Clinical supervision in general practice training: the interweaving of supervisor, trainee and patient entrustment with clinical oversight, patient safety and trainee learning

Abstract

Australian general practice trainees typically consult with patients from their first week of training, seeking in-consultation supervisory assistance only when not sufficiently confident to complete patient consultations independently. Trainee help-seeking plays a key role in supervisor oversight of trainee consultations. This study used focus groups and interviews with general practice supervisors to explore their approaches to trainee help-seeking and in-consultation supervision. Supervisor approaches are discussed under three themes: establishing a help-seeking culture; perceptions of in-consultation assistance required; and scripts for help provision. Within these themes, three interwoven entrustment processes were identified: supervisor entrustment; trainee self-entrustment; and ‘patient entrustment’ (patient confidence in the trainee’s clinical management). Entrustment appears to develop rapidly, holistically and informally in general practice training, partly in response to workflow pressure and time constraints. Typical supervisor scripts and etiquette for help-provision involve indirect, soft correction strategies to build trainee self-entrustment. These scripts appear to be difficult to adapt appropriately to under-performing trainees. Importantly, supervisor scripts also promote patient entrustment, increasing the likelihood of patients returning to the trainee and training practice for subsequent review, which is a major mechanism for ensuring patient safety in general practice. Theories of entrustment in general practice training must account for the interplay between supervisor, trainee and patient entrustment processes, and work-related constraints. Gaps between entrustment as espoused in theory, and entrustment as enacted, may suggest limitations of entrustment theory when extended to the general practice context, and/or room for improvement in the oversight of trainee consultations in general practice training. © 2020, Springer Nature B.V.

Keywords

Author Keywords

medical education Help-Seeking Clinical supervision Patient Safety entrustment General practice training Clinical oversight

Index Keywords

learning adult female human male medical education psychology Humans Internship and Residency Article interview qualitative research Australia education general practice Interviews as Topic medical school middle aged perception organization and management clinical supervision consultation patient safety organizational culture aged trust Faculty, Medical drug safety workflow

Author Affiliations

Primary Care Clinical Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

New South Wales Regional Health Partners, Newcastle, NS, Australia

Funding & Acknowledgements

Royal Australian College of General Practitioners, RACGP

This research project was supported by the Royal Australian College of General Practitioners with funding from the Australian Government under the Australian General Practice Training program. We also acknowledge the support of General Practice Training Queensland with recruitment and data collection.

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Clinical supervision in general practice training: the interweaving of supervisor, trainee and patient entrustment with clinical oversight, patient safety and trainee learning

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