EV GP Training, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
MCCC GP Training, Monash University, Clayton, Victoria, Australia.
Med Educ. 2018 Feb;52(2):192-205. doi: 10.1111/medu.13468. Epub 2017 Oct 16.
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.
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.
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.
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.
寻求帮助的监督会面为准备独立实践的学员提供了重要的学习经验。尽管有大量关于监督会面应该如何进行的专家意见和理论，但支持的经验数据有限。对于高级全科医生（GP）学员来说尤其如此。如果不知道这些会议期间发生了什么，我们就无法知道如何最大限度地发挥它们的教育潜力。本研究旨在了解高级 GP 学员在照顾患者时向其主管求助时会发生什么情况，以及当这种情况发生时如何增强学习效果。
这是对五对全科医生监督对的多案例研究数据的分析，每对都有一名全科医生注册医师和他们的主管。数据是 45 次监督会议、78 次会议后反思和 6 次访谈的记录。我们使用了 Wenger 的实践社区理论和修辞体裁理论作为分析视角。
监督会议遵循一致的格式，符合体裁的形式。在这种体裁内，确定了三种占主导地位的交互模式，我们将其标记为“管理为”、“管理通过”和“管理与”。每种模式都提供了不同的机会，并利用了不同的技能。主要议程始终是为患者制定计划。教育议程包括获取知识、发展技能和实现独立。其他议程包括控制、可信度和关系建设问题。主管和学员都可以在监督参与中具有目的性。
为了让主管和学员充分发挥监督会面的教育潜力，他们需要具备灵活性。这取决于对监督会面体裁、正在发挥作用的议程、他们在参与中的选择以及利用这些选择的技能的理解。教育者可以帮助主管和学员获得这种理解和技能。我们建议对监督会面的体裁进行进一步研究。
