Triangulation – a method by which a teacher gathers evidence about a learner.
Triangles are everywhere in Medical Education. We have Bloom’s Taxonomy, Maslow’s Heirechy and of course, Miller’s Pyramid.
We have assessment triangles, and triangles to approach learning.
The reason why educators like triangles so much is that they help us formulate an accurate picture of performance, and that’s why exams are based on triangles too. There is even a triangle of success! More often than not, doctors who are struggling with medical assessments and exams are using an obtuse approach and require guidance to point them in the right direction.
A preoccupation with knowledge is the commonest mistake and without recognition of the skills and attitudes to apply the knowledge, the triangle remains broad based and lacks height and integrity. This tendency to flatten the triangle can occur for several reasons:
- Knowledge is easy to measure, and easy to resource.
- The learner may have been taught medicine in a didactic manner, which is less likely to acknowledge other perspectives.
- The learner may not have had the exposure to activities that triangulate learning, e.g. direct observation of clinical practice with feedback.
For a few years now, I’ve been working on some learning approaches that will keep the learning triangle equilateral.
Knowledge (Knows/Knows how)
A one size fits all approach to ‘learning stuff’ doesn’t always work. We all have our individual areas of interest and proficiency in medicine, also influenced by the patients that choose to see us, the patients we choose to see (by way of our skill-sets), where and how we learned medicine, and where we practice. Even if we memorise Murtagh and all of the guidelines, Checks and AFPs for the last five years, an assessment pass is not guaranteed. That’s because we may not have the skills or attitudes to apply that knowledge. The Medical Assessment Planning App is a program that incorporates an individual’s personal, patient, and and practice demographics with confidence in each of 30 RACGP curriculum areas, to create an individualised plan for learning. For example, an older male doctor who has trained primarily overseas and is working in a large urban practice, will likely need to spend more time on women’s health and mental health. In an ideal world, broadening our patient demographic profile would be the best approach, but this is of course not very practical – so we need other strategies.
Skills (Knows how/Shows how)
So how can we ‘practice’ our knowledge without real patients? We need to some prompts to help us think about the patients that we see from different perspectives. We can also use curriculum based activities to trigger contextualisation of our knowledge in the absence of relevant patients. The GP Study System can help with that. The GP Study System is a curriculum-based resource that provides activities for each topic area in the MAP App, from the perspective of each domain of practice. It also contains learning and teaching activities that assist in exploring the topics. The Flashcards can be used for in-practice teaching or in study groups, whilst the online version contains curated, linked resources for each topic area.
Attitudes (Shows how/Does)
Even if we have the knowledge and the skills to apply it, our attitudes and biases can influence how we receive and perceive the clinical encounter. The Clinical Reasoning Compass course will guide you through the common clinical biases, and provide a structured approach to clinical reasoning. You can then apply these skills to answer short answer questions for each area of the curriculum, and check your answers against detailed responses with clinical reasoning explanations.
Any of these resources can be used in isolation, but like a triangle, the structure will be better if you use them all together. Take the time to think about how you triangulate your learning, and what shape of triangle you have. If you’ve tried the GP exams before and been unsuccessful, consider which side of the triangle may have been too short or too long. Consider the last consultation you did that didn’t go as planned – could that have been due to a wonky triangle? Finally, the curriculum (a map or ‘course’ for learning) sits in the middle of the triangle but is often overlooked.
Placing equal emphasis on knowledge, skills and attitudes not only makes us better learners and teachers, it makes us better clinicians.