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Informal learning techniques

Informal Supervision techniques

P. Shah

Traditional apprentice Modern apprentice

Traditional apprentice Modern apprentice

Traditional apprentice Modern apprentice

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Aims of study

Understand nature of informal learning

within postgraduate training.

Describe practices that support ‘service

based’ learning.

Describe factors associated with positive supervisory experiences.

Describe factors that commonly influence learning experiences.

Case Study

Participants

Specialist trainees

Clinical Supervisors

Setting

Clinical hospital environment

NW Deanery

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Methods: Data Collection

Observation •External

perspective

•Systems view

•2 observers

Audiodiary • Trainee & trainer

perspective

• Contemporaneous

• Interventional

Group

Discussion •Clinical Groups

•Exploring

emergent themes

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Data Set

50 hours of observation field work across 7

hospitals in variety of clinical settings.

20 Trainee audio-diaries

5 Consultant audio diaries

4 Clinical group discussions

Quality Learning in

practice

Sharing tacit

knowledge Express clinical

reasoning

Team exchange

Open culture

Supported

autonomous practice

Informal practices supporting

learning

Quality Learning in

practice

Sharing tacit

knowledge Express clinical

reasoning

Team exchange

Open culture

Supported practice

‘I find it, in terms of learning, if I’ve done

90% of the work, er, I feel I get a lot more

er, out of a discussion with, with a more

experienced er, rheumatologist.’ ‘The review with the consultant didn’t

add very much beyond what I had

already set in motion but it was

nonetheless reassuring to see that

there wasn’t anything that I’d missed

and the management plan wasn’t

changed so that was a good outcome’.

Quality Learning in

practice

Sharing tacit

knowledge Express clinical

reasoning

Team exchange

Open culture

Supported

autonomous practice

‘This morning we added in a

couple of things to the plan after

discussion between the team.

The open nature of these ward

rounds is very helpful with a free

sharing of ideas.’ (ST4, AD)

‘I feel like I can ask anything here

and I can question things. It wasn’t

the same at my last hospital (ST5

AD)’

Quality Learning in

practice

Sharing tacit

knowledge Express clinical

reasoning

Team exchange

Open culture

Supported

Autonomous practice

‘I had to put a CVP line in. The intensive

care registrar there told me some fine

and nifty little manners in which to

maintain sterility , which made the

insertion much easier. .. These little

tweaks and techniques I've learnt now

I'm definitely going to try and use in my

practice and teach my house officer‘

(ST3, AD)

Quality Learning in

practice

Sharing tacit

knowledge Express clinical

reasoning

Team exchange

Open culture

Supported practice

‘Yeah, well, actually the letters that

are a transcription of the thought

processes, as opposed to simply the

results, the conclusion; this is my final

report, they’re the best. When you

get an insider glimpse into the

gastroenterologist’s mind, for example.

Erm.’ (ST5, FG)

Quality Learning in

practice

Sharing tacit

knowledge Express clinical

reasoning

Team exchange

Open culture

Supported practice

' I found it very useful going through the

differential (diagnosis) with the consultant as it

gave me an opportunity of understanding his

thinking pattern which is how I feel I best learn,

that is to say, understanding how other people

think and adapting that into my thinking strategy

if I feel appropriate.’

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How to make your trainee

like you...

Touch base daily. Short, regular

‘nudges’ in the right direction.

Acknowledge efforts and make

reassuring comments.

Guide and suggest. Share your tacit

knowledge and uncertainties.

Articulate clinical reasoning in

correspondence and conversations.

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How to ensure your trainee

feels part of the team

Maintain an open, questioning culture

within team.

Utilise walks between wards for

questions and team chat.

Make clear your expectations, team

rules and expose your hidden

curriculum early.

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How to ensure trainees gets the

most out of your job..

Encourage a mixed workload and

variety.

Dull work can be made into a learning

encounter by a single discussion.

Encourage use of on line resources

between patient encounters.

Encourage follow up of cases- virtually

or real.

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Summary

In the right environment, trainees make

no distinctions between service and

training.

Quality of learning parallels the level of

interaction/communication with CS and

team.