July 2014

Tip:

Ask a departing Registrar to make notes for the forthcoming Registrar on “things I wish I’d known at the start of my job.”

Reason this may be useful:

Registrars may identify some things which would be really useful to know at the start of the placement, which the ES may not be aware of. Asking a departing Registrar to identify some useful tips helps them to focus on the needs of a new Registrar and can help them in considering the needs of colleagues when they move into independent practice. Such a list will also help the new Registrar settle into the practice more quickly. This list could be added to the Registrar welcome pack.

June 2014

Tip:

Focus on wider aspects of General Practice in the final months of training

Reason this may be useful:

After completing their final WPBA assessments and ESR the Registrar has completed formal assessments. Their mind is then freed to consider wider aspects of General Practice which are not necessarily related to formal competencies and assessments but which are useful in the real world. Discussing such things as practice agreements, accounts, curriculum vitae, interview technique, staff appointments, etc can be useful preparation for independent practice. Also, an informal practice swap may be useful to explore a different computer system; perhaps done as a half day reciprocal swap with another Registrar, so that each Registrar teaches each other about their computer, practice systems, etc.

May 2014

Tip:

Base tutorials around actual cases and scenarios rather than topics

Reason this may be useful:

If the registrar wishes to have a tutorial about a particular topic, ask her to prepare a short factual presentation for the start of the tutorial, perhaps based on formal guidelines or protocols. Then the ES can use the main part of the tutorial to explore cases and scenarios, and discuss how the guidelines can be used and modified in practice. It is not a good use of time for the ES to teach formal topics, but the ES can bring her practical experience to interpret topic guidelines in the real world.

April 2014

Tip:

Do some tutorials in different locations

Reason this may be useful:

Doing a tutorial whilst walking around the local area can be a useful way of discussing community facilities, for example sports centre, library, meeting places, factory, etc. The Registrar is more likely to remember these kinds of local facilities when she has seen them, been inside some of them, and possibly even experienced some of them, rather than just sitting in a consulting room talking about them. Sitting in the surgery garden, or on a seat outside the surgery, can aid memory association and encourage a relaxed learning environment.

March 2014

Tip:

Use the Educator Notes section to document advice and feedback

Reason this may be useful:

The Educator Notes section can be used for recording feedback and advice to the Registrar. The ES does not have to be concerned that the Registrar has a problem before using this section. However, if problems do actually occur later, then it is useful to have formally recorded any advice we have given at the earlier stage. The Educator Notes section can also be used by the ES to record ‘days in practice’ of an ST1 Registrar (as well as the Registrar herself writing a log entry after practice visits).

February 2014

Tip:

Spend some time getting to know and understand your Registrar as a person

Reason this may be useful:

Sometimes we can spend many months working with a Registrar and only discuss formal work related matters. By spending some time discussing the Registrar as a person we can get to know what they enjoy doing when they are away from work. This helps us to understand their personality, attitudes and values, which may explain some of their behaviours at work. If we start early to understand our Registrar as an individual person, we can modify how we relate to them at work, and provide them with a learning environment more suited to them as an individual.

January 2014

Tip:

Ask the Registrar what aspects of their work they would like feedback about.

Reason this may be useful:

Feedback is most effective when it is requested by the learner. If we give feedback when it is not wanted, it is unlikely to be helpful, and can sometimes lead to defensiveness. If we ask the Registrar what he would like us to comment about, he is receptive to our comments, and we can help him to learn the specific points he is interested in developing at that time. We must ensure the feedback is done in a supportive helpful way, and then it is likely that the Registrar will ask for further feedback in future.

December 2013

Tip:

When doing joint consultations, focus on a ‘skill of the day’.

Reason this may be useful:

Sometimes it is difficult to improve all aspects of consulting at the same time. If we focus on one specific skill then it is often easier to develop the skill quickly, and then choose another skill to develop. During a joint surgery, the ES and Registrar could jointly decide which skill to focus on that day, for example, the opening minute, explaining, verbal echo, etc. Firstly, we can discuss details of the skill; the ES can demonstrate the particular skill whilst the Registrar watches; if needed the Registrar can practise the skill with the ES; and then while consulting with patients while the ES watches. The Registrar can continue practising this skill in her own surgeries until she feels fluent, and then choose another skill.

