What are we trying to achieve?

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One of the main tasks of the clinical teacher in working with students or trainees is to support the learner in raising their awareness of their own strengths and areas for further development. One widely used model which summarises self-knowledge at any one time is the the Johari window (1955).

	Known to self	Unknown to self
Known to others	Open arena	Blind spot
Unknown to others	Hidden (façade)	Unknown

The task of the clinical teacher through feedback, formative (developmental) assessment, and appraisal and support is to help the learner expand the ‘open’ arena (in which a person feels able to ‘be themselves’, is authentic and behaviours are routinised) so that they start to become aware of or feel able to reveal those aspects that fall in the other three areas:

‘blind spot’ – i.e. where others can see their deficiencies or gaps but the learner cannot. This is where formative assessment techniques and a trusting relationship can help the learner become aware of learning needs
‘hidden’ or ‘façade’ – those aspects where the learner is aware of needs, gaps or deficiencies but others are not. This requires trust to be developed between the clinical teacher and the learner so that the learner feels able to admit weaknesses or deficiencies or reveal fears
‘unknown’ – this is where the teacher and learner work together to identify areas for development.

There are many opportunities for assessing learning needs and setting learning outcomes with learners on a day-to-day basis. Spencer’s article ‘Learning and teaching in the clinical environment’ (2003) describes a range of aspects and activities concerned with helping clinical teachers to optimise teaching and learning opportunities that arise in daily practice, such as planning, using appropriate questioning techniques and teaching in different clinical contexts. Such techniques often involve discussing learners’ performance or understanding, but the techniques are built into everyday practice.

Those assessing educational needs can help the learner to move through the stages in the ‘competency model’ of professional development (Proctor, 2001, Hill, 2007) as shown in the table below.

	Unconscious incompetence	Conscious incompetence	Conscious competence	Unconscious competence
Learner	Low level of competence. Unaware of failings	Low level of competence. Aware of failings but not having full skills to correct them	Demonstrates competence but skills not fully internalised or integrated. Has to think about activities	Carries out tasks with conscious thought. Skills internalised and routine. Little or no conscious awareness of detailed processes involved in activities
Clinical teacher: assessing learning or educational needs	Supportively helps learner to recognise weaknesses, identify areas for development and become aware of learning/development needs and thus conscious of ‘incompetence’	Uses range of skills and techniques to assess learner’s development in relation to defined expectations for the level and stage of learning. Helps learner to develop and refine self-assessment skills. Reassures and supports	Helps learner to develop and refine skills, reinforces good practice and competence through positive regular feedback and a focus on areas for development and refinement of skills, additional knowledge required and an integration of competences	Raises awareness of detail and unpacks processes for more advanced learning. Helps learner to identify any areas of weakness/bad habit that they may not be aware of