Development of teaching, mentoring and supervision skills for basic training registrars: a frustrated apprenticeship?

Abstract

Teaching, mentoring and supervision (TMS) are fundamental skills with a specific commitment within the Royal Australasian College of Physicians professional practice framework. The new basic training standards include 'use of appropriate educational techniques to facilitate the learning of peers, junior colleagues and other health professionals and to provide supervision for junior colleagues' but it is unclear how basic physician trainees and equivalent grade doctors (hereinafter 'registrars') will provide, learn or develop TMS skills. To explore how registrars provide, learn and develop TMS skills. Mixed methods approach. New Zealand registrars were invited to participate in anonymous survey regarding TMS experiences and learning. Focus groups explored skill acquisition and development more deeply. A total of 121 registrars from 16 District Health Boards responded. Registrars supervise two juniors daily (range 0-4+). Fewer than 1:4 have formal training in TMS skills. Free text and focus group themes include: informal development by observing role models plus personal experience of giving and receiving TMS, inequitable access to development opportunities and formal training, barriers include workload and unsupportive learning cultures. Some registrars lack confidence in delivering TMS. Registrars are expected to teach, mentor and supervise junior colleagues but experience a 'frustrated apprenticeship': formal training is minimal and informal training is dependent on variable role models, opportunities and systematic support. Registrars feel unprepared and lack confidence despite wanting to succeed in this domain. Suggestions for improvement include baseline formal training, purposeful role modelling by seniors and equitable promotion of TMS opportunities.