Introduction In the Bowel Screening Wales (BSW) programme screeni, UKng colonoscopists must meet specified performance criteria and pass both a knowledge-based and practical skills assessment. As such they are highly skilled endoscopists who engage in self-directed learning. We aimed to determine the nature and frequency of ongoing learning opportunities arising on BSW screening lists and practicality of using a structured learning diary.

Methods A stratified randomisation identified six BSW colonoscopists (one from each Health Board). A structured diary recording ‘active’ learning opportunities and self-reflection on learning events (after Knowles) was combined with semi-structured interviews after data collection (minimum 4 BSW lists). A deductive approach to data analysis using a modified grounded theory approach described by Burnard et al. (2008) was used.

Results BSW colonoscopists identified lesion assessment and decision-making (cognitive skills) as the most common learning points. Technical challenges (skills based) and aspects of team performance (attitudinal) were also common. Problems requiring ‘situational awareness’ or where things were not going to plan (including equipment failure) were less common but prompted more active reflection by colonoscopists. Cumulative entries recorded 35 distinct learning points (some duplicated by more than one colonoscopist) in the following domains; polyp detection and assessment; optimising field of view and access; polyp pre-treatment or lifting; snare selection/technique; diathermy modes and settings; complications; situational awareness and teamwork; judgement and decision-making. All participants felt the data recorded was representative of their normal screening lists (making the learning points transferable to other colonoscopists) and felt that using the diary was feasible and helpful. Participants did not always translate recorded reflections into discernable action plans with specific learning goals mainly due to time constraints – where behaviour changed this was facilitated by local opportunities to discuss with near-peers or during formal endoscopy-based multi-disciplinary meetings. A variety of learning resources were used.

Conclusion The structured learning diary proved to be a practical and useful tool to identify learning opportunities in the context of routine BSW screening lists. Participants identified a number of learning needs – most commonly reported were cognitive skills related to lesion assessment and decision-making. Active reflection promoted by using this kind of tool is most effective when leading to the setting of specific goals and linked to supportive local collaborative working patterns.

Reference Burnard P, Gill P, Stewart K, et al. Analysing and presenting qualitative data. Br Dental J 2008;204:429–432.

Disclosure of Interest None Declared.