Becoming a practitioner

1. Becoming a practitioner Tim Wilkinson Dale Sheehan

2. I have learnt more this year (PGY1) than in my last three years at medical school

3. Performance equation Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance

4. Performance equation Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance

5. Performance equation Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance ✗

6. Performance equation Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance xxx xxx

7. Performance equation Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance Tacit knowledge xxx xxx

8. Performance equation Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance Tacit knowledge xxx xxx Workplace

9. Performance equation Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance

10. Performance equation Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance

11. What do newly qualified doctors learn in their first year of practice? • Joint enquiry • Target group was those entering PGY2 • Qualitative group interviewing • Focus groups in 3 locations • 2 metropolitan • 1 regional • Facilitated by PGY3 doctor (Emily Bowie) • Post interview individual reflection

12. We asked • What do you need to know to do your job that you didn’t learn in medical school? • Compare and contrast now and 12 months ago. • What are the skills that you have developed over the last 12 months/intern year? • What is your role as a junior doctor? • What would you tell a trainee intern to expect from their intern year? • What was the hardest thing / biggest change / in the conversion from being a student to an intern?

13. Themes • Concrete tasks • Project management • Identity formation

14. Themes ✗ • Concrete tasks • Project management • Identity formation

15. Project Management • Paper work • Keeping the show on the road • Getting things ready for ward rounds

16. Project Management • Discharge planning • Team liaison • Patient and family negotiation/advocacy • Prioritization

20. Themes • Concrete tasks • Project management • Identity formation

21. Dealing with self to align professional expectations to personal expectations • becoming an employee • mistakes/limits • identity /image development • emotions (dealing with death etc) • relationship with other professionals particularly the relationship with nurses

22. At med school you seem to think you can deal with anything, but then once started work realised so much is out of your hand. • You do not want to lose respect from other doctors • Getting thrown into situations where you are out of your depth and have little understanding • Bluffing that you know what to do when really you have very little idea

23. Difficulty working with nurses! At med school, seem to think we are all supposed to work together. Was not prepared for the reality of it! • Expect to get stressed out with nurses • Learning the key words to use to get what the team wants done • Learning which nurses to trust and which to ignore

24. Is this “just" conflict? OR is there another lens we can use to understand this experience?

25. Identity - Holmes’s model

26. Using this lens that Holmes gives us What are the implications for • Supervisors • The New Practitioner

27. Supervisors first

28. Role Coaching and Pastoral Care • Supporting the intern through the trajectory of identity formation • Affirming professional identity • Coaching in peer and patient communication, conflict resolution • Providing feedback on communication interactions.

29. Practice Mentoring - Sponsoringwithin the Interprofessional (IP) Team • Supporting and encouraging participation • Orientation to the team • Initiating introductions, membership • Role modeling of collaborative practice • Encouraging interprofessionallearning

30. Lest we forget There are other significant roles of the supervisor • Clinical Oversight –Patient Safety • Educational and Career Mentoring and Guidance

31. The 4 roles of the supervisor • Clinical Oversight • Educational and Career Mentoring and Guidance • Role Coaching and Pastoral Care • Practice Mentoring - Sponsoring within the Interprofessional team

32. Responsibilities of the Supervisee

33. ? The role of objectives and approaches to learning across the continuum

34. On a tight lead – focused objective

35. Thinking your free but on an extending lead

36. First weeks on the job!

37. But soon, out exploring with the mixed breed team

38. Meeting the supervisor recording what we found what we learnt

39. First ?’s Does the role and place of objectives or competency statements change through the continuum ? If they change how are they best used at each stage ? Are they even relevant by the end of PGY1 or are junior doctors actually learning in the team and practitioner community then?

40. And Are we coaching and assessing the right things ?

41. What appears to be may actually be • Paper work • Interprofessional conflict • Chasing things up • Getting stressed with nurses • Prioritizing pages • Being thrown in the deep end • Not being listened to • Identity development • Project management

42. What appears to be may actually be • Paper work • Interprofessional conflict • Chasing things up • Getting stressed with nurses • Prioritizing pages • Being thrown in the deep end • Not being listened to • Identity development • Project management

43. Performance equation ✗ Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance

44. Performance equation Competency 1 + Competency 2 + Competency 3 + Tacit knowledge Competence + Workplace = performance

45. Implications for assessment • Engagement with supervision • Taking opportunities • Offering to contribute • Reflecting on events • Questioning • Interacting with team • Case coordination

46. Questions What feedback (and preparation) assists with these the development of project management skills? What feedback and perhaps coaching helps a novice in any profession manage their way through the fields of "undetermined identity? What is a "successful performance" in PGY1 and perhaps PGY2? What are the indicators that a HO is ready for a registrar (or consultant) role?