Surgery (Austin & Northern Health) - Research Publications

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    Ad hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation
    Clement, T ; Brown, J ; Morrison, J ; Nestel, D (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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    "Underdiscussed, underused and underreported": pilot work in team-based qualitative research
    Morrison, J ; Clement, T ; Nestel, D ; Brown, J (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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    The supervisory encounter and the senior GP trainee: managing for, through and with
    Brown, J ; Nestel, D ; Clement, T ; Goldszmidt, M (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.