Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
New South Wales Regional Health Partners, Newcastle, Australia.
BMC Fam Pract. 2020 Feb 7;21(1):28. doi: 10.1186/s12875-020-1084-7.
'Ad hoc' help-seeking by trainees from their supervisors during trainee consultations is important for patient safety, and trainee professional development. We explored trainee objectives and activities in seeking supervisor assistance, and trainee perceptions of the outcomes of this help-seeking (including the utility of supervisor responses).
Focus groups with Australian general practice trainees were undertaken. All data was audio-recorded and transcribed, coded using in-vivo and descriptive codes, and analysed by the constant comparison of provisional interpretations and themes with the data. Findings are reported under the over-arching categories of help-seeking objectives, activities and outcomes.
Early in their general practice placements trainees needed information about practice facilities, and the "complex maze" of local patient resources and referral preferences: some clinical presentations were also unfamiliar, and many trainees were unaccustomed to making patient management decisions. Subsequent help-seeking was often characterised informally as "having a chat" or "getting a second opinion" so as not to "miss anything" when trainees were "not 100% sure". Trainees emphasised the importance of being (and demonstrating that they were) clinically safe. Workflow constraints, and supervisory and doctor-patient relationships, had a powerful influence on trainee help-seeking activities. An etiquette for providing help in front of patients was described. Trainees assessed the credibility of supervisors based on their approach to risk and their clinical expertise in the relevant area. Several trainees reported reservations about their supervisor's advice on occasions.
A trainee's subsequent help-seeking is strongly influenced by how their supervisor responds when their help is sought. Trainees prefer to seek help from credible supervisors who respond promptly and maintain trainee 'face' in front of patients. Trainees learn through help-seeking to make their own clinical decisions but may remain uncertain about professional and societal expectations, and curious about how other general practitioners practise. Trainees value opportunities throughout their training to observe expert general practice.
在住院医师咨询期间，住院医师向其上级主管“临时”寻求帮助对患者安全和住院医师的专业发展非常重要。我们探讨了住院医师寻求上级主管协助的目标和活动，以及住院医师对这种寻求帮助的结果的看法（包括主管回应的效用）。
对澳大利亚全科医学住院医师进行焦点小组讨论。所有数据均进行录音和转录，使用现场和描述性代码进行编码，并通过对临时解释和主题与数据的不断比较进行分析。研究结果在寻求帮助的目的、活动和结果的总体类别下进行报告。
在全科医学实习的早期，住院医师需要了解实践设施的信息，以及当地患者资源和转诊偏好的“复杂迷宫”：一些临床表现也不熟悉，许多住院医师不习惯做出患者管理决策。随后的寻求帮助通常是非正式的，称为“聊天”或“寻求第二意见”，以便在住院医师“不确定”时“不遗漏任何东西”。住院医师强调保持临床安全的重要性。工作流程的限制，以及监督和医患关系，对住院医师的寻求帮助活动有很大的影响。描述了在患者面前提供帮助的礼仪。住院医师根据其对风险的态度和在相关领域的临床专业知识来评估主管的可信度。几位住院医师报告说，在某些情况下对其主管的建议有所保留。
当上级主管在寻求帮助时做出回应时，住院医师随后的寻求帮助会受到强烈影响。住院医师更喜欢寻求有能力的主管的帮助，这些主管能够迅速做出回应，并在患者面前维护住院医师的“面子”。通过寻求帮助，住院医师学会做出自己的临床决策，但可能对专业和社会期望仍然不确定，并且对其他全科医生的实践方式感到好奇。住院医师在整个培训过程中都重视有机会观察专家级的全科实践。