October 2013

Tip: 

Help the Registrar to organise their PSQ and MSF early.

Reason this may be useful:

Organising the PSQ and MSF usually takes much longer than we imagine, as people are on holiday, or other events seem to take priority. By starting to plan early, we can help the Registrar ensure they get sufficient replies in good time, and they will avoid feeling the pressure of a last minute rush.

September 2013

Tip:

Start reviewing the Registrar’s e-portfolio early in their attachment.

Reason this may be useful:

Some Registrars do not write entries in their learning log at the beginning of their attachment, as they are busy settling in and learning many new things. However, these early experiences can provide many areas for discussion and reflection and can be a rich source of learning. Writing them in the e-portfolio can help to maximise this learning, and also maintain the required number of log entries as they go along, rather than leaving them until later when they can become a chore and less useful for learning. By reviewing and commenting on log entries early during the attachment, Educational Supervisors can encourage this learning, and make writing the entries a useful learning process. 

July 2013

Tip:

When planning induction for a new Registrar, consider doing a short quiz for the Registrar to complete, asking questions about some common practice procedures, staff roles and names, etc.

Reason this may be useful:

When a Registrar starts working in a GP surgery, it is helpful if they have some practice documentation to help them learn about their new working environment. For example, it is useful to have a list of staff names and roles, some basic practice procedures, some useful telephone numbers, etc. As well as providing information, a quiz encourages the Registrar to ask questions of receptionists, secretaries, and other colleagues, so that new colleagues get to know each other. A quiz can also be more fun and interesting than just reading lots of information.

May 2013

Tip:

During the last few months of a Registrar’s training, encourage them to be ‘first in line’ for short periods, eg during a partner’s holiday.

Reason this may be useful:

Once the Registrar has completed their formal assessments, and is coming towards the end of their training period, it is helpful for them to increase their workload towards that of a fully qualified GP. When a partner is on holiday, it can be a good opportunity for the Registrar to deal with all their paperwork, and miscellaneous queries. This will expose them not only to increased workload, but also to some unusual or even novel problems which they may not have seen whilst working as a Registrar. They still have the opportunity to discuss unusual problems with their supporting GP colleague, but by being first in line to deal with all problems, the Registrar has the opportunity of preparing for a real working role in a supportive environment.

April 2013

Tip:

When preparing questions for a CBD, choose a few competency domains only.

Reason this may be useful:

During a Case Based Discussion, it is more effective to choose 2, 3 or 4 competency domains and explore these in detail, rather than trying to cover many domains during one discussion. We can use a planning template, and design questions to probe deeply into the chosen competency domains, using the word pictures from the e-portfolio. By reading the word pictures first, and considering the particular case, we can design questions to probe whether the registrar demonstrated particular word picture competencies. For each CBD, we can choose a different set of competencies, so that over time we probe deeply into all of the competencies, but only doing a few during each individual CBD.

March 2013

Tip:

When giving feedback, use verbs rather than adjectives.

Reason this may be useful:

Feedback is most effective when we describe what we have seen and heard, ie we describe the behaviours that we have witnessed. If we use adjectives (e.g. good, bad, fantastic, lazy, etc) then we are making value judgements and the person will interpret this as criticising them as a person. If we describe the behaviours we have seen and heard, and compare these to the expected behaviours, then we can have a conversation about whether the person should continue with the current behaviours or how they might wish to change their behaviour. They are much more likely to accept a discussion about behaviour, than a comment about character traits, personality, or their core identity.

February 2013

Tip:

When assessing a consultation using the COT (Consultation Observation Tool), ask your Registrar to self-assess each area of consulting, and then compare with your own assessments.

