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