Education beyond competencies: a participative approach to professional development

Objectives New curricula for UK medical training emphasise work-based learning and assessment of competencies. It is debatable whether competency-orientated training is sufficient to prepare doctors for consultant clinical, managerial and professional roles. This article describes a novel approach to postgraduate medical education in palliative medicine for a small group of consultants and specialty trainees. The aim of the study was to extend learning beyond the behaviourist focus of competencies by sharing experience and knowledge through discussion of professional practice. Methods Seven doctors met weekly for a 2-hour specialty education session. Participative action research was conducted over four cycles in 2008. Qualitative analysis of semi-structured group discussions and interviews, together with participants' comments, modified the programme's structure and content. Results Participants developed a framework for discussion of educational subjects based on the specialty curriculum. Thematic analysis suggested that they valued others' experience and found learning through discussion with colleagues supportive and stimulating. Early preference for 'free-flowing' discussion was modified by recognition that structure in planning, preparation and summarising enhanced learning. The framework changed from a learner-led approach to one of collaboration with clearer roles for consultants and trainees. Conclusions It is important that doctors' education encompasses opportunities to share and develop expertise with experienced colleagues. The group developed an education programme for small-group learning based on social constructivist principles and learning within a community of practice. This was facilitated by the context for learning in palliative medicine and may be applicable to other specialties with small groups of trainees.