A mixed-methods study of the experience of GP educational supervisors

Competing time demands

Significant distress was expressed about the toll on training time by increasing clinical demands:

’The workload is squeezing out the time and energy left for GP training.’ (GP 89)

Lack of available backfill exacerbates this problem:

’There are adequate [educational] opportunities but finding cover in practice to attend these has been challenging.’ (GP 96)

In addition, the training workload has increased:

’It is currently vast and increasing.’ (GP 32)

Only 6% of responders agreed that the training grant funds sufficient time. Personal time is used by the majority of responders to satisfy training demands. Less than half (49%) of the responders agreed they had enough time for clinical supervision in the working day. A third of trainers reported support of trainees suffers:

’... Little time in the job to provide pastoral care or document issues.’ (GP 70)

There were worries about patient safety and medico-legal risk:

’This is becoming an issue in balancing patient safety/access to facilitating training.’ (GP 13)

’Higher concern around litigation and complaints means the support we need to give trainees has risen.’ (GP 43)

A few responders were coping:

’Currently the workload is manageable, but I am lucky I have a sturdy practice setup.’ (GP 55)

Some trainers used the wider practice team to help:

’Patients that can be seen by allied health professionals…. will free up time to supervise/train STs.’ (GP 6)

Fears for the future were expressed:

’We are struggling, however, to persuade younger colleagues to take on trainer role so might not be able to continue.’ (GP 12)

Supplementary Figure S2 shows the quantitative data that demonstrated how the majority of ESs have insufficient protected time and how many find the role to be emotionally draining, and yet the work of training remains satisfying.

There are many calls for improved funding. Assistance with time planning was also suggested, including notice of events:

’It would be great to get a calendar of events that are happening over a 12-month period.’ (GP 48)

’[Providing] a better idea for practices on the amount of time needed by the ES to complete all the necessary requirements for a trainee.’ (GP 23)

Trainees have more variable needs

There are more trainees than before and their needs are more variable, with a sense that:

’Baseline medical knowledge is not as high for many new trainees as in the past.’ (GP 43)

Trainee attitudes can be problematic:

’Some trainee’s perception that they are entirely supernumerary is very difficult.’ (GP 35)

‘GP registrars are often at stage of life [family/caring roles/new citizens of Scotland] where the pathway through training is more complicated.’ (GP 8)

Trainees experiencing difficulties and international medical graduates require more training investment and have additional needs:

‘Trainees with additional needs are becoming more common.’ (GP 11)

The majority of trainers knew how to access help, but find trainees with additional needs challenging:

’If you have any issues with a trainee this can become intolerably time-consuming and can impact the trainer emotionally.’ (GP 9)

Unhappiness existed about the competence of a minority of trainees who commence GP training:

’These trainees are not of the standard foundation training gives UK graduates and it feels like starting with a medical student.’ (GP 24)

ESs perceived it to be largely their responsibility to get doctors through training:

’There is far too big an emphasis on trying to get poor and failing trainees to pass through rather than failing them.’ (GP 38)

Three years of training may be insufficient for some international medical graduates:

’Often trainees who have never worked in NHS until 1st GPST1 post struggle take longer to complete training.’ (GP 28)

’Sometimes if the culture is very different, either they are not receptive to pastoral support or I am not able to give it.’ (GP 63)

Yet Supplementary Figure S3, which described the quantitative data in this area, demonstrated that the majority of ESs have confidence in their ability to attend to the pastoral and additional development needs of their trainees.

