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

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

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

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.

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

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

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

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

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

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

Registrars What is different? Pros? Cons?

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

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

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.

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

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

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’!

Registrars with problems

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?

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

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.

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

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.

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

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

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