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Doctor’s are very clever human beings – so why do we struggle with assessment, and in particular, why do we feel that it doesn’t measure our clinical practice accurately?

The answer lies in Johari’s window which is a framework to understand the ‘self’.  Understanding the RACGP curriculum is the KEY to looking through Johari’s window.

Let me explain.

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  • The ‘Open’ corner of the window are the topics that everyone knows you have trouble with.
  • The ‘Hidden’ window contains the topics you are not confident with, but others don’t know about.   Sometimes we develop strategies to ‘cover-up’ our known inadequacies.
  • The ‘Blind Spot’ contains the clinical areas that you are unaware that you have difficulty with, although patients, supervisors or colleagues have noted.
  • The ‘Unknown’ – this is where the curriculum fits – how do you know what you don’t know?

What is a curriculum?

It’s not just a soporific document for pressing flowers.   Curriculum comes from the Latin word which means ‘race’ or the ‘course of a race’ and indeed the RACGP curriculum is that – it’s the course that leads to different levels of competency in General Practice.  The RACGP has curriculum criteria for:

  • Pre-general practice;
  • General practice under supervision (pre-Fellowship);
  • General practice – lifelong learning.

Having a good look at the curriculum can help you with the ‘blind spot’ and ‘unknown’ panes of Johari’s window.   The curriculum provides the key so that you can unlock the door and look through Johari’s window from a different perspective.

It’s also good to be aware of the different types of curricula:

  1. Explicit:  Knowledge, skills and attitudes GPs are expected to acquire.
  2. Implicit:  Learnings from the ‘culture’ of medicine and the behaviours, attitudes and expectations of the profession.
  3. Hidden:  This is often called the ‘tacit’ or implied curriculum.  These are the aspects of General Practice that we learn from ‘doing’ what we learn, and interacting with our colleagues.   This aspect is often the most challenging to teach, and underpins the ‘apprenticeship model’ in General Practice.
  4. Excluded:  Topics and perspectives outside the scope of mainstream General Practice.

Many docs are good at exploring Types 1 and 2, but do to little of 3 and too much of 4.

So how do we use the curriculum to plan our exam approach?

The RACGP 2016 curriculum is outcomes-based, providing a description of what GPs should be able to do.   This however, can make it difficult to use for study as it doesn’t prescribe what you need to learn, which was a useful aspect of the RACGP 2011 curriculum.  So why not combine the best of both worlds?    The content of General Practice doesn’t change much, just the depth and currency of knowledge, and on reviewing the two curricula, there are 30 topics to consider in your study:

curricula

These topics can then be prioritised.  Their priority is not just about the prevalence of presentation but about building on knowledge, e.g.  It would be very difficult to learn Oncology and Palliative Care without a good understanding of Acute and Serious Illness and Chronic Disease.   You can rank the topics and allocate your study time accordingly.

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Importantly, remember that the curriculum is a guide to the knowledge, skills and attitudes required in General Practice BUT assessment looks at contextualisation of that knowledge – spitting out facts is not enough.    The following factors will influence how much time you spend on each topic:

  • How you learned medicine:  Did you learn medicine in a system which was ‘didactic’ (i.e. required factual knowledge mainly) or was ‘socratic’ (i.e. problem-based).
  • How you like to learn:   What type of learner are you?   If you’re not sure, here’s a simple Learning Styles questionnaire.
  • What is your previous medical and life experience?  You may have extensive knowledge/experience in a particular topic already.
  • Your patient demographic profile:  Do you see a certain type of patient?   Why is that?   Are they selecting based on your skill set?   If you are not seeing particular patient groups it will be difficult to contextualise knowledge.
  • Your previous performance in assessment:  Review your feedback and change your study plan accordingly.  Reassess what may have gone wrong and where you are headed (read “What to Do when you don’t get through’ for some more tips).

Admittedly, the RACGP curriculum (and any for that matter) can be difficult to tame and turn into a useful document for study preparation.     As a Medical Education Consultant I’ve been mapping the curriculum for years – to learning plans, AHPRA undertakings, education programs, remediation programs, exam questions, and even curricula from other countries – so I know this stuff is important.  I also spend a lot of my time supporting doctors that are having difficulty passing, so am passionate about ensuring that GPs are prepared for the  ‘start of the race’, rather than having to do the post-race debrief when performance wasn’t as expected.

I’d like to share my race plan and strategies:

  • Topic area priorities for the 30 topics
  • A 24 week Curriculum-based study plan

Please recognise that these are generic documents and will be influenced by the factors above. (Shoosh…. we have a little APP coming out soon that will do this for you…)

To access the documents, register for a GP Study System – Bronze Subscription.  This is FREE and will allow you to access other useful exam resources.

If you’d like more resources:.

gpss_logo-01 croppedThe GP Study System provides a curriculum-based learning and resource guide (for the 30 topics)  including specific areas to focus on and key resources to study.

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Clinical Reasoning Compass is a 30 question, (one for each topic), timed, KFP-style question and answer course with model answers and clinical reasoning techniques.

 

Whatever your method of approaching GP assessment, I’d like to share with you two thoughts:

“If someone is going down the wrong road, he doesn’t need motivation to speed him up.  What he needs is education to turn him around.”     Jim Rohn

“The whole purpose of education is to turn mirrors into windows.”  Sydney J. Harris

Disclaimer:  The concepts and documents are not endorsed by the RACGP, and have been developed independently.

 

 

 

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