Suggestions included better ’vetting’ of GP trainees, advance notice of trainees with additional needs, and extra support tailored to the requirements of the trainee. That could be financial:

’With high predictor of selection scoring and outcomes the training grant should be tiered to reflect this.’ (GP 43)

But it could also be more deanery support:

’More open dialogue and info about trainees in difficulty would be good.’ (GP 43)

’Periodic "check ins" perhaps.’ (GP 10)

There were suggestions for trainee allocation;

’Consider the allocation system where the best trainees can choose leafy suburb practices.’ (GP 53)

for induction;

‘I think common induction for GPST1s… would be helpful.’ (GP 18)

and for early human resources support:

’[Human resources] needs to be better. We had a trainee who had very little support when arrived in country in terms of accommodation, etc.’ (GP 24)

Assessment requirements

ESs found:

’[The] ePortfolio is a huge drain on [the] trainer.’ (GP 35)

Many responders claimed:

’ePortfolio is exclusively done at home in my own time.’ (GP 7)

Many comments noted the rising volume of assessments over the last few years. Also frequent changes in assessment requirements have been a source of stress:

’I find it very difficult to keep up with the constant changes in the requirements for trainees, this is emotionally draining and decreases job satisfaction!’ (GP 107)

’A lot of it seems difficult for the trainee to understand how to complete.’ (GP 63)

Assessment responsibilities may be crowding out important aspects of training:

’Getting through all this can become the focus for trainee and trainer rather than just learning to do the job well.’ (GP 66)

Some ESs feel the tension between their role as mentor and assessor:

’Can be difficult to be brutally honest with trainee.’ (GP 43)

Many questioned the value of assessments:

‘I feel the ePortfolio is a series of jumping through ineffectual hoops for the trainee.’ (GP 94)

Improvement with new technology is noted:

‘ESRs [educational supervisor reviews] are much easier to do on 14fish [a new IT platform] than on old system.’ (GP 114)

Not all responders were unhappy:

’ePortfolio is a very rigid tool but combined with skills of an ES is a reasonable assessment tool.’ (GP 59)

There were calls to:

’Reduce ePortfolio requirements for supervisors.’ (GP 17)

However, the quantitative data (shown in Supplementary Figure S4) suggest that most trainers were coping with the ePortfolio.

Support of trainers

Trainers used strategies to self support, such as experience in the role:

’... is a bit like passing a driving test. There is still a lot of learning on the job.’ (GP 113)

Another used transferable skills:

’Feel being a GP is useful in developing skills to provide support to trainees.’ (GP 30)

Half of trainers found the work to be emotionally draining:

’We are burning out and the difficulty in fitting in training to a high standard is becoming increasingly challenging.’ (GP 56)

In contrast, the quantitative data in Supplementary Figure S5 suggest that most ESs feels adequately prepared for their training role, although less than half of them can find protected time for their own professional development.

There were mixed feelings about practice colleagues, some positive and others less positive:

’I am lucky to work with colleagues who are interested and supportive of GP training.’ (GP 2)

’Non-trainers see training activities as skiving often.’ (GP 7)

Peer support, from trainer’s groups was valued, shown strongly in the quantitative data, Supplementary Figure S5.

Support from training programme directors was universally praised:

‘We have very active, visible, approachable and fair-minded [training programme directors]; would be happy to seek advice.’ (GP 8)

However, appreciation of deanery support was less consistent:

’Deanery good at identifying issues, not so good at solving.’ (GP 24)

Opinions varied on the Trainer’s Conference:

’The regional conference is well organised and it is good to meet and network with trainers outside my local area.’ (GP 2)

’The Trainers Conference would be improved by more interactive small group work and less lectures.’ (GP 49)

Recent restrictions in venues for development sessions, due to cost saving, was an issue for ESs.

Specific support suggestions called for:

’Provision of a pool of tutorial resources.’ (GP 58)

’IT skills and organisational tips for GP trainers.’(GP 48)

Better notice of events and more exam guidance was requested, in particular, advice on the ePortfolio and managing a difficult trainee:

’[The induction course should include the] nuts and bolts of training.’ (GP 24)

Online resources should have a well designed webpage with easy access to:

’Details on [for example] BLS rules, child protection requirements, details of what is needed for ESR.’ (GP 45)

’Induction suggestions, trainee visit policy, data protection policy.’ (GP 105)

’Shared guidance/policies relevant to re-accrediting practices.’ (GP 104)

More webinars and podcasts were welcomed.