more than an educational undertaking. This integration of needs assessment, education, and quality assurance of the service was first made explicit in 1989 in relation to clinical audit, which would identify practices in need of improvement and ensure that educational and organisational interventions were made to address these needs.4 Accordingly, audit was described as "essentially educational" and the educational process surrounding it described. 5Long before these recent developments, needs assessment outside medicine was presented as an important part of managed education and learning contracts, which are the predecessors of the personal development plans to be developed for all NHS healthcare professionals. 6 In his descriptions of adult learning Knowles assumed (he did not claim to have research evidence) that learners needed to feel a necessity to learn and that identifying one's own learning needs was an essential part of self directed learning. 7 In medicine a doctor's motivation to learn would therefore derive from needs i...

This paper describes variables critical to diagnostic thinking that are based on research by Bordage and Grant & Marsden on the diagnostic thinking of medical students and experienced doctors. The purpose of the study is to use their findings to develop an inventory of diagnostic thinking. A 56-item diagnostic thinking inventory was initially developed; each item contains a stem followed by a 6-point, semantic differential scale. The inventory is designed to measure two aspects of diagnostic thinking: the degree of flexibility in thinking and the degree of knowledge structure in memory. The specific goal of the study is to determine which items discriminate best between weaker and stronger diagnosticians and to reduce the inventory to only those items which significantly contribute to the overall score. Thirty subjects from nine groups, each representing a distinct phase of medical education and clinical practice, participated, namely first- and third-year clinical medical students, house officers, senior house officers, registrars, senior registrars, consultants, trainees in general practice, and general practitioners, all from the UK (n = 270). Discrimination indices were calculated for each item. The revised version of the inventory contains 41 items. All the subjects found the exercise meaningful and the resulting scores showed variance and discrimination. The inventory will eventually be used to assess individual student's and clinician's diagnostic thinking and to plan ways of improving their diagnostic thinking.

Competency based training describes progression through training referenced to the demonstrated ability to perform certain tasks. In recent years, this has become the dominant curriculum model. We seek to examine who benefits from a competency based approach to medical education. For the regulators and service, the apparent advantage is in terms of apparent measurable accountability and flexibility. For assessors, the promise of competence based assessments in the workplace to provide a reliable and objective measurement of a trainee's performance has not been demonstrated in practice. For the doctor in training, there is very little evidence to show benefit from competency based training. Competency based training places emphasis on individual skills rather than overall learning experience thus risks diminishing the role of the trainee in the workplace. Any form of medical education that devalues workplace based learning will ultimately harm the profession and, in turn, patient care.