Medical Education - Research Publications
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ItemAd hoc supervisor encounters between GP-supervisors and GP-registrars: Enhancing quality and effectiveness(Southern GP Training, 2014-02-28)This report focuses on what happens during ad hoc encounters between GP-supervisors and GP-registrars. These encounters typically result from a registrar’s immediate learning and practice needs that arise during a consultation with patient and require a timely and appropriate response from the supervisor. These ad hoc encounters are understood as an important means for how registrars learn to be general practitioners, but are under-researched. The research design was an exploratory multiple-case study using qualitative methods. The core research participants were five pairs of GP-supervisors and GP-registrars who captured what happened during these ad hoc encounters using real-time audio recordings. The data set, which included interviews, were analysed using framework and template analysis. The Findings are presented as five descriptive case studies of the supervisor-registrar pairs that illuminate the ‘real work’ of supervision. The aim was to ‘paint a picture’ of each case, prior to an explanatory understanding of ad hoc supervision. Each case provides a contextual description, giving information about the practice, the registrar and supervisor, and their perceptions of the supervisory relationship. This is followed by a presentation of themes that were identified in the data, which go some way to describing the ‘what’ and ‘how’ of the respective ad hoc encounters. The Findings conclude with a cursory cross-case synthesis of significant themes from the five cases. Improving the quality of registrar supervision is likely to arise from understanding the real work of supervising; using methods that capture what supervisors are actually doing. This innovate study creates a compelling rationale for having a look at what actually happens during the ad hoc supervision of GP-registrars.
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ItemUsing organisational role theory and job analysis to identify and define the roles of an effective Australian general practice supervisor(TAYLOR & FRANCIS INC, 2022-07-04)General practice (GP) supervisors - the key resource for training the future GP workforce - are often described as 'occupying a role' or enacting a series of roles. However, as much of the discourse uses a lay understanding of role, or merely hints at theory, a significant body of theoretical literature is underutilised. We reasoned that a more rigorous application of role theory might provide a conceptually clearer account of the GP-supervisor's job. To this end, we describe the use of organisational role theory and job analysis to identify and define the roles of the Australian GP-supervisor. Our search of the academic literature identified 64 role titles, which we condensed to an initial iteration of core roles, using inclusion and exclusion criteria. We analysed GP training organisations' documents to map embedded supervisory tasks against our list of roles to verify their presence, review our role titles and definitions, and look for additional roles that we may have missed. We used subject matter experts iteratively, to authenticate a final list of ten roles and their accompanying definitions, which can be used to support Australian GP-supervisors to perform effectively. We encourage those who support GP-supervisors in other countries and those who educate other health professionals in primary care settings to review the roles to judge whether they are transferable to their contexts.
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ItemAd hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation(SPRINGER, 2016-05)General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.
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ItemTaking GP Supervisor Professional Development to Teaching Practices: A Guidebook for Medical Educators(MCCC GP Training, 2022-01-31)Clinical supervisors engage in ongoing professional development to continuously improve as educators. Yet, in the general practice context, questions have been raised about the effectiveness of the dominant mode of professional development – ‘short programs’ – typically delivered in face-to-face workshops. Concerns include the perennial transfer of training problem, inappropriate content, little impact on ‘hard to crack’ issues, and attendance difficulties for employees in small practices. As a potential resolution of these weaknesses, we designed a professional development intervention that is delivered in teaching practices. This medical educator-facilitated intervention is based on a generic quality improvement cycle, where the quality improvement actions to be taken are designed in response to a ‘problem’ identified by the primary supervisor, supervisory team, or practice. Underpinned by ‘collaborative inquiry’ a medical educator guides participants through the quality improvement cycle and supports participants to inquire productively into their practices. This guidebook is written for those medical educators who wish to support general practice supervisors to inquire into their practices and improve the teaching and learning environments where they work.
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Item"Underdiscussed, underused and underreported": pilot work in team-based qualitative research(EMERALD GROUP PUBLISHING LTD, 2016)Purpose The authors, with disparate organisational affiliations and in different geographic locations, worked together on a qualitative multiple-case study of ad hoc supervisory encounters between general practice (GP) supervisors and GP-registrars. The purpose of this paper is to share our experiences and learning to highlight how valuable pilot work can be when conducting team-based qualitative research. Design/methodology/approach This paper outlines the value of pilot work in consolidating whole team understanding of the research plan, using our experiences as an example. We first offer a synthesis of published literature relating to pilot work, especially in qualitative research approaches. Next, we outline and justify the pilot work undertaken for the ad hoc supervision study. Lastly, we use each researcher’s voice to describe our experiences and then share the lessons we learned undertaking pilot work in qualitative research. Findings We found that while pilot work can be useful in refining strategies, data collection processes and analytic instruments. There are further benefits in galvanising whole team understanding of the research plan, in encouraging reflexivity, in ensuring transparency of the research process, and for ethical considerations. Originality/value There are few published papers or books which offer researchers guidance regarding pilot work, especially within a qualitative paradigm. Our experience shows there is value in planning and conducting pilot work. We believe others may benefit from our experience as they embark on team-based research.
