How best to assist struggling trainees? Developing an evidence-based framework to guide support interventions

Abstract

Key mechanisms identified for assisting struggling trainees all involve increasing trainees' awareness of gaps in their knowledge and ways of communicating. These included timely and accurate feedback delivered sensitively, potentially from multiple sources. Once GP specialty trainees are aware of their learning needs they can then engage with further support from the local education and training board (LETB) and external specialists. Therefore, LETBs should consider the support they are able to give trainers to facilitate their work with trainees in difficulty.

A systematic review of supervisory relationships in general practitioner training

“…Regarding the importance of the supervisory alliance, good relationships were deemed fundamental to the teaching of core clinical competencies, influencing career choice, assisting struggling trainees or those in need of remediation, supervising trainees remotely and improving trainee confidence . The ‘luxury’ of the trainee and supervisor relationship was recognised and trainees were keen to ensure that the 1:1 relationship with their supervisor was not lost …”

“…This appeared particularly important in rural or remote supervision . Personality ‘clashes’ were given as reasons for relationship problems or breakdown in communication . For trainees, emotional distance or lack of personal contact from the supervisor was perceived to hinder their learning …”

“…Supervisors ensured trainees were safe to practice autonomously, through having general oversight, monitoring progress and acting as a gatekeeper . Other roles included role model, assessor and mentor, through providing reassurance and personal support . Supervisors also facilitated inclusion of trainees by acting as a broker with the wider practice …”

A preliminary investigation to explore the cognitive resources of physicians experiencing difficulty in training

“…It is important to understand potential causes of difficulty, implement interventions, and support physicians through this process [2], since if they are not identified and supported, there may be negative consequences for their practice, patient care and safety. Across a range of medical specialties, physicians’ competence, and thus quality of patient care, is related to cognitive resources [3–6].…”

“…poor clinical judgement, insufficient medical knowledge, and inefficient use of time), leading to significant gaps in basic clinical knowledge, diagnoses and management of patients. There have been several different explanatory frameworks put forward to explain difficulties faced by both physicians [2, 14, 15] and medical students [16–19], and these have included not only cognitive resources, but also factors such as personal circumstance, learning style, personality and experience. Existing research suggests that differences in cognitive resources may provide an explanation for some of the difficulties faced by physicians.…”