Why should some trainees have difficulty completing their training to a satisfactory standard? After all, they have all been selected as being suitable for general practice.
There are many reasons why some trainees struggle during their training, but they broadly fall into two groups: those whose entry route into general practice has not equipped them with compatible skills, and those who develop problems along the way.
Identifying struggling trainees
Trainees experience difficulties for a variety of reasons.
They may have worked in another specialty and decided on a career change, or simply have difficulty adapting to the constant pressures that general practice can involve.
It is important to look for early warning signs of difficulty. These include poor time management, disorganisation, failure to engage with you or other staff, inadequate entries in the ePortfolio and failure to prepare adequately for training sessions.
These problems need to be tackled early in a constructive way. It may be that the trainee is simply having difficulty adjusting to the unfamiliarity of working in the community and the duties expected of them.
Difficulties with clinical work are what worry trainers the most. This can take the form of inadequate clinical knowledge, poor communication or consulting skills, lack of ability to reflect on the consultation process, dangerous prescribing and failure to make referrals or to take action on abnormal results. It is possible that trainees in difficulty will display multiple problem areas.
Ways to help
As GP trainers, our role is to identify ways in which we can help individual trainees. The following techniques can be used to deal with difficulties:
- Making a note of problems is invaluable, both as a record and as learning points for trainees to reflect on. I find the 'educator's notes' section in the ePortfolio particularly helpful as your notes can be shared easily with the trainee. However, if the problem escalates, you may need to keep an independent file.
- The 'competence' descriptors in the ePortfolio are useful in working out where the fundamental difficulties lie and identifying the trainee's learning needs. This can pave the way for educational intervention. For example, you may need to do more consultation analysis with very specific feedback or you may want to review the trainee's prescribing, perhaps with some help from the practice pharmacist.
- Once learning needs have been identified, it is helpful to recommend some extra reading or an online educational module.
- Organisational skills can be tackled in a specific task-based way. Frequent reviews with objective setting in all problem areas is key. It is vital to establish the fundamental skills and attitudes before worrying about exam preparation.
- All the practice staff have a part to play in GP training. You may wish to discuss problems with your partners and practice staff and ask them to encourage the trainee, while feeding any concerns back to you. Similarly, it is important that the trainee knows what each staff member does, can approach them for help and values their contribution in their training.
You also need to be aware of failure to progress in a trainee who has started off well. Personal problems or illness can happen to anyone and, for this reason, you should ensure your trainee is registered with a GP outside of the practice.
If they find it difficult to speak to you, perhaps one of your partners may help, and failing this, the BMA can offer advice.
While many international trainees will do very well in their trainee year, this group is statistically more likely to have problems. The problems usually originate from international trainees having little knowledge of colloquial language, customs, cultural norms or religious observance.
This can pose difficulties when making important decisions about patients' physical and mental health.
Similarly, many international trainees are used to a didactic, lecture-based teaching style, and our problem-orientated, patient-centred training can seem quite alien.
To help ease the pressure, it is important to get to know your trainee personally. Understanding their family, culture and background may help you find out what makes them tick.
Encourage them to watch British television and read a popular newspaper. Although their English should be good, a heavy accent might be difficult for patients to understand, and it is advisable to ask them to listen to themselves on tape.
Support for the trainer
If you feel you are in for a difficult year, you should discuss your concerns with your post-graduate director early on. It is also helpful to enlist the support of other trainers by meeting regularly to discuss concerns and share advice.
A practice swap for a week may be beneficial for both you and the trainee, as other trainers may see problem areas from a fresh perspective. This is important as you want to make sure you are being fair and accurate in your assessment.
The whole objective is to equip your trainee to pass their assessments and to enter independent practice, however, on rare occasions, you will have to accept that this may not be possible. Some trainees may need further training, and a few, despite your best efforts, may be best placed in another discipline.
- Dr Glenesk is a GP trainer in Aberdeen
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