General practitioners' self assessment of knowledge

Editor—Factual recall is only one element of a needs assessment that should be taken into account in developing continuing medical education programmes for general practitioners. A poor correlation of self assessed knowledge with performance in a knowledge test, as shown by Tracey et al,1 does not invalidate the rationale for a needs assessment. The knowledge tests used by Tracey et al do not reflect the range of practical issues relevant to patient management. Knowledge of practical management that is relevant to the concerns and questions likely to be raised by patients, and confidence and experience in dealing with specific conditions, are the needs that should be assessed in planning continuing medical education programmes. In two studies evaluating guidelines in primary care, one set for the use of magnetic resonance imaging for common orthopaedic conditions (182 general practitioners)2 and the other for the management of breast conditions in primary care (113 general practitioners),3 we undertook needs assessments with the participating practices. In each study doctors rated their confidence in using magnetic resonance imaging or managing breast conditions respectively and identified problems from recent clinical practice, and knowledge of practically relevant issues was assessed. In the first study the doctors indicated their frequency of using magnetic resonance imaging. Good knowledge of the contraindications for magnetic resonance imaging was associated with higher self assessed knowledge (P<0.05) and confidence (P<0.01) and frequency (P<0.05) of using magnetic resonance imaging in practice. Knowledge of lifetime risk of breast cancer was associated with confidence in dealing with breast conditions (P<0.05). Knowledge was also associated with membership of the Royal College of General Practitioners (P<0.01) General practitioners can correctly assess their knowledge and needs if the relevant aspects are explored. Identifying needs from personal experience is perhaps more valid than general rating scales of knowledge; the knowledge that is assessed should be relevant to the discussions that take place with patients and the management issues that arise in combination with up to date factual information. The range of clinical conditions encountered in primary care is too vast for high levels of personal knowledge to be maintained in all these areas. It is more important that general practitioners can access information when required rather than having it readily accessible. The nature of general practice is also characterised by high levels of uncertainty in dealing with many patients’ conditions, and general practitioners have to be able to cope with this in everyday practice.4 Assessing knowledge of practical management, experience, and confidence can then inform the content and method of an educational programme.