These are the essentials that must be present to ensure that the learner is able to learn. They include selfreflective ability, sufficient interpersonal skills to be able to interact effectively for learning, and the ability to be aware of their environment so that they may interact with it, learn from it, and translate that learning into other situations. Without these prerequisites, it is unlikely that success will be able to be gained in any other area.
a. Learning Difficulties
Unmanaged specific learning difficulties can impact on a person’s ability to learn. For example - dyslexia, difficulties with attention and other specific learning disorders (SLD) may all impact areas of learning that can set a registrar up for failure. These can be undeclared, unrecognised, and/or not managed and may become unmasked during the General Practice training program.
b. Interpersonal Skills
This relates to the broader ability to interact, communicate, and relate to others. It includes skills necessary in clinical consultations, however specific consulting skills are an additional level required for the conduct of medical consultations. For anyone to learn, they need to have the ability to effectively relate to others, not just within medicine. The ability to read emotions, respond appropriately and be articulate in speech all fall within the core components of interpersonal skills.
c. Awareness of Context
Knowledge application and behaviours are context specific. Being aware of the environment you arecurrently in enables you to store and use knowledge, skills, and behaviours relevant to that context. When someone has little awareness of their context, they do not have the ability to interpret and apply behaviours effectively for the current context and will have difficulty adapting that behaviour to different contexts. This impacts on their ability to apply knowledge and skills in an appropriate way. E.g. Sending off a tropinin
blood test on a patient is appropriate in the Emergency Department where the patient can continue to be monitored, but is not appropriate in general practice where the patient goes home and the result is not available by the end of the work day.
d. Self-awareness
Self-awareness is a foundation for self-reflection. It is critical in effective interpersonal skills. Being aware of how you present, how you interact, the impact you have on others and how you can modify this is central to learning many skills. Awareness of when you have and do not have knowledge, and awareness of your own limitations is required for active learners to seek improvement.
e. Ability to learn from experiences
This combines self-awareness and ‘awareness of context’ to progress to the next step and be able to learn from experience. The process of having an experience, evaluating it, considering other options, and developing change, forms the basis of Kolb’s (1984) cycle of learning. A registrar who lacks self-awareness and ‘awareness of context’ will be unlikely to effectively work through this cycle that is required for learning and progression. In theory, we should be confident that all pre-requisites for learning are present and managed in our registrars. However, experience shows that these are sometimes absent in someone who is underperforming. When the problem lies within these areas, it is likely to be a much greater challenge and have a lower probability of success. If they are not considered or addressed, then failure is guaranteed. This relationship is reflected in Kolb’s Cycle of Learning.