Grouping Registrars in Practice Placements

1. Grouping Registrars in Practice Placements How many can one trainer supervise? Dr. Jo Buchanon, Y&H Deanery

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

3. 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

4. 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.

5. Trainers • Why get involved? • What are the benefits? • What are the costs?

6. Trainers – why involvement • New, interesting and challenging • Professional development • Had been asked • Inspired by a course All practices had received funding for extra rooms

7. 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

8. 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

9. Practices - benefits • Positive effect on atmosphere • Improve the practice’s 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

10. Practices - costs • Complex organisationally – timetabling PT, FT, ITPs / room allocation • ‘Induction fatigue’ • Can’t be treated as supernumerary with holidays – in a small practice particularly

11. Registrars • What is different? • Pros? Cons?

12. 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 trainer’s views

13. Registrar Benefits - contd • Learn about functioning as a group • More independence – feedback to the practice easier • Relate to more than one trainer

14. 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.

15. 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

16. 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

17. 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’!

18. Registrars with problems

19. 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?

20. 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

21. 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.

23. 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

24. 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.

25. 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

26. 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

27. 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