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

2. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Outline of this talk “The fate of our times” What do trainees learn? How do they learn it? What is your role?

3. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Outline of this talk “The fate of our times” What do trainees learn? How do they learn it? What is your role?

4. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research ‘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. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research ‘The fate of our times’ NOUNS Training Competencies Skills Simulation Feedback Supervision Assessment

6. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research ‘The fate of our times’ NOUNS Training Competencies Skills Simulation Feedback Supervision Assessment DISCOURSE Simplicity Outcomes Standardisation Accountability

7. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research ‘The fate of our times’ NOUNS Training Competencies Skills Simulation Feedback Supervision Assessment DISCOURSE Simplicity Outcomes Standardisation Accountability

8. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Outline of this talk “The fate of our times” What do trainees learn? How do they learn it? What is your role?

9. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

11. Context

12. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research 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 Approaches to problems Schön 1983

13. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research The swampy lowlands of practice Schön 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. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research ‘The fate of our times’ NOUNS Training Competencies Skills Simulation Feedback Supervision Assessment DISCOURSE Simplicity Complexity Outcomes Process Standardisation Individualisation Accountability Emancipation

15. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research ‘The fate of our times’ NOUNS Training Competencies Skills Simulation Feedback Supervision Assessment DISCOURSE Simplicity Complexity Outcomes Process Standardisation Individualisation Accountability Emancipation Complexity

16. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Outline of this talk “The fate of our times” What do trainees learn? How do they learn it? What is your role?

17. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research How do people learn to do a job?

18. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research How do people learn to do a job?

19. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Study of occupational learning in early Imperial China, Hellenic Greece etc Billett 2014 Novices engaged in work activities incrementally and progressively They learned by their own effort, indirectly guided by more experienced workers

20. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Study of occupational learning in early Imperial China, Hellenic Greece etc Billett 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. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research How do people learn to do a job? Billett 2014 Mimesis

22. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Outline of this talk “The fate of our times” What do trainees learn? How do they learn it? What is your role?

23. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

24. “Mutual interdependence” Billett 2006 Learning environment offers

25. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research “Mutual interdependence” Billett 2006 Learning environment offers

26. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research “Mutual interdependence” Billett 2006 Learning environment offers

27. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research “Mutual interdependence” Billett 2006 Learning environment offers (Authentic) patient care

28. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Wearne 2012

29. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Organising Setting the scene Negotiating and agreeing an agenda

30. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Wearne 2012

31. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Assessing Identifying gaps Asking stimulating questions Making it safe to admit mistakes

32. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Wearne 2012

33. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Promoting Acting as a mirror Providing resources (and being one) Giving feedback including praise Role modelling Wearne 2012

34. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Wearne 2012

35. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Wearne S 2012; in preparation Monitoring the person Observing practice – particularly with junior learners

36. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Wearne S 2012; in preparation

37. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Wearne S 2012; in preparation Monitoring learning Encouraging supervisee to speak Listening intently

38. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Wearne S 2012; in preparation

39. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research GP supervision – the evidence Expert clinician Ensures patient safety Wearne S 2012; in preparation Summarising Putting learning into words Planning future sessions

40. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research 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

41. Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research