What and how do general practice trainees learn in practice ? Tim Dornan

1. What and how do general practice trainees learn in practice ? Tim Dornan

2. Outline of this talk • “The fate of our times” • What do trainees learn? • How do they learn it? • What is your role?

3. Outline of this talk • “The fate of our times” • What do trainees learn? • How do they learn it? • What is your role?

4. ‘The fate of our times’Frank 2013 That, which is particular to a given historical period … and determines the fate of people who live then

5. ‘The fate of our times’ NOUNS • Training • Competencies • Skills • Simulation • Feedback • Supervision • Assessment

6. ‘The fate of our times’ NOUNS • Training • Competencies • Skills • Simulation • Feedback • Supervision • Assessment DISCOURSE • Simplicity • Outcomes • Standardisation • Accountability

7. ‘The fate of our times’ NOUNS • Training • Competencies • Skills • Simulation • Feedback • Supervision • Assessment DISCOURSE • Simplicity • Outcomes • Standardisation • Accountability

8. Outline of this talk • “The fate of our times” • What do trainees learn? • How do they learn it? • What is your role?

11. Context

12. Approaches to problems Schön 1983 • Technical rationality: Using the fruits to science to solve problems • Practice: • Problems do not present themselves to the practitioner as givens • “Problem-setting” involves naming the things to which we will attend, framing the context in which we will attend to them • Practitioners “design” solutions

13. The swampy lowlands of practiceSchön 1983 • We have no satisfactory way of …accounting for the artful competence which practitioners reveal in what they do • Complexity, uncertainty, instability, uniqueness, and value-conflict do not fit the model of Technical Rationality

14. ‘The fate of our times’ NOUNS • Training • Competencies • Skills • Simulation • Feedback • Supervision • Assessment DISCOURSE • Simplicity Complexity • Outcomes Process • Standardisation Individualisation • Accountability Emancipation

15. ‘The fate of our times’ NOUNS • Training • Competencies • Skills • Simulation • Feedback • Supervision • Assessment DISCOURSE • Simplicity Complexity • Outcomes Process • Standardisation Individualisation • Accountability Emancipation Complexity

16. Outline of this talk • “The fate of our times” • What do trainees learn? • How do they learn it? • What is your role?

17. How do peoplelearn to do a job?

18. How do peoplelearn to do a job?

19. Study of occupational learning in early Imperial China, Hellenic Greece etcBillett 2014 • Novices engaged in work activities incrementally and progressively • They learned by their own effort, indirectly guided by more experienced workers

20. Study of occupational learning in early Imperial China, Hellenic Greece etcBillett 2014 • Novices engaged in work activities incrementally and progressively • They learned by their own effort, indirectly guided by more experienced workers • Does that sound familiar?

21. How do peoplelearn to do a job?Billett 2014 Mimesis

22. Outline of this talk • “The fate of our times” • What do trainees learn? • How do they learn it? • What is your role?

24. “Mutual interdependence”Billett 2006 Learning environment offers

25. “Mutual interdependence”Billett 2006 Learning environment offers Learner receives and responds

26. “Mutual interdependence”Billett 2006 Learning environment offers Learner receives and responds

27. “Mutual interdependence”Billett 2006 Learning environment offers (Authentic) patient care Learner receives and responds

28. GP supervision – the evidence Expert clinician Ensures patient safety Wearne 2012

29. GP supervision – the evidence Organising • Setting the scene • Negotiating and agreeing an agenda Expert clinician Ensures patient safety

30. GP supervision – the evidence Expert clinician Ensures patient safety Wearne 2012

31. GP supervision – the evidence Expert clinician Ensures patient safety Assessing • Identifying gaps • Asking stimulating questions • Making it safe to admit mistakes

32. GP supervision – the evidence Expert clinician Ensures patient safety Wearne 2012

33. Promoting • Acting as a mirror • Providing resources (and being one) • Giving feedback including praise • Role modelling GP supervision – the evidence Expert clinician Ensures patient safety Wearne 2012

34. GP supervision – the evidence Expert clinician Ensures patient safety Wearne 2012

35. Monitoring the person • Observing practice – particularly with junior learners GP supervision – the evidence Expert clinician Ensures patient safety Wearne S 2012; in preparation

36. GP supervision – the evidence Expert clinician Ensures patient safety Wearne S 2012; in preparation

37. Monitoring learning • Encouraging supervisee to speak • Listening intently GP supervision – the evidence Expert clinician Ensures patient safety Wearne S 2012; in preparation

38. GP supervision – the evidence Expert clinician Ensures patient safety Wearne S 2012; in preparation

39. GP supervision – the evidence Expert clinician Ensures patient safety Summarising • Putting learning into words • Planning future sessions Wearne S 2012; in preparation

40. Summary • “The fate of our times” • (Over)simplification in order to regulate • What do trainees learn? • The complexity of practice • How do they learn it? • Work; mimesis; inviting environment • What is your role? • Form an educational alliance