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ItemVideo-triggered professional learning for general practice trainers: using the 'cauldron of practice' to explore teaching and learning(TAYLOR & FRANCIS INC, 2020-03-03)Many clinicians who take on a formal role of supervising or teaching trainees need to be taught how to teach and then continuously improve as educators. We describe the research-informed design of a novel professional development intervention that may be perceived by clinical educators as challenging, but being based on the key features of effective professional development is likely to lead to changes in their teaching practices. The video-club brings together a small group of clinical educators who have a shared interest in exploring their educator role and their teaching practices. It supports their learning through collective inquiry, using video-recordings of their authentic teaching practices as stimuli for discussion. A pilot has produced findings that are promising in terms of outcomes and impact. Participants responded to the educational design in the way that was envisioned and engaged with the requisite risk-taking and vulnerability that was necessary for their own learning and promoting learning for others.
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ItemThe supervisory encounter and the senior GP trainee: managing for, through and with(WILEY, 2018-02)OBJECTIVE: Help-seeking supervisory encounters provide important learning experiences for trainees preparing for independent practice. Although there is a body of expert opinion and theories on how supervisor encounters should happen, supporting empirical data are limited. This is particularly true for the senior general practice (GP) trainee. Without knowing what happens during these encounters, we cannot know how to maximise their educational potential. This study aimed to understand what happens when senior GP trainees call on their supervisor when caring for patients and how learning can be enhanced when this occurs. METHODS: This is an analysis of data from a multi-case study of five GP supervisory pairs, each with a GP registrar and their supervisor. The data are recordings of 45 supervisory encounters, 78 post-encounter reflections and six interviews. We used Wenger's communities of practice theory and rhetorical genre theory as analytical lenses. RESULTS: The supervisory encounters followed a consistent format, which fitted the form of a genre. Within this genre, three dominant interactional patterns were identified, which we labelled 'managing for', 'managing through' and 'managing with'. Each pattern presented different opportunities and drew on different skills. The primary agenda was always developing a plan for the patient. Education agendas included acquiring knowledge, developing skills and achieving independence. Other agendas were issues of control, credibility and relationship building. Both supervisor and trainee could be purposeful in their supervisory engagement. CONCLUSIONS: For supervisors and trainees to achieve the educational potential of their supervisory encounters they require flexibility. This depends on understanding the genre of the supervisory encounter, the agendas at play, the options they have in engaging and having the skills to utilise these options. Educators can facilitate supervisors and trainees in acquiring this understanding and these skills. We recommend further research into the genre of the supervisory encounter.
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ItemEvaluation of a mobile learning platform for clinical supervision(University of Melbourne, 2021)Context: This report details a formative evaluation of the Clinical Supervision Online (CSO) course, a fee-paying, fully online ‘light touch’ program of study for clinical supervisors offered by the Melbourne Medical School, which was developed in conjunction with the University’s Mobile Learning Unit. The course requires between six to ten hours of self-directed study and is designed for any clinicians who teach. Methods: Evaluation of the course was guided by Rossi, Lipsey and Freeman’s (2004) approach to program evaluation, addressing the need for the course, its design, implementation, impact, and return on investment. Data were collected through interviews with key informants, document analysis, an embedded student survey, learning analytics data, financial data, and an audit against ‘best practice’ standards for online course design. Findings: The findings suggest that course development was driven by both a financial imperative and genuine concern to meet training needs of clinical supervisors. Two hundred and four students enrolled on the course in its first 18 months. This has been enough to cover its developmental costs. In relation to 64 quality standards for online course design, the level of performance was rated as ‘meets’ for 44 items; ‘exceeds’ for one item; ‘developing for 13 items’; and, ‘non-existent’ for six items. An additional 33 items were identified as ‘not applicable’ for the ‘light touch’ course design. Significance: From a learning design perspective there is much to like about the CSO course and the outcome of assessing it against the standards for ‘best practice’ online course design suggests that an evolutionary approach - making incremental changes - could improve the course whilst retaining its existing ‘light touch’ format. The CSO course on its own is unlikely to realise the depth of achievement implied in the course aims and learning outcomes. The CSO course may best be seen as an entrée into the art of clinical supervision.