Grouping Registrars in Grouping Registrars in Practice PlacementsPractice Placements

How many can one trainer How many can one trainer supervise?supervise?

Dr. Jo Buchanon, Y&H Dr. Jo Buchanon, Y&H DeaneryDeanery

QuestionQuestion

What is the impact of:What is the impact of:

• a trainer supervising more than one a trainer supervising more than one registrar?registrar?

• grouping registrars in practice grouping registrars in practice placements?placements?

TrainersTrainers

• 3-16 years as a trainer3-16 years as a trainer

• Practices – 3,000 – 14,000 patientsPractices – 3,000 – 14,000 patients

• Some supervising one FT reg and one Some supervising one FT reg and one PT or ITP PT or ITP

• 3 were supervising 2 FT registrars3 were supervising 2 FT registrars

• 5 of 11 Course organisers or ex COs 5 of 11 Course organisers or ex COs

RegistrarsRegistrars

• 7 interviewed, all with prior 7 interviewed, all with prior experience of one to one training experience of one to one training relationshiprelationship

• All had experience of joint tutorials, 5 All had experience of joint tutorials, 5 had experience of joint debriefshad experience of joint debriefs

• Trainers were supervising up to three Trainers were supervising up to three mostly a combination of full time and mostly a combination of full time and part time.part time.

TrainersTrainers

• Why get involved?Why get involved?

• What are the benefits?What are the benefits?

• What are the costs?What are the costs?

Trainers – why involvementTrainers – why involvement

• New, interesting and challengingNew, interesting and challenging

• Professional developmentProfessional development

• Had been askedHad been asked

• Inspired by a courseInspired by a course

All practices had received funding for All practices had received funding for extra rooms extra rooms

Trainers – benefitsTrainers – benefits

• Enjoyable, challenging, interestingEnjoyable, challenging, interesting

• Developed as an educator [6]Developed as an educator [6]

• Enjoyable watching the registrars interactEnjoyable watching the registrars interact

• Altered structure of the day – more time Altered structure of the day – more time for teaching less seeing patients – easier for teaching less seeing patients – easier to prioritise teaching time [80/20 to 50/50]to prioritise teaching time [80/20 to 50/50]

Three easier than twoThree easier than two

Trainers - costsTrainers - costs

• Stressful – but generally positive S.O.s Stressful – but generally positive S.O.s worried about burnoutworried about burnout

• Less available for patientsLess available for patients

• Partners – ‘how many patients did you Partners – ‘how many patients did you see today?’see today?’

• Need to be well organisedNeed to be well organised

• Need for flexibilityNeed for flexibility

• Balancing needs – like a familyBalancing needs – like a family

Practices - benefitsPractices - benefits

• Positive effect on atmospherePositive effect on atmosphere• Improve the practice’s understanding of Improve the practice’s understanding of

trainingtraining• Enhance the learning environment –Are Enhance the learning environment –Are

up to date and model a learning groupup to date and model a learning group• Easier for registrars to contribute to Easier for registrars to contribute to

meetingsmeetings• Increase in availability of appointmentsIncrease in availability of appointments• Positive effects on patients Positive effects on patients

Practices - costsPractices - costs

• Complex organisationally – Complex organisationally – timetabling PT, FT, ITPs / room timetabling PT, FT, ITPs / room allocationallocation

• ‘‘Induction fatigue’Induction fatigue’

• Can’t be treated as supernumerary Can’t be treated as supernumerary with holidays – in a small practice with holidays – in a small practice particularlyparticularly

RegistrarsRegistrars

• What is different?What is different?

• Pros? Cons?Pros? Cons?

Registrars - benefitsRegistrars - benefits

• Less isolated socially and professionallyLess isolated socially and professionally• Decreased intensity of trainer registrar Decreased intensity of trainer registrar

relationship – less dependency and relationship – less dependency and collusioncollusion

• Opportunity for teachingOpportunity for teaching• Easier to prepare for tutorialsEasier to prepare for tutorials• Greater depth in tutorials – ethical issuesGreater depth in tutorials – ethical issues• More challenge of trainer’s viewsMore challenge of trainer’s views

Registrar Benefits - contdRegistrar Benefits - contd

• Learn about functioning as a groupLearn about functioning as a group

• More independence – feedback to the More independence – feedback to the practice easierpractice easier

• Relate to more than one trainerRelate to more than one trainer

Registrar - costsRegistrar - costs

• Less individual timeLess individual time

• Feedback given poorly by another registrarFeedback given poorly by another registrar

• Issues over sharing rooms – tidiness etcIssues over sharing rooms – tidiness etc

• Difference in quality of 360 degree feedbackDifference in quality of 360 degree feedback

• Personality clashesPersonality clashes

• Registrars with difficultiesRegistrars with difficulties

• One registrar – concern about disruption to One registrar – concern about disruption to teaching caused by a practice move.teaching caused by a practice move.

