What and how do general practice trainees learn

Outline of this talk • “The fate of our times” • What do trainees

‘The fate of our times’ Frank 2013 That, which is particular to a given

‘The fate of our times’ NOUNS • Training • Competencies • Skills • Simulation

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

Context Faculty of Health Medicine & Life Sciences – Department of Educational Development and

Approaches to problems Schön 1983 • Technical rationality: Using the fruits to science to

The swampy lowlands of practice Schön 1983 • We have no satisfactory way of

How do people learn to do a job? Faculty of Health Medicine & Life

Study of occupational learning in early Imperial China, Hellenic Greece etc Billett 2014 •

How do people learn to do a job? Billett 2014 Mimesis Faculty of Health

“Mutual interdependence” Billett 2006 Learning environment offers Faculty of Health Medicine & Life Sciences

“Mutual interdependence” Billett 2006 Learning environment offers Learner receives and responds Faculty of Health

“Mutual interdependence” Billett 2006 Learning environment offers (Authentic) patient care Learner receives and responds

GP supervision – the evidence Organises Assesses registrar's learning needs Sumarises learning Expert clinician

GP supervision – the evidence Organises Assesses registrar's learning needs Sumarises learning Organising Expert

GP supervision – the evidence Promoting • Acting as a mirror • Providing resources

GP supervision – the evidence Monitoring the person • Observing practice – particularly with

GP supervision – the evidence Monitoring learning • Encouraging supervisee to speak • Listening

Summary • “The fate of our times” – (Over)simplification in order to regulate •

Slides: 41

Download presentation

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

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

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

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

Approaches to problems Schön 1983 • 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 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 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

How do people learn 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 etc Billett 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 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? Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

How do people learn to do a job? Billett 2014 Mimesis 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 Learner receives and responds Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

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

GP supervision – the evidence Organises Assesses registrar's learning needs Sumarises learning Expert clinician Monitors learning process Ensures patient safety Monitors registrar well-being Promotes learning Wearne 2012 Monitors learning Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

GP supervision – the evidence Organises Assesses registrar's learning needs Sumarises learning Organising Expert clinician patient • Setting the. Ensures scene safety • Negotiating and agreeing an agenda Monitors learning process Promotes learning Monitors registrar well-being Monitors learning Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

GP supervision – the evidence Organises Assesses registrar's learning needs Sumarises learning Expert clinician Ensures patient safety Assessing • Identifying gaps • Asking stimulating questions • Making it safe to admit mistakes Monitors learning process Monitors registrar well-being Promotes learning Monitors learning Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

GP supervision – the evidence Promoting • Acting as a mirror • Providing resources (and being one) • Giving feedback including praise • Role modelling Organises Assesses registrar's learning needs Sumarises learning Expert clinician Monitors learning process Ensures patient safety Monitors registrar well-being Promotes learning Wearne 2012 Monitors learning Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

GP supervision – the evidence Monitoring the person • Observing practice – particularly with junior learners Organises Assesses registrar's learning needs Sumarises learning Expert clinician Monitors learning process Ensures patient safety Monitors registrar well-being Promotes learning Wearne S 2012; in preparation Monitors learning Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

GP supervision – the evidence Organises Assesses registrar's learning needs Sumarises learning Expert clinician Monitors learning process Ensures patient safety Monitors registrar well-being Promotes learning Wearne S 2012; in preparation Monitors learning Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

GP supervision – the evidence Monitoring learning • Encouraging supervisee to speak • Listening intently Organises Assesses registrar's learning needs Sumarises learning Expert clinician Monitors learning process Ensures patient safety Monitors registrar well-being Promotes learning Wearne S 2012; in preparation Monitors learning Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

GP supervision – the evidence Organises Assesses registrar's learning needs Sumarises learning Expert clinician Monitors learning process Ensures patient safety Monitors registrar well-being Promotes learning Wearne S 2012; in preparation Monitors learning Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

GP supervision – the evidence Organises Assesses registrar's learning needs Sumarises learning Expert clinician Ensures patient Summarising safety • Putting learning into words • Planning future sessions Monitors learning process Promotes learning Monitors registrar well-being Wearne S 2012; in preparation Monitors learning 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

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