BMJ  2003;327:1064 (8 November), doi:10.1136/bmj.327.7423.1064

Editorial

Launching BMJ Learning

Online learning resources based on the best available evidence

Online textbooks, e-conferences and telemedicine. Cyberpatients and virtual doctors. Lots of learning is available on the web, but much of it is flawed, indecipherable, and biased. Much of it uses new technologies for their own sake rather than as an aid to learning. Drug companies sponsor many of these learning initiatives. But in the United Kingdom the Department of Health has a programme to improve the experience of patients. Providing patients with choice is a key objective of the programme. And it is likely that patients would choose for their doctors to learn from independent sources.

Against this background the BMJ is launching bmjlearning.com—a service initially for general practitioners. Since the last editorial on BMJ Learning in January of this year, we have constructed learning resources based on the best available evidence so that doctors will be better equipped to improve quality of care.¹ If they can record their learning experiences systematically they should feel more confident about appraisal. Appraisal has been in place for general practitioners for just over six months. There are concerns that it will be used to judge performance, but its aim is to encourage personal development.² So far it is clear that a good appraisal needs preparation, confidentiality, and ownership by the doctor being appraised. More than anything a good appraisal needs time—time to plan learning, time to learn, and time to record learning.³

But time is something that general practitioners feel they have very little of. They feel they do lots of learning already—learning on the job—and they want to capture it.^w1 Doctors are not good at knowing what they don't know and want help in identifying reliable learning resources.^w2 They are being asked to become lifelong learners, to embrace personal development when many have been through a traditional medical education that promoted rote learning.⁴

Too often in the past the patient has been used as a prop in medical teaching—"go and see the Marfan's in bed three." A learning site must be patient centred. In developing our learning resources we have asked patients and their carers what the most important things are that doctors should learn about. Patients should have a voice in what they think their doctor should know.⁵

For our first attempt we have based our content on the quality clinical indicators in the new contract for general practitioners⁶ and the standards laid out in the national service frameworks for the United Kingdom. Where the National Institute for Clinical Excellence has issued guidance on a subject we have referred to this guidance in the text. Where possible the learning materials on the site are based on Clinical Evidence and our United States besttreatments.org website. We are also delighted to be working with the Royal College of General Practitioners.

We hope there is something for everyone. The site has interactive case histories, to train and test your consultation skills. These modules do more than just test your knowledge: they test how well you apply your knowledge in everyday practice. We have "just in time" modules that offer bite sized chunks of clinical information to the busy general practitioner. But a lot of the learning isn't clinical—it is about learning what sort of doctor you are, what sort you want to be, and how to balance your work and life.^w3

Reflection is a key ingredient of personal development and learning.^w4 Our read reflect respond modules allow general practitioners to read about a topic, think about issues such as bullying, and send their opinions in. Responses will be pasted up on the site and other readers will be able to view them.

Tension exists between how wacky you should be on a website and getting information to general practitioners quickly. We have erred on the side of interactivity for a purpose—you won't need broadband to use it. We will be building more interactivity on the site, which will challenge learners by introducing the views of patients and other healthcare professionals. The site is based on the needs of doctors from the United Kingdom, but the idea of identifying learning needs with the objective of becoming a good doctor is relevant to doctors worldwide. Ideally we would like to develop the site into a multidisciplinary learning resource.

BMJ Learning is the BMJ Publishing Group's first venture into formal learning for general practitioners. It is hard to translate good learning theory into a web product, and we realise that online learning will only ever be one part of learning—you can't replace the apprenticeship part of medicine.^w5 Many doctors enjoy learning from their peers at meetings so we will also be launching an events guide later this year—to let doctors know about educational meetings in their local area. Nothing will be too small to put in.

In 1995 Bates said "newer technologies such as computers and video conferencing are not necessarily better (or worse) for teaching or learning than older technologies... they are just different... the choice of technology should be driven by the needs of the learners and the context in which we are working, not by its novelty."^w6 We have based our site around the needs of patients and learners and the communities in which they work—the principles of work based learning. We are also delighted to offer all these learning resources, at least for the next six months, for free. Just type in bmjlearning.com and off you go.

BMJ Learning, London WC1H 9JR

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Additional references w1-w6 appear on bmj.com

Competing interests: KW and LD are employed by BMJ Learning, which is a subsidiary of the BMJ Publishing Group.

References

1. Briffa E, Abbasi K. BMJ Learning. BMJ 2003; 326: 176-7.[Free Full Text]
2. General Medical Council and Department of Health. Appraisal and revalidation. www.revalidationuk.info (accessed 24 Oct 2003).
3. Department of Health. Appraisal for general practitioners working in the NHS. www.doh.gov.uk/gpappraisal (accessed 24 Oct 2003).
4. Slotnick HB. How doctors learn: education and learning across the medical-school-to-practice trajectory. Acad Med 2001; 76: 1013-26.[ISI][Medline]
5. Spencer J. ABC of learning and teaching in medicine: Learning and teaching in the clinical environment. BMJ 2003; 326: 591-4.[Free Full Text]
6. GP Committee of the BMA and the NHS Confederation. Investing in general practice: The new general medical services contract. London: BMA, NHS Confederation, 2003.

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