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? a trainer supervising more than one registrar? grouping registrars in practice placements? grouping registrars in practice placements?

3. Trainers 3-16 years as a trainer 3-16 years as a trainer Practices – 3,000 – 14,000 patients Practices – 3,000 – 14,000 patients Some supervising one FT reg and one PT or ITP Some supervising one FT reg and one PT or ITP 3 were supervising 2 FT registrars 3 were supervising 2 FT registrars 5 of 11 Course organisers or ex COs 5 of 11 Course organisers or ex COs

4. Registrars 7 interviewed, all with prior experience of one to one training relationship 7 interviewed, all with prior experience of one to one training relationship All had experience of joint tutorials, 5 had experience of joint debriefs 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 were supervising up to three mostly a combination of full time and part time.

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

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

7. Trainers – benefits Enjoyable, challenging, interesting Enjoyable, challenging, interesting Developed as an educator [6] Developed as an educator [6] Enjoyable watching the registrars interact 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] 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 Stressful – but generally positive S.O.s worried about burnout Less available for patients Less available for patients Partners – how many patients did you see today? Partners – how many patients did you see today? Need to be well organised Need to be well organised Need for flexibility Need for flexibility Balancing needs – like a family Balancing needs – like a family

9. Practices - benefits Positive effect on atmosphere Positive effect on atmosphere Improve the practices understanding of training Improve the practices understanding of training Enhance the learning environment –Are up to date and model a learning group Enhance the learning environment –Are up to date and model a learning group Easier for registrars to contribute to meetings Easier for registrars to contribute to meetings Increase in availability of appointments Increase in availability of appointments Positive effects on patients Positive effects on patients

10. Practices - costs Complex organisationally – timetabling PT, FT, ITPs / room allocation Complex organisationally – timetabling PT, FT, ITPs / room allocation Induction fatigue Induction fatigue Cant be treated as supernumerary with holidays – in a small practice particularly Cant be treated as supernumerary with holidays – in a small practice particularly

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

12. Registrars - benefits Less isolated socially and professionally Less isolated socially and professionally Decreased intensity of trainer registrar relationship – less dependency and collusion Decreased intensity of trainer registrar relationship – less dependency and collusion Opportunity for teaching Opportunity for teaching Easier to prepare for tutorials Easier to prepare for tutorials Greater depth in tutorials – ethical issues Greater depth in tutorials – ethical issues More challenge of trainers views More challenge of trainers views

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

14. Registrar - costs Less individual time Less individual time Feedback given poorly by another registrar Feedback given poorly by another registrar Issues over sharing rooms – tidiness etc Issues over sharing rooms – tidiness etc Difference in quality of 360 degree feedback Difference in quality of 360 degree feedback Personality clashes Personality clashes Registrars with difficulties Registrars with difficulties One registrar – concern about disruption to teaching caused by a practice move. One registrar – concern about disruption to teaching caused by a practice move.

15. Educational effects Comparing progress Comparing progress Develop skills of an independent learner Develop skills of an independent learner Issues about differences in learning needs – not often Issues about differences in learning needs – not often Recognising hidden learning needs Recognising hidden learning needs Deeper and more thorough learning in joint training 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 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 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 Joint tutorials – More relaxed, less intense, trainers need group facilitation skills

17. Peer contact Sharing knowledge and experience Sharing knowledge and experience Learn the obvious from each other Learn the obvious from each other Easier to ask a peer Easier to ask a peer Bounce ideas off each other Bounce ideas off each other More fun More fun Social contact Social contact Observed talking the talk!

18. Registrars with problems

19. Scheme Organisers concerns High level of organisation at practice and scheme level High level of organisation at practice and scheme level Importance of equity between practices Importance of equity between practices Lack of clarity about who the trainer is Lack of clarity about who the trainer is A stressed practice A stressed practice ?should be additional criteria ?should be additional criteria Will all these registrars have jobs? 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 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 Registrars value peer contact Practice environment enhanced Practice environment enhanced Need to maintain some one to one Need to maintain some one to one Flexibility required to deal with individual needs Flexibility required to deal with individual needs Need to loose the concept of registrar being supernumerary 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. Adequate time for a balance of one to one and joint activities in the week. Debriefing should not be solely a joint activity 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 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 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 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. 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 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. 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 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 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 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. 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 Having multiple trainees in a practice takes a lot of very careful organisation