Training is not the only issue to consider when evaluating practice; however, the burgeoning number of training courses attended surmises that attending purposively designed educational interventions will lead to greater learning, and through transfer of skills into the workplace subsequently positively alter outcomes. The paper from Wake et al1 poses some uncomfortable questions looking at the impact of self-perceptions of competence and training on the management of obesity. This paper's importance is in considering clinical practice when addressing a significant health issue, and illustrates the difficulties around assessing the impact of training when tackling difficult and challenging issues.

The impact of training is most frequently evaluated simplistically around the perceived quality of the session (Kirkpatrick's first level). Addressing whether training alters the learner's behaviours is also relatively easily undertaken by evaluating change in practice, and additionally by alignment with measurable learning outcomes from the training course. However, evaluation of impact upon patient care and outcomes is where the major challenge arises; training being only one relatively small piece of the jigsaw involved in influencing outcomes in complex areas, such as in obesity management, where other influences …