When we set out to find an answer to a question we look to the most accessible option and rely on our inner confirmation biases to stop when we conclude that we have found what we are looking for.

An interesting adjunct to thinking about gaps in learning is the Dunning-Kruger effect which describes misplaced self-evaluation of skills sets both by low and high educational achievers, pithily summarised by Bertrand Russell who said that ‘the trouble with the world is that the stupid are cocksure and the intelligent are full of doubt.’

Doubt is a foundation stone of medical education. ‘Guessing’ is anathema. If you don’t know then ask someone who does. This is the cornerstone of patient referral guidance between generalists and specialists. In addition, we were often told that at graduation 50% of what we had learnt would be obsolete and that within 5 years of leaving medical school, all our knowledge would be out of date. It was therefore incumbent on us to maintain our clinical expertise employing any approach, which proved useful.

Presently there is growing interest in clinical e-learning, defined as ‘any educational intervention mediated electronically via the internet’. Usually incorporating some interactivity and active participation on the part of the learner, these courses are designed to be undertaken asynchronously and at a self-directed pace and time.

They have the added advantages of allowing students to access content remotely without incurring travel costs, providing rapidly updated course content, personalized instruction and allows spontaneous learning, when facing the demand of a new clinical query.

These benefits seem self-evident, but there are questions which remain such as, ‘are these courses any good?’ or ‘are we able to assert that learners find them useful?’ And perhaps most importantly, ‘Do they make a difference to outcomes?’

Interestingly the sequential answers to these questions seem to be ‘sometimes, yes and maybe’.

It has been found that well-structured e-learning based on high quality, up-to-date content can be relied upon by learners to provide them with answers to clinical questions and appropriate continuing professional development. Learners have also found that e-learning can be a valuable adjunct to their approaches to knowledge acquisition.

However, as to the question ‘does e-learning have a positive impact on patient care?’ There is conflicting evidence from published data. A meta-analysis published in 2009 asserted that e-learning was associated with ‘large positive effects’ notably improved skills of clinicians. In comparison a Cochrane review from 2018 concluded that although ‘no worse’ than standard learning methodologies e-learning there was ‘no difference between e-learning and traditional learning on patient outcomes at one year’. This included an evaluation of skills and knowledge.

Should we therefore conclude that e-learning may have merits for users but none for patients? Not quite. The Cochrane review admitted that the research underpinning their meta-analysis contained ‘very low certainty of evidence’. The jury may therefore be ‘out’ on patient benefits, but for clinicians quality e-learning is useful, important and delivers a key source of continuing professional development.

Our charity partner Health Poverty Action works with incredible health professionals in 17 countries across Africa, Asia and Latin America. Often the circumstances in which they work are incredibly challenging; a lack of resources, geography and political isolation make it increasingly difficult for them to do their jobs.

Through this charity partnership, we will continue supporting health professionals in the UK, whilst extending that support worldwide.

Check out their ‘As One’ campaign and see how you can empower, support, and share knowledge with health professionals worldwide, from right here in the UK. United in this network we can make a significant impact on our colleagues around the world: https://www.healthpovertyaction.org/take-action-now/support/as-one/

 

 

Primary Care Networks will be a grouping of GP practices, typically covering a population of 30,000-50,000 people. By July 2019, it is expected that all areas of England will be served by a Primary Care Network.

The BMA suggests that they should be ‘small enough to still provide the personal care valued by both patients and GP practices, but large enough to have impact and economies of scale through deeper collaboration between practices and others in the local health and social care system’.

In the future PCNs are expected to become a larger more inclusive primary care team, with practices expected to work with Community Trusts, the voluntary sector and other agencies.

From 2020 PCNs will be expected to assess risk of ‘unwarranted health outcomes’ and work with community services to support people most in need.

Therefore significant new clinical, technical and IT responsibilities will fall on practices and PCNs, who will need to evaluate their current readiness to provide such services and their capabilities to disseminate such information across their networks and beyond.

Short lead times will mitigate against complex IT projects and instead a proven off-the-shelf product will be the only solution to effect such a radical change in current working practices.

PCNs will therefore need to make the best use of technology to improve efficiency, maximise income and strengthen their workforce.

Experience has shown that such efficiencies are achieved through centralised management and administrative activities, standardised and streamlined operating processes, to improve performance.

In particular, the use of sharing technology such as TeamNet contributes to this sustainability through clinical, training and administrative functions and underpins the delivery of new forms of access.

There are many unanswered questions regarding PCNs. It is however clear that a vehicle for sharing, collaboration and communicating with all stakeholders will be a vital component of any successful PCN. TeamNet is here to help and has a proven track record moving organisations from ‘problem identified’ to ‘problem solved’.

 

To find out more contact us at teamnet@clarity.co.uk

 

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