The tacit rules of the game in the GP trainee-trainer supervisory relationship: experienced educators describe GP supervision.

A key aspect of support in UK General Practice training is the trainee-trainer supervisory relationship. A small but significant number of trainees struggle in training, and relationship 'breakdown' can result. This study aims to better understand the nature of the supervisory interaction when a trainee faces difficulty. Using Bordin's 'Supervisory Working Alliance' and Egan's 'Skilled Helper Model' as a conceptual framework, four semi-structured interviews were undertaken with GP educators all experienced with trainees in difficulty, purposively sampled based on geography and gender. Interviews were transcribed verbatim, and content and coding analysis were undertaken to identify key themes. Trainee factors (insight, engagement, GP as 'best fit' career and difficulties in training) and trainer factors (failure to fail, tensions in role) were perceived as contributing to relationship breakdown. A lack of agreement in the goals and tasks of supervision was described when relationships broke down. Relating to Bordin's model, the trainee and trainer may hold differing expectations, particularly relating to the goals and tasks of supervision. Making expectations more explicit could be part of the solution to an improved supervisory working alliance. Further study on the influence of structure and agency is required to better understand the relationship in context.