Educational effectsEducational effects

• Comparing progressComparing progress

• Develop skills of an independent Develop skills of an independent learnerlearner

• Issues about differences in learning Issues about differences in learning needs – not oftenneeds – not often

• Recognising hidden learning needsRecognising hidden learning needs

• Deeper and more thorough learning in Deeper and more thorough learning in joint trainingjoint training

Specific activitiesSpecific activities

• Video Video – second opinion, feedback – second opinion, feedback very good for MRCGP, 5 submitted very good for MRCGP, 5 submitted video all passed 2 with meritvideo all passed 2 with merit

• Joint debriefingJoint debriefing – positive can see – positive can see how peers perform, learn from others how peers perform, learn from others mistakes – but can be lengthymistakes – but can be lengthy

• Joint tutorialsJoint tutorials – More relaxed, less – More relaxed, less intense, trainers need group intense, trainers need group facilitation skillsfacilitation skills

Peer contactPeer contact

• Sharing knowledge and experienceSharing knowledge and experience

• Learn the obvious from each otherLearn the obvious from each other

• Easier to ask a peerEasier to ask a peer

• Bounce ideas off each otherBounce ideas off each other

• More funMore fun

• Social contactSocial contact

Observed ‘talking the talk’!Observed ‘talking the talk’!

Registrars with problemsRegistrars with problems

Scheme Organisers Scheme Organisers concernsconcerns• High level of organisation at practice High level of organisation at practice

and scheme level and scheme level

• Importance of equity between practicesImportance of equity between practices

• Lack of clarity about who the trainer isLack of clarity about who the trainer is

• A stressed practiceA stressed practice

• ?should be additional criteria?should be additional criteria

• Will all these registrars have jobs?Will all these registrars have jobs?

ConclusionsConclusions

• Some trainers are prepared to work in this way Some trainers are prepared to work in this way – developing skills as an educationalist within – developing skills as an educationalist within the practice 17% of trainers delivering 30% of the practice 17% of trainers delivering 30% of capacitycapacity

• Registrars value peer contactRegistrars value peer contact• Practice environment enhancedPractice environment enhanced• Need to maintain some one to oneNeed to maintain some one to one• Flexibility required to deal with individual needsFlexibility required to deal with individual needs• Need to loose the concept of registrar being Need to loose the concept of registrar being

supernumerarysupernumerary

And finally…And finally…

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

Action Points - The training Action Points - The training programmeprogramme

• Adequate time for a balance of one to one Adequate time for a balance of one to one and joint activities in the week. and joint activities in the week.

• Debriefing should not be solely a joint activityDebriefing should not be solely a joint activity

• There needs to be flexibility in the training There needs to be flexibility in the training timetable to enable changes to be made timetable to enable changes to be made according to the needs of individuals according to the needs of individuals

• Timetabling should ensure that the registrars Timetabling should ensure that the registrars have opportunity for informal contact in a have opportunity for informal contact in a normal working daynormal working day

Action Points –Action Points – the practicethe practice

• The whole practice needs to be The whole practice needs to be committed to training. committed to training.

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

Action Points - RegistrarsAction Points - Registrars

• Registrars need to take responsibility Registrars need to take responsibility for most of the record keeping for most of the record keeping

• Educational processes and skills e.g. Educational processes and skills e.g. the giving of effective feedback the giving of effective feedback should be discussed at the start of should be discussed at the start of each attachment. each attachment.

• Should be encouraged to contribute Should be encouraged to contribute to practice activitiesto practice activities

Action Points – trainer Action Points – trainer developmentdevelopment

• Trainers should be asked to submit Trainers should be asked to submit videos of joint training activities as videos of joint training activities as part of the trainer re-approval part of the trainer re-approval processprocess

• Trainers to be offered the Trainers to be offered the opportunity to develop their group opportunity to develop their group skillsskills

The two most impt thingsThe two most impt things

• A trainer who wants to have multiple A trainer who wants to have multiple trainees needs to redefine the ratio of trainees needs to redefine the ratio of education to practising medicine in education to practising medicine in their working week – Jo suggested their working week – Jo suggested that education would take up 50% that education would take up 50% rather than 20% of their time. rather than 20% of their time.

• Having multiple trainees in a practice Having multiple trainees in a practice takes a lot of very careful organisationtakes a lot of very careful organisation