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Trainees in difficulty

Trainees in difficulty are those who are not making sufficient progress in training or who are experiencing difficulties with certain elements of training. Trainees enter the workplace following years of intensive, formal education. A report commissioned by the GMC (Illing et al., 2008) shows that new graduates report feelings of un-preparedness for practice, of uncertainty about the roles and responsibilities they carry, and they may have very limited experience of hands-on care. In contrast, most doctors’ postgraduate learning is in the workplace, happening alongside service commitments and arising opportunistically. It is valuable to emphasise the point, since failure to progress educationally as a doctor is usually likely to relate to a failure in learning within the workplace.

Swanwick (2005) describes the role of the trainer as that of ‘structuring experiences, rather than transmitting knowledge’, which underlines the importance of the experiences themselves as the vehicle for learning, rather than the knowledge of the trainer. In ‘structuring experiences’ in this way, the educational supervisor not only makes learning opportunities in the workplace explicit, but also has the ability to modify the learning culture within the workplace.

Trainees in difficulty may need help in identifying the learning opportunities that arise in the workplace, and encouragement to value and seize the opportunities for learning they offer. Such trainees (particularly those who are felt to lack insight) may have reduced access to certain types of work as trainers have concerns about quality of care and so do not delegate certain aspects of work activity to them. Limiting trainees’ learning opportunities may compound the difficulties the trainees are experiencing. Supervisors can help by identifying ways of enabling learning, making learning opportunities explicit, and using briefing and debriefing to help the trainee appreciate the value of these opportunities. Trainees in difficulty need more experience rather than less, if they are to make progress. As a supervisor, your role in ‘safety netting’ becomes increasingly important. The module on Facilitating learning in the workplace provides additional guidance on how to make the most of workplace-based learning experiences.

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