<p>Supervision of New Trainers – an introduction</p><p>The traditional process of trainer development is being improved to ensure that new trainers have a range of teaching skills and confidence in their abilities at the outset of training rather than learning to teach “on the job” with the first few registrars. We are building in supervised teaching experience prior to appointment and linking this with the new, expanded and improved introductory seminars.</p><p>An additional challenge is that, as you may be aware, we are charged with a rapid expansion of the training workforce to facilitate the government’s desire to rapidly expand the GP workforce. We feel it is vital that quality is not lost in the drive for quantity.</p><p>Priority is to be given to the development of trainers in areas currently considered “under- doctored”.</p><p>In the emerging scheme of development we envisage that intending trainers will be allocated an educational supervisor when, or soon after, their application is received. The supervisor will provide educational support for approximately six months prior to appointment and allocation of a registrar, continuing for a variable period after appointment depending on the trainer’s needs.</p><p>A trainer development scheme similar to this has been in place in the Northern region for some time and is described on the attached document, a reprint of a paper in Medical Teacher.</p><p>The following information is drawn from the Northern scheme.</p><p>Function of Supervisory Trainers</p><p>To increase CONFIDENCE in intending trainers by providing:</p><p> successful teaching experience; positive feedback; time and encouragement for reflection</p><p>Characteristics of Supervisory Trainers</p><p>They should: 1. usually have a minimum of 5 years experience as a trainer; 2. display willingness and enthusiasm to teach; 3. be willing to have their own training practices analysed; 4. be able to provide time for supervisory training; A nominal tutorial between intending trainer and GPR should last between 1 and 2 hours. Spoken feedback from the supervisory trainer to the intending trainer will last between a half and one-and-a-half hours. This includes written feedback to the intending trainer, which may be best written after there has been time for reflection. There may be an opportunity for teaching to take place in the intending trainer’s practice. Video-taping teaching/feedback sessions may be helpful, though there is a lack of a formal method of analysis of the videos apart from Pendleton’s rules. Some intending trainers review these videos in private. There are advantages and disadvantages to both recorded and “sitting in” teaching sessions. 5. have feedback skills; 6. be willing to challenge; 7. allow modelling; 8. recognise the development from knowledge to skills; 9. become involved in a two-way learning process.</p><p>The following checklist was produced a few years ago by a group of mentors in discussion with Dr Adrian Dunbar. The nMRCGP headings have been added to the list more recently. In addition are a few really useful links.</p><p>Identification of new trainer’s learning needs</p><p> o Planning learning o Teaching on the consultation o Topic tutorials o Random Case Analysis o Teaching on problem cases o Teaching audit and project work o Giving feedback o nMRCGP curriculum o Workplace Based Assessment o e-Portfolio, Educational Supervision and ARCP panels</p><p>Administration and Organisation of training</p><p>Managing change in the practice to facilitate learning The training culture The training library IT resources Paperwork for training Attendance at VTS half day release meetings Attendance at Trainer’s workshops</p><p>Internet Resources http://www.bradfordvts.co.uk/EDUCATORS/intendingtrainers.htm Dr Ramesh Mehay’s excellent Bradford VTS website: The Intending Trainers section. http://www.gp-training.net/training/gptrainer/index.htm Dr Brad Cheek’s excellent website: An educational resource for GPs, GP trainers and doctors in specialty training for general practice. http://www.yorksandhumberdeanery.nhs.uk/general_practice/educators_trainers/intendin g_trainers.aspx The Intending Trainers’ section of the Yorkshire and the Humber Deanery website. FAQs</p><p>What are the different routes to training?</p><p>Currently over 90% of prospective trainers take the IS seminar route but the Deanery is encouraging people to view the Leeds Post Graduate Certificate in Education for Primary Care as the preferred route. Other routes include the Hull and York Medical School - Certificate in Medical Education due to start December 09 and the De Montfort Course/Certificate for New and Intending Trainers in Leicester. There no longer appears to be a minimum number of years in practice required and salaried doctors and partners may both become trainers.</p><p>What does mentoring involve?