Reason this may be useful:

Self-assessment is a good way of encouraging the Registrar to develop insight into their consulting style. If they have used a particular consulting technique which was effective, it can be useful for them to reflect on this, and say why and how it was effective. We can then point out additional areas where the Registrar demonstrated good consulting skills. If the Registrar notices areas that were not so effective, they can see why we might mark them as ‘needing further development’, and this may encourage them to discuss how they could develop their skills. By making independent assessments, then comparing and discussing, the Registrar is more involved in analysing their own consulting skills, and identifying areas they wish to develop.

January 2013

Tip:

Open more than one view when doing the ESR (Educational Supervisor’s Review)

Reason this may be useful:

When writing the review, it is often helpful to look at several areas in order to collate evidence when assessing each competence. Although it is possible to click back and forth using the navigation arrows, this can become confusing and tedious. We can open up several views of the e-portfolio by right-clicking one of the sections in the list on the left hand side of the screen. For example, right-click on ‘Learning Log’ and then select ‘Open link in new tab’. Then it is easy to click on the tabs to move back and forth between the particular competence that we are reviewing and the learning log. Similarly, we could right click on ‘Evidence’ to have a third tab available. By opening up several views, each with their own tab, it is easy to move back and forth throughout the e-portfolio, whilst maintaining our focus on the one specific competence that we are writing about at the time.

December 2012

Tip:

Take your Registrar with you on a visit to a local place of interest, for example local museum, heritage centre, library, Art Centre, etc.

Reason this may be useful:

Registrars are often living and working in an area which is new to them; they are frequently working hard, and studying in their spare time. Visiting a local place of interest can give them an insight into the local area, its history and culture, and they can see some of the local factors which affect the lives of their patients. It can also help Registrars to maintain or develop an interest outside of medicine. As well as helping them to demonstrate their ‘Community Orientation’ competency, this can also help Registrars to maintain a healthy work-life balance by thinking about aspects of life away from their work.

November 2012

Tip:

When doing joint consultations, arrange the seating so that the observing doctor has a clear view of the consulting doctor.

Reason this may be useful:

The purpose of a joint consultation is for the observing doctor to observe specific behaviours of the consulting doctor. If we arrange the seating in a suitable way, this enhances the ability of the observer to notice details about the consulting doctor. Because we are usually focused on observing the patient, it is common for the observing doctor to watch the patient, and not notice details of the consulting doctor's behaviour. Although the observing doctor may be behind the patient, and therefore not able to see details of the patient's body language etc, if the observer has a clear view of the consulting doctor then they are more able to focus on the doctor, and notice the details of the doctor’s eye contact, body language, gestures, etc.

October 2012

Tip:

Use the word "you" as part of most questions when having a Case Based Discussion (CBD).

Reason this may be useful:

Case based discussions are an opportunity to explore the thinking processes of the Registrar. By asking questions containing the word "you" or "your", the question will inevitably explore how the Registrar is thinking, rather than focusing on the patient. For example, "what management options did you consider?” focuses on the Registrar’s thinking in this particular case. If we ask questions such as "what are the treatment options for X?” we are asking about background theoretical knowledge rather than focusing on how the Registrar dealt with this particular patient. By including the word "you" (or equivalent) we encourage the Registrar to reflect on how they were thinking and feeling at the time of the consultation.

September 2012

Tip:

Invite your Registrar to make a 2 minute home movie using the practice video camera.

Reason this may be useful:

Registrars are often apprehensive about videoing themselves consulting with patients. Although part of the apprehension relates to watching themselves on screen, many registrars are also apprehensive about using the technology of the video camera, and worry they may become flustered about the technical aspects when they are also trying to consult. By making a brief home movie, the Registrar can become familiar with the video camera, and all the buttons, the tripod, zoom, remote control, etc in a relaxed environment without worrying about patients at the same time. They could also learn how to transfer the recording onto a computer, or learn how to connect to the television in order to view the finished product. The home video could be simply a video of a room or garden, as the content is irrelevant, but the important point is the process of understanding the camera, and then making and showing of a video.

Topical Tips for Training is collated by Damian Kenny using tips from various colleagues