BMJ Learning

The surprise about appraisal and revalidation for doctors in the United Kingdom is not that it is happening but that it was not introduced earlier.^1–3 For appraisal to be successful it will have to be centred on learning, which in conceptual terms allows the learner to take control in the way that education—with its top down connotations—rarely seemed to. This change in emphasis is also reflected this week in an interview with Professor Graeme Catto (p 183), president of the General Medical Council, and the start of an ABC series on learning and teaching in medicine (p 213). Helping doctors to learn is central to the BMJ mission, which is why we are launching BMJ Learning.

The proposition is simple. If doctors have access to online learning resources, based on the best available evidence, they will be better equipped to improve quality of care. If they can record their learning experiences systematically they should feel more confident about appraisal. As five successful appraisals seem likely to be the main requirement for revalidation, it may make that hurdle seem less daunting. We envisage that this service will develop into a learning resource for all doctors internationally, but the initial emphasis will be on appraisal in the United Kingdom because that is where many of our readers are hurting.

How should we build a successful medical learning service? We have looked at possible models from around the world and reviewed available evidence. In the United States, much online continuing medical education is driven by the need to accumulate points and by the product awareness campaigns of pharmaceutical companies. Among the exceptions is a website devoted to the medical response to weapons of mass destruction, with 10 modules covering subjects ranging from anthrax to smallpox.⁴ North of the 49th parallel, the story is more positive. The Royal College of Physicians and Surgeons of Canada has led many of the initiatives in self directed learning that regulators in the United Kingdom now wish to implement. Although many interesting initiatives have started in response to this regulatory drive, in Europe and North America, our judgment is that there is no comprehensive service that adequately meets doctors' learning needs.

Over the past year we have conducted focus groups and interviews with general practitioners in the United Kingdom to help understand what users want from such a service. There are few tears for the demise of the old system but widespread suspicion that appraisal will prove to be a disciplinary process dressed up in the sheep's clothing of self directed development. Most doctors have little understanding of what appraisal requires and see it as yet another exam to be passed, but one for which there are no past papers to look up.

Three strong requirements shine through. Doctors want a wide range of high quality learning resources to suit different learning styles. BMJ Learning's offerings will include case histories, video lectures, and a new resource for busy clinicians called just in time learning. All of these will build on existing BMJ Publishing Group resources, such as Clinical Evidence. Doctors also like the idea of an online personal development plan and record that catalogues the needs they identify and the learning they undertake—be it online or by traditional means, such as lectures and postgraduate meetings. They value a guide to the emerging range of learning resources from universities and other publishers. But all this depends on the service being fun, bite sized chunks of learning, and being confidential.

So that is what we are building, and we hope to launch in autumn of this year. BMJ Learning will be internet based but it will complement, not replace, human contact with tutors and colleagues that can make learning a professional pleasure. We want the service to be free for users and the best way to ensure that would be to secure central funding from the United Kingdom's department of health or the NHS. We plan to start small but think big, and grow rapidly if successful. One day it may mean providing learning resources that will enable medical professionals to learn from their first day at medical school to wherever their career may finally take them—and beyond. Life long learning is becoming an integral part of other professions. Medicine is following suit and we intend BMJ Learning to support doctors in this changing and uncertain climate.

News p 183Clinical review p 213