Abstract
Background‘Ad hoc’ help-seeking by trainees from their supervisors during trainee consultations is important for patient safety, and trainee professional development. We explored trainee objectives and activities in seeking supervisor assistance, and trainee perceptions of the outcomes of this help-seeking (including the utility of supervisor responses).MethodsFocus groups with Australian general practice trainees were undertaken. All data was audio-recorded and transcribed, coded using in-vivo and descriptive codes, and analysed by the constant comparison of provisional interpretations and themes with the data. Findings are reported under the over-arching categories of help-seeking objectives, activities and outcomes.ResultsEarly in their general practice placements trainees needed information about practice facilities, and the “complex maze” of local patient resources and referral preferences: some clinical presentations were also unfamiliar, and many trainees were unaccustomed to making patient management decisions. Subsequent help-seeking was often characterised informally as “having a chat” or “getting a second opinion” so as not to “miss anything” when trainees were “not 100% sure”. Trainees emphasised the importance of being (and demonstrating that they were) clinically safe. Workflow constraints, and supervisory and doctor-patient relationships, had a powerful influence on trainee help-seeking activities. An etiquette for providing help in front of patients was described. Trainees assessed the credibility of supervisors based on their approach to risk and their clinical expertise in the relevant area. Several trainees reported reservations about their supervisor’s advice on occasions.ConclusionA trainee’s subsequent help-seeking is strongly influenced by how their supervisor responds when their help is sought. Trainees prefer to seek help from credible supervisors who respond promptly and maintain trainee ‘face’ in front of patients. Trainees learn through help-seeking to make their own clinical decisions but may remain uncertain about professional and societal expectations, and curious about how other general practitioners practise. Trainees value opportunities throughout their training to observe expert general practice.
Highlights
Following the completion of hospital-based training requirements, Australian general practice trainees work for three 6-month terms (Terms 1, 2 and 3) across two accredited training practices, and complete a final 6 month advanced training term (Term 4) in either a general practice or hospital post
Trainees are encouraged to seek help from their general practitioner supervisors before, during and/or after consultations if they are not certain how to manage patients independently [4, 5], and ‘ad hoc’ help-seeking during consultations in particular is believed to contribute to ensuring patient safety and trainee learning and development [5,6,7]
In-consultation help-seeking by general practitioner trainees is a complex social interaction embedded in the pace and pressure of general practice work
Summary
Following the completion of hospital-based training requirements (a minimum of two years), Australian general practice trainees work for three 6-month terms (Terms 1, 2 and 3) across two accredited training practices, and complete a final 6 month advanced training term (Term 4) in either a general practice or hospital post. Trainees are able to practise without direct supervision of every clinical encounter from their first general practice term [1,2,3], the supervisor is expected be onsite and available during office hours for most of the time in Term 1 [3]. In-consultation help-seeking by general practitioner trainees is a complex social interaction embedded in the pace and pressure of general practice work. Various conceptual approaches have been used to frame medical trainee help-seeking, including the following theories: expected utility [8]; self-regulation [4]; organisational safety [9, 10]; legitimate participation [11]; and workplace affordances [12]
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