Grouping Registrars in Practice Placements

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Grouping Registrars in Practice Placements

• How many can one trainer supervise?
• Dr. Jo Buchanon, YH Deanery

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Question

• What is the impact of
• a trainer supervising more than one registrar?
• grouping registrars in practice placements?

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Trainers

• 3-16 years as a trainer
• Practices 3,000 14,000 patients
• Some supervising one FT reg and one PT or ITP
• 3 were supervising 2 FT registrars
• 5 of 11 Course organisers or ex COs

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Registrars

• 7 interviewed, all with prior experience of one
  to one training relationship
• All had experience of joint tutorials, 5 had
  experience of joint debriefs
• Trainers were supervising up to three mostly a
  combination of full time and part time.

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Trainers

• Why get involved?
• What are the benefits?
• What are the costs?

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Trainers why involvement

• New, interesting and challenging
• Professional development
• Had been asked
• Inspired by a course
• All practices had received funding for extra
  rooms

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Trainers benefits

• Enjoyable, challenging, interesting
• Developed as an educator 6
• Enjoyable watching the registrars interact
• Altered structure of the day more time for
  teaching less seeing patients easier to
  prioritise teaching time 80/20 to 50/50
• Three easier than two

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Trainers - costs

• Stressful but generally positive S.O.s worried
  about burnout
• Less available for patients
• Partners how many patients did you see today?
• Need to be well organised
• Need for flexibility
• Balancing needs like a family

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Practices - benefits

• Positive effect on atmosphere
• Improve the practices understanding of training
• Enhance the learning environment Are up to date
  and model a learning group
• Easier for registrars to contribute to meetings
• Increase in availability of appointments
• Positive effects on patients

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Practices - costs

• Complex organisationally timetabling PT, FT,
  ITPs / room allocation
• Induction fatigue
• Cant be treated as supernumerary with holidays
  in a small practice particularly

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Registrars

• What is different?
• Pros? Cons?

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Registrars - benefits

• Less isolated socially and professionally
• Decreased intensity of trainer registrar
  relationship less dependency and collusion
• Opportunity for teaching
• Easier to prepare for tutorials
• Greater depth in tutorials ethical issues
• More challenge of trainers views

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Registrar Benefits - contd

• Learn about functioning as a group
• More independence feedback to the practice
  easier
• Relate to more than one trainer

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Registrar - costs

• Less individual time
• Feedback given poorly by another registrar
• Issues over sharing rooms tidiness etc
• Difference in quality of 360 degree feedback
• Personality clashes
• Registrars with difficulties
• One registrar concern about disruption to
  teaching caused by a practice move.

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Educational effects

• Comparing progress
• Develop skills of an independent learner
• Issues about differences in learning needs not
  often
• Recognising hidden learning needs
• Deeper and more thorough learning in joint
  training

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Specific activities

• Video second opinion, feedback very good for
  MRCGP, 5 submitted video all passed 2 with merit
• Joint debriefing positive can see how peers
  perform, learn from others mistakes but can be
  lengthy
• Joint tutorials More relaxed, less intense,
  trainers need group facilitation skills

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Peer contact

• Sharing knowledge and experience
• Learn the obvious from each other
• Easier to ask a peer
• Bounce ideas off each other
• More fun
• Social contact
• Observed talking the talk!

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Registrars with problems
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Scheme Organisers concerns

• High level of organisation at practice and scheme
  level
• Importance of equity between practices
• Lack of clarity about who the trainer is
• A stressed practice
• ?should be additional criteria
• Will all these registrars have jobs?

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Conclusions

• Some trainers are prepared to work in this way
  developing skills as an educationalist within the
  practice 17 of trainers delivering 30 of
  capacity
• Registrars value peer contact
• Practice environment enhanced
• Need to maintain some one to one
• Flexibility required to deal with individual
  needs
• Need to loose the concept of registrar being
  supernumerary

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And finally

• My experience here has been that the informal
  discussions have almost been as good as the
  formal tutorials. I have felt better for it.
  I have gained more from it from a personal
  openness point of view talking to the other
  registrar. And I preferred it that way, than
  being here on my own as an only registrar, with
  the benefits of having more one-to-one. It's
  more enjoyable having another registrar here.

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Action Points - The training programme

• Adequate time for a balance of one to one and
  joint activities in the week.
• Debriefing should not be solely a joint activity
• There needs to be flexibility in the training
  timetable to enable changes to be made according
  to the needs of individuals
• Timetabling should ensure that the registrars
  have opportunity for informal contact in a normal
  working day

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Action Points the practice

• The whole practice needs to be committed to
  training.
• The practice needs to provide a high standard of
  organisation and clarity for the registrars about
  supervisory arrangements.

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Action Points - Registrars

• Registrars need to take responsibility for most
  of the record keeping
• Educational processes and skills e.g. the giving
  of effective feedback should be discussed at the
  start of each attachment.
• Should be encouraged to contribute to practice
  activities

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Action Points trainer development

• Trainers should be asked to submit videos of
  joint training activities as part of the trainer
  re-approval process
• Trainers to be offered the opportunity to develop
  their group skills

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The two most impt things

• A trainer who wants to have multiple trainees
  needs to redefine the ratio of education to
  practising medicine in their working week Jo
  suggested that education would take up 50 rather
  than 20 of their time.
• Having multiple trainees in a practice takes a
  lot of very careful organisation