The overwhelming reason for developing a
discipline in learning is to improve our knowledge, skills and
performance for the benefit of our patients. How we learn is very
much an individual preference, or even a habit, though the present
emphasis on self-directed, self-assessment and self-regulation is
not suited to all individuals. An ineffective self-assessment by
some can result in an overestimation of self-competence thus
leading to poor recognition of clinical skills and knowledge. At
best this results in a failure to improve clinical practice, at
worst it may result in serious consequences to patients.
Traditional ways in which psychiatrists gain
knowledge and skills have changed over the years. Lecture based
learning or sitting in libraries poring over text books have been
superseded by learning in groups and a number of different ways of
internet learning. Each method has its own supporters and critics;
didactic lectures are more likely to add to knowledge and effect an
attitudinal change but may be less likely to enhance performance.
On the other hand, case based discussions, role play and hands-on
practice sessions are regarded as more effective in influencing
Figure 1. Factors
Whatever style of learning one adopts, it has
to be underpinned by two main pillars: it has to be engaging and
there has to be a subsequent event which reinforces what has been
learnt. In practice, psychiatry is as much about acquiring skills
and maintaining knowledge as it is about learning from mistakes. In
the prevailing compensation culture the latter is stress provoking,
but a demonstration of personal attitude and an ability to adopt
corrective methods might go some way to mitigate against such
clinical errors. There are both positive and negative factors that
affect our performance (Fig 1).
Some very practical work-related issues can
act as impediments to continuing professional development, such as
pressures of work, inability to take study leave for an appropriate
course, and limited study leave budget. On the other hand, there
are some who might regularly not turn up at local teaching meetings
and case conferences because they have a negative attitude to
It is not necessarily true that psychiatrists
become more competent with maturing age. There is some evidence
that age and performance have a concave relationship so that in
some respects clinical skills and personal attitudes might actually
worsen with time. It is important then to be aware, whatever the
age, what factors contribute positively to our clinical abilities.
- Setting clear objectives for
your professional development.
- Taking time to reflect on
your practice and obtaining constructive feedback both formal and
informal from peers and patients.
- Carrying out periodic
- Ensuring that there is a
practice of reviewing any serious untoward incidents in the
- And perhaps most important of
all, having the motivation and commitment to learn and teach.