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Ability to reflect and learn

Under the terms of your registration with the Health Professions Council, you are obliged to continually update your professional knowledge and skills. This usually means enrolling in some kind of formal learning programme on a subject relevant to your clinical practice in order to earn credits.

Successful CPD depends to a great extent on planning, and good planning is predicated on an accurate assessment of learning needs. Before you can assess your learning needs, however, you need to identify them – something that’s not always that easy to do because it means finding out what you don’t know that you don’t know or, as Maslow put it, your unconscious incompetence.

Abraham Maslow published his model of the four stages of learning back in the 1940s, and it’s still widely employed by educationists. It’s a simple model – two axes (unconscious—conscious and incompetent—competent) give rise to a matrix comprising four quadrants, as illustrated below.

In many respects, getting from the first stage – unconscious incompetence – to the second stage – conscious incompetence – is the most difficult transition because, by definition, we’re not conscious of the deficits in our competence.

Box 15: Maslow’s four stages of learning



Many of these deficits will naturally advance into the realm of conscious incompetence as you come face to face with them in your daily practice, or because you’re made aware of new information through reading journals and talking to colleagues. Others, though, are harder to uncover and you will need to employ various techniques to identify your shortcomings.

The best ways to find out where you’re falling short are either to measure your performance against an accepted standard (auditing), or to get feedback from colleagues and patients. Sources of information might be formal or informal, planned or unplanned, and although some might arise from solitary reflection, most require some form of feedback from colleagues, patients or others.

Keeping mistakes in perspective

Even though we all know that to err is human, few of us can easily accept our own mistakes
Even though we all know that to err is human, few of us can easily accept our own mistakes. This is probably more the case in healthcare than in most other occupations, because errors can have such serious consequences. In a survey of MPS members who had experienced untoward incidents in their practice, almost all of them found that it shook their confidence and eroded their job satisfaction. Complaints from patients tended to be taken as personal attacks, with the doctor feeling angry, hurt and betrayed. Some of these effects lasted for years.

The intensity and duration of the emotional aftermath does not seem to relate closely to the seriousness of the error or the nature of the complaint; the crucial factor is the ability of the individual doctor to put the experience into perspective and seek out practical and emotional support.

Lessons can be drawn from this:

  • Assess the circumstances realistically – don’t blow an error or a complaint out of all proportion; remind yourself of all the things you do get right and all the patients who are satisfied with your care.
  • Talk the matter through with trusted colleagues and friends who can both empathise with you and give you a realistic assessment of the situation.
  • Contact MPS for practical assistance in dealing with a complaint or claim and for advice about handling the emotional repercussions.
  • Learn from the situation. If you did make a mistake, acknowledge it. Report it as an adverse incident and engage with your colleagues in developing strategies to prevent similar errors occurring in the future.
  • If you have been unjustly accused of substandard care, think what may have brought the accusation about – was it a communication problem, for example? How might you have handled it differently?
  • If a patient has complained about you, try not to react defensively by avoiding the issue or making counterthreats. Comply with your practice’s complaints procedure and be prepared, if you have made a mistake, to give the patient their due – a full face-to-face explanation, a sincere apology and an assurance that you will take steps to avoid a repetition of the problem.
  • If, after the complaint has been investigated, it is evident that the complaint has no foundation, you should still see the patient and explain the outcome of the investigation, give a full account of events and try to ascertain whether the complaint has been caused by a misunderstanding that you can put straight.
  • Patients expect a great deal from their doctors, not least of which are superhuman abilities. This means that you are almost certain to disappoint some of your patients some of the time. All you can hope to do in the circumstances is to try and turn negative experiences into positive learning opportunities, thus refining your skills and building, rather than eroding, your confidence.
The crucial factor is the ability of the individual doctor to put the experience into perspective and seek out practical and emotional support