</p><p>The above checklist forms a basic curriculum for mentoring. Different prospective trainers will need to spend time on some or all of these areas dependent on their own learning needs. The sessions could be recorded using the teaching and training section of the appraisal toolkit or by keeping a contemporaneous record in any format. Records should be kept since the Deanery will request feedback from the Mentor ahead of the prospective trainer attending their Interview. Mentors thought it would be of great value attending such interview panels in order to gain experience of what is expected of a prospective trainer. There was thought to be no reason why a mentor could not run some joint sessions in a small group situation when looking at videos for example but that individuals would also need individual sessions.</p><p>Who organises things?</p><p>Prospective trainers applying to the Deanery should be directed to their local Training Programme Directors (TPD) for an Informal Visit to be arranged. It seems sensible that a prospective trainer is encouraged to think of an experienced trainer, outside of their own practice, who they could approach themselves to act as a mentor. If this is possible then the TPD needs to be informed and may pass details of the mentoring scheme to both parties: if not the TPD will circulate a request for volunteers from amongst local trainers. A mentor should be identified as soon as possible to support the prospective trainer along their chosen pathway and into training with their first GPStR.</p><p>What paperwork is involved?</p><p>When claiming their fee from the Deanery the expectation is that both parties should be able to agree that the checklist has been covered to the satisfaction of the prospective trainer and a claim is made for sessions on a pro rata basis as described above. The mentor should be in a position to report to the Deanery request for information on the basis that they “know of no reason why the prospective trainer should not go forward to interview at this time”. If they have concerns they should be detailed and provided to the Deanery.</p><p>Tell me about the Introductory Seminars again…</p><p>Prospective trainers apply to Leanne Sorby at the Deanery. They will go through Introductory Seminar on Consultation Skills (ISCS) then onto IS1 focusing on Teaching Methods and then, after an interval of 4 to 8 months, on to IS2 where they will look to put the theory into practice. Dr Jon Chadwick has produced material as “homework” between IS1 and IS2. In many ways it mirrors the checklist above with the focus on teaching and assessments. *** copy of Jon’s work here***</p><p>Tell me about the Leeds Certificate route again…</p><p>Further detail on the course may be provided by contacting either Angela Hemingway [email protected] or Dr Kirsty Baldwin [email protected] There is funding available for all intending trainers and for current trainers, though the latter group will need to contact their local APD for approval. This funding is of some £1,600 for each of the certificate, diploma and masters stages. Money is available to fund the course but not for backfill. The time commitment includes 16 days in a year at the University as well as time for personal study. Any credits gained for a module or stage remains valid for 7 years. Thus the modules and stages could be spread over time but with the consequent decrease in continuity likely to affect the learning to be gained. </p><p>The “Gap” as regards preparation for WPBA and use of the e-Portfolio etc may be met through prospective trainers attending the relevant sessions at the Deanery Spring and Autumn schools but that mentors should expect to provide additional support for these nMRCGP areas with this group of prospective trainers in particular.</p><p>What of the other routes?</p><p>The York and Hull certificate gets off the ground in December 09 and the de Montfort option continues for now. Both are directed solely at GPs and thus have more of a focus over the Leeds course which is available to practice managers and nurses for example. There is also the future prospect of a course directed at the newly appointed trainer.</p><p>Focusing on Feedback Skills</p><p>A useful mnemonic to help when giving feedback is the ABCDE approach:</p><p> Approach: Sensitive to the person and their learning agenda</p><p> Balance: Of positives and negatives as per Pendleton. Credits before Withdrawals to avoid an “Emotional Overdraft”</p><p> Change: Facilitation of change through response to cues and sufficient challenge to identify their problem and, through skill rehearsal, to work on their solution.</p><p> Description: Feedback based on fact and not on opinion throughout.</p><p> Exact: Feedback focusing on specific areas throughout. Feedback on Setting the Scene- state the rules of the game including confidentiality and support from facilitator and group</p><p>Describe feelings and thoughts-how did it go?</p><p>Describes what went well, prompting if needed, positive feedback on specific skills demonstrated.</p><p>Agree the main challenges, what do they want help with? Prompting if needed (blind spots) </p><p>Facilitators Active Listening Skills and Response to Cues</p><p>Helping doctor work on their suggested solutions</p><p>Offer specific solutions from self or group- specific practical alternatives if needed</p><p>Rehearsal of suggested solutions from doctor</p><p>DON’T:  forget the receiver’s emotional response  criticise without recommending  comment on personal attributes (that can’t be changed)  generalize </p>