Managing expectations around in-practice teaching

One of the most common critiques of supervisors by GPT1/ PRRT1 registrars is that they are not getting their three hours of in-practice teaching.

In reality, when they are investigated, most practices actually are fulfilling their in-practice teaching, but like feedback, many registrars don’t recognise when it is being given.

Add to this a registrar’s reluctance, fear or incapacity to provide feedback to their supervisors and you have a recipe for a festering wound that left unchecked can bring the whole training term undone, a terminal employer-employee relationship and dissatisfaction for all concerned.

Here is a checklist of how to pre-empt this common issue and navigate it before it becomes an issue:

1) Make sure feedback and teaching are explicitly featured as a topic of discussion during your registrar’s orientation.

2) Ask your registrar how they like to give and receive feedback. Think setting, mechanism, language, timing and scenarios. Sometimes your registrar might find it difficult to articulate what they do want, so you can start with what they don’t want. You can instigate this conversation by sharing stories of what you experienced as you progressed throughout your career in terms of challenging feedback situations that weren’t handled appropriately to enable them and make them feel comfortable about sharing some of their own vulnerable feedback experiences. Understanding their triggers and what hasn’t worked for you and them, and why, will help you land on a strategy that works for you both.

3) Design together where, when and how that feedback will take place. How will you as their supervisor provide feedback in front of a patient when your registrar has suggested a course of action that is not appropriate?

4) Pull out a verbal signpost when you are giving feedback so your learner knows they are receiving feedback: “I am giving you feedback now.” For example, someone might say “Some of the staff have commented that your clothes set you apart from the rest of the doctors at this practice.” If that’s what the registrar was going for, then they may receive that as a compliment. If they don’t particularly like the way others dress, they may also identify that comment as invalid and not receive it as feedback.

5) Ask your registrar what teaching interventions work best for them. Like the feedback discussion, sometimes they may not be able to articulate what works for them and why, and or what works for them may not even be feasible within the context of your practice. You can again invite them then to articulate what has not worked or any negative learning experiences they remember, and why those methods stick out as being particularly negative for them. What the discussion will do is alert you to any triggers to try and avoid, and if they are unavoidable it also gives you an opportunity to explain why up front to help manage their expectations.

6) Design together where, when and how in-practice teaching will take place. Are you both happy?

7) Pull out a verbal signpost when your are teaching so your learner knows they are receiving in-practice teaching: “I am teaching you now.” Sometimes having a work-related discussion in the tea room at lunch isn’t recognised. We all need to help our registrars to recognise when feedback and teaching is being given.

8) Talk to your registrar about the variety of ways their in-practice teaching requirement will be fulfilled by you and the rest of the team.

9) Start with the RTO requirements. Some RTOs require that one of the three hours typically required for a GPT/ PRRT1 must be quarantined education time and the remaining two hours can be corridor consults, teaching on the run, lunchtime discussions, time with the practice nurse, practice manager, etc. Again you should start with your RTO’s explicit requirements of what the three hours must consist of. A really great RTO will provide a FAQ sheet for both the registrar and the practice on what must be done and what can be done to fulfill the requirement. And this FAQ can then be used during the registrar’s orientation to your practice to ensure both parties are on the same page with regard to their teaching and feedback needs and requirements.

10) Make it explicitly known that in-practice teaching may be clinical or non-clinical in nature and whom in the team is likely to be involved in the delivery of in-practice teaching.