What and how do general practice trainees learn in practice ? Tim Dornan
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?
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?
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
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
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
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
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?
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
Ski
ll ba
sed
Slip
s
Pat
ient
62,
44
Workload82,80,76, 64,61,44, 27,14,3
Rushing 82,80,76,64,
61,44,27,14,3,1
Doing >1 job at a time 64,62,44
A&E policy 44
Wanting to go home 82
Understaffed 80,64,27,3
Pressure from nurses 64
Feeling flustered 89,61
Not checking82,44,14
Poor communication with other Drs
poor 80,46
Others error/violation 46,80,14
Unknown patients 82,
62
Tired 80,64
Covering lots of wards 64
Only paid for 48 hrs 27
Ignored E rxingwarning 76
Design of E rxingsystem 76
Alert fatigue 76
Nurse 82,19,61,14
Pharmacist 3,1
On call 76
Slips (12)
Self 80,76,64,27,46
Start
Start
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
Ski
ll ba
sed
Slip
s
Pat
ient
62,
44
Workload82,80,76, 64,61,44, 27,14,3
Rushing 82,80,76,64,
61,44,27,14,3,1
Doing >1 job at a time 64,62,44
A&E policy 44
Wanting to go home 82
Understaffed 80,64,27,3
Pressure from nurses 64
Feeling flustered 89,61
Not checking82,44,14
Poor communication with other Drs
poor 80,46
Others error/violation 46,80,14
Unknown patients 82,
62
Tired 80,64
Covering lots of wards 64
Only paid for 48 hrs 27
Ignored E rxingwarning 76
Design of E rxingsystem 76
Alert fatigue 76
Nurse 82,19,61,14
Pharmacist 3,1
On call 76
Slips (12)
Self 80,76,64,27,46
Start
Start
Context
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
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
The swampy lowlands of practiceSchön 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
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
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
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?
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
How do peoplelearn to do a job?
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
How do peoplelearn to do a job?
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
Study of occupational learning in early Imperial China, Hellenic Greece etcBillett 2014
• Novices engaged in work activities incrementally and progressively
• They learned by their own effort, indirectly guided by more experienced workers
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
Study of occupational learning in early Imperial China, Hellenic Greece etcBillett 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?
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
How do peoplelearn to do a job?Billett 2014
Mimesis
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?
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
“Mutual interdependence” Billett 2006
Learning environment
offers
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
“Mutual interdependence” Billett 2006
Learning environment
offers
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
“Mutual interdependence” Billett 2006
Learning environment
offers
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
“Mutual interdependence” Billett 2006
Learning environment
offers
(Authentic) patient care
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
GP supervision – the evidence
Expert clinician
Ensures patient safety Wearne
2012
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
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
GP supervision – the evidence
Expert clinician
Ensures patient safety Wearne
2012
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
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
GP supervision – the evidence
Expert clinician
Ensures patient safety Wearne
2012
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
Wearne2012
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
GP supervision – the evidence
Expert clinician
Ensures patient safety Wearne
2012
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
GP supervision – the evidence
Expert clinician
Ensures patient safety Wearne S
2012; inpreparation
Monitoring the person•Observing practice – particularly with junior learners
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
GP supervision – the evidence
Expert clinician
Ensures patient safety Wearne S
2012; inpreparation
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
GP supervision – the evidence
Expert clinician
Ensures patient safety Wearne S
2012; inpreparation
Monitoring learning•Encouraging supervisee to speak•Listening intently
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
GP supervision – the evidence
Expert clinician
Ensures patient safety Wearne S
2012; inpreparation
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
GP supervision – the evidence
Expert clinician
Ensures patient safety Wearne S
2012; inpreparation
Summarising•Putting learning into words•Planning future sessions
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
Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research
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