Supporting trainees in challenging learning environments - is there a way?

The working and learning environment within the NHS is challenging. 46% of GPs report emotional exhaustion, and trainees experience burn-out with higher prevalence than expected. Attending Balint groups (BGs) has been suggested to prevent burnout and compassion fatigue, helping GPs to thrive in their jobs. For this pilot service evaluation of BGs for GP trainees we used qualitative research methodology including surveys, participant observation, and semi-structured interviews. Fonagy's concept of resilience was used as the theoretical frame of reference. The data-led analysis identified trainees having burn-out sensations: un-met expectations for their training; their need for more support and the value of attending the BGs. Trainees experienced BG as a safe place, allowing open discussions and honest accounts of anxieties, facilitating clinical learning and learning skills of reflection as an important supplement to normal training. The theory-led analysis showed that BG sessions taught trainees new approaches to improve elements that are assessed as key in the selection process for GP training and as Fonagy described as characteristic for people with resilience. As a result of this project, a number of trainees expressed interest in continuing Balint group work. Trainees were recruited to an ongoing monthly BG, within the GP training scheme. However, due to budget restraints, difficulties with new interest and failing to find a non-training GP facilitator in the local area, the group has floundered.

Understanding the fundamental elements of global health: Using the sen capability approach as the theoretical framework for a health needs assessment in deprived communities.

Background: The health needs in poor communities are often dictated by data that is not relevant to the community. The capabilities approach (CA) offers a philosophical and practical way to frame and analyse data and apply it to a community using the World Health Organisation socioeconomic framework. This was part of the NHS Health Education England East Midlands Global Health Exchange Fellow Programme. Methods: A team of 2 Kenyan and 2 UK community clinicians worked together in deprived communities in Kenya and the UK using qualitative research methods to facilitate the communities to define and prioritise their health needs and to explore their potential resources and how they might achieve their needs sustainably. The CA was used in the data collection and data analysis phases. Results: The team of fellows gained personal understanding of the reality of the impact of social determinants on health experiences and outcomes. The CA offers the health systems and services a way to engage hard to reach communities with issues that they know to be important and are then able to prioritise. Clinicians who are taught in the evidence based style need to reframe their understanding of community needs if they are to be effective in their work. Working in this way can challenge their own values and beliefs. With planned support this can be a powerful developmental process and the CA is a set of principles that can be used to facilitate the empowerment of communities, the service planners and providers.