Flags for seeking help: making supervisor expectations of general practice trainee help-seeking explicit.

Timely supervisor input into patient care plays a key role in ensuring the safety of patients under the care of general practice trainees. Current models of clinical supervision for trainees in both hospital and general practice training have, however, been criticised for placing too much onus on the trainee to request assistance, despite the many known barriers for trainees to do so. An important barrier to general practice trainee help-seeking is trainee uncertainty about when and how their clinical supervisor expects them to seek this assistance. We introduce a tool, 'Flags for Seeking Help', which was modified from an existing checklist, to assist supervisors to tailor their input to the care of their trainee's patients. The tool aims to make supervisor expectations of trainees explicit, including when trainees should request assistance during consultations (rather than defer this until more convenient opportunities) and when this assistance should be face-to-face (rather than by phone or messaging systems). Our aim is to reduce the barriers for trainees to request in-consultation and face-to-face supervision, in particular, when it is indicated. We outline the evidence which informed the development of the tool, and present some preliminary findings from a pilot in Australian general practice training.

Getting good help: a guide for reflection, debriefing and feedback conversations about in-consultation supervision.

Timely supervisor input to the care of their trainees' patients plays a key role in ensuring the safety of patients under the care of general practice trainees. Supervisor responses to trainee calls for assistance are also important for trainee learning and professional identity formation. The in-consultation supervisory encounter in general practice training is, however, a complex social space with multiple trainee, supervisor and patient agendas. Trainee requests for assistance during their consultations are known to present general practitioner supervisors with a number of challenges. From the trainee's perspective, a safe learning environment is essential during these supervisory interactions. A number of factors may act as barriers to, or reduce the usefulness of, in-consultation assistance in particular, resulting in trainees being less likely to seek such assistance on future occasions. It is therefore important to improve both trainee and supervisor skills in safe, effective and efficient in-consultation supervision. Making time for trainee and supervisor conversations about their help-seeking and help provision may uncover opportunities for improving skills, aligning agendas and enhancing outcomes. Finding time for debriefing, reflection and effective feedback conversations may be challenging, however, and opportunities for trainees to provide feedback to their supervisors are known to be particularly limited. We introduce a Debriefing, Reflection and Feedback Guide which is designed to prompt reflection, and structure effective and efficient debriefing and reciprocal feedback conversations. We outline the evidence which informed the development of the Guides, and present some preliminary findings from a pilot in Australian general practice training.

Good help: a model for providing in-consultation supervision of general practice trainees.

Timely clinical supervision of trainee consultations plays a key role in ensuring the safety of patients under the care of general practice trainees, and in trainee learning and professional development. Trainee requests for assistance during their consultations present supervisors with a number of challenges, however, and a number of factors act as barriers to, or reduce the utility of, this in-consultation assistance from the trainee's perspective. Face-to-face supervision in the presence of the patient presents particular challenges and opportunities. It is important to address barriers to trainee help-seeking and improve both trainee and supervisor skills in promoting safe, effective and efficient in-consultation supervision. We introduce a model (ß-LACTAM) to assist supervisors in planning and delivering their face-to-face in-consultation supervision. The recent evidence which informed the development of this model is outlined, and some preliminary findings from a pilot of ß-LACTAM in Australian general practice training are presented.