College of Medical and Dental Sciences, Medical School, University of Birmingham, Birmingham, UK.
School of Education, University of Birmingham, Birmingham, UK.
Educ Prim Care. 2022 Jan;33(1):13-31. doi: 10.1080/14739879.2021.1888661. Epub 2021 Sep 6.
The supervisory relationship is a key source of support for postgraduate GP trainees in the United Kingdom. This article focuses on the institutional influences on GP supervision through an analysis of training documentation.
Training documents were identified through a search of key sources of institutional influence: General Medical Council, Royal College of General Practitioners, Health Education West Midlands and a local university's supervisor-training material. Searches were run from September 2016 until February 2019, and 60 documents identified. Content analysis was undertaken, and documents were considered based on audience, context, language and purpose.
Institutional expectations regarding the functions of trainees and supervisors were identified, and supervisory relationships appeared entangled within the broader contexts of the training practice, wider profession and political events. Collation of evidence, quality assurance and patient safety were prominent messages within the documents. The institutional hierarchy was accentuated through these messages, and through processes for trainees to raise concerns. Moving down this hierarchy, messages from within the profession changed in emphasis and content.
With patient safety paramount, and high-quality training and supervision expected, the hierarchical system outlined by the documents is perhaps unsurprising. However, unintended messages may result: collation of evidence may be prized above quality and trainees may feel unable to raise legitimate concerns. Furthermore, conflicting messages from different institutions illustrate the tensions and complexities of GP supervision. For trainees and supervisors, these inconsistencies could lead to different perspectives and expectations as they interact within the supervisory relationship.
督导关系是英国研究生家庭医生培训的主要支持来源。本文通过分析培训文件，重点研究了督导关系的制度影响。
通过搜索主要的制度影响来源，确定培训文件：英国医学总会、皇家全科医师学院、西米德兰兹健康教育署和当地大学的导师培训材料。搜索于 2016 年 9 月至 2019 年 2 月进行，共确定了 60 份文件。采用内容分析法，根据受众、背景、语言和目的对文件进行了考虑。
确定了培训生和导师的职能的制度期望，督导关系似乎交织在培训实践、更广泛的专业和政治事件的更广泛背景中。文件中的突出信息是证据的整理、质量保证和患者安全。通过这些信息和学员提出关切的流程，突出了机构层次结构。在这个层次结构中，来自专业内部的信息在重点和内容上发生了变化。
由于患者安全至上，以及对高质量培训和监督的期望，文件中概述的层级系统或许并不令人惊讶。然而，可能会产生意想不到的信息：证据的整理可能比质量更受重视，学员可能觉得无法提出合理的担忧。此外，来自不同机构的相互矛盾的信息说明了家庭医生监督的紧张和复杂性。对于学员和导师来说，这些不一致可能导致他们在督导关系中互动时产生不同的观点和期望。
