Table 5 Trainee help-seeking: Illustrative quotations

Trainee objectives

1a. Managing workflow: Managing the transition to general practice

P1: Getting to know the ropes of the referral processes and pathology and the computer system as well. . .

P2: And just that whole world of community-based services was a bit overwhelming at first.. . where can I get almost like the best deal for patients. . . A lot of it is by word of mouth so talking to the supervisors and seeing what other patients have used. FG2

1b. Managing workflow: Keeping to time

P2: But, yeah, sometimes (waiting for the supervisor) can blow my consult out completely.

P1: Yeah. And then you’ve got issues around the patient waiting. . .

P2: In an ideal world if my supervisor was sitting doing nothing, then I would always get them in to look at the patient, yeah. FG4

2. Patient safety

P2: And you want to make sure that you are safe. And that you have shown that you have been safe by discussing with your supervisor about something that you – you are unsure about.

Q: Showing to the patient or to the supervisor or?

P2: I think to yourself. To the medical legal systems, to the patient and to your supervisor. What everyone wants to know is that you are safe in your practice as a registrar and that, if you are unsure, then you will talk to someone. FG3

3a. Managing relationships with patients

P2: I’ll say, ‘I don’t know, exactly, what’s going on here, but I think we could do this and I can talk to somebody more experienced- - - I’ll get you back and we’ll talk about it more’.

P1: Yeah, I found a similar thing. Just being able to just say straight up to patients ‘I’m not sure what’s happening, I’m not entirely sure what’s going on’. A lot of the time they actually seem oddly reassured by that [laughs]. .. and they seem to think, ‘oh, I’m getting a second consult’, um, you know, ‘I’m getting a lot of attention’, that’s why I find patients generally like it. FG5

3b. Managing relationships with supervisors

My situation’s very different this year and I don’t call for help much at all, and there’s lots of reasons for that. One of them is that I don’t have much of a relationship at all with my supervisor this year. .. they’re not the kind of person that really has much interest in teaching. FG1P2

4. Professional development

You kind of are wondering, “What are all these other GPs doing in their room?” You know what I mean? Is what I am doing the standard? And you can look up guidelines and stuff. But so much of what we do – there’s a lot of grey. And so getting a sense of what is a – you know what is – what are my colleagues doing? What is the expectation – both from a legal perspective but also just from a practical, what is the right thing to do, perspective. Um, and I think that is what we need to get a good sense of, in these two years that we do have supervisors available FG2P3

Trainee activities

1. Deferring assistance

P2: At first, I would want help here and now all the time. .. so that was (Term 1), I’m now coming to the end of (Term 2). .. I’ll go, ‘Okay. Well, I’m not exactly sure what’s going on but I know it’s not urgent, I’ve ruled out everything serious’. So, I’m going to go away, do a bit of a reading or I’m going to take this case at lunch time and discuss it. So that pattern’s changed. I mean I still ring them here and now, can you come and look at this, but not all the time. I’m confident. And again, I think it’s a confidence thing to say, well, I know this can definitely wait.

P1: Yeah, I find a very similar thing FG3

2a. Constructing help: Selecting a help-provider

You ask the person who you really trust who’s just going to give you a quick opinion and who’s always bloody right! FG5P4.

2b. Constructing help: Presenting the case

It depends on, on the person I am speaking to um, as to what their style is, how they like the registrar interaction to go and you get a feel for that as you work in the practice for longer. Um, but yeah usually everyone appreciates you being direct upfront about what you need. And then showing that you have given some thought to it beforehand P1FG2

3. Managing supervisor's response

I think it’s probably the GPs that have been GPs for many, many years, with patients that expect certain things, it’s hard for them to perhaps start to change their practice in a way that’s more in line with antibiotics stewardship. .. the necessity for antibiotics sometimes, you’ll take that really with a grain of salt, and see whether you’re reasonable in not prescribing and having a good return plan FG3P2

Outcomes of traineehelp-seeking

1. Scaffolding trainee clinical skills

P3: Yes, you’ve asked for their opinion but they’re just fleshing it out of you. . .

P1: And she’s, like, ‘And what else could it be?’.. . And then you, kind of, have had that chance to synthesise your thoughts and in – with basically, like, having a person in your brain going ‘yeah, yeah, you’re doing good, you’re doing good, you’re doing good, yeah, you got it’ FG4

2. Managing uncertainty

The thing that one of my supervisors said to me one day when I was asking her about someone. .. she was, like, ‘Well, is she going to die today?’ like, quite blunt and I was, like, ‘No, actually’.. . I could say to this woman, ‘Let’s give this a try and I’ll see you in a week to two weeks and we’ll follow it up’. .. coming to grips with that change in general practice which is that it is a lower acuity, stuff that you do over a longer period of time FG5P1

3. Feedback on trainee help-seeking

So I called up my boss and I said like, ‘Would you mind having a feel of her tummy and seeing what you think?’. .. (The supervisor) is like, ‘Well what – what do you think should happen?’ I’m like, ‘I think she should go to hospital.’ He said, ‘Well, that is what should happen I guess.’ In a way kind of saying, “Well, do I really need to see her?”. .. Like I realise that I should be trusting my instincts but in these two years I am here to learn and I am here to get a second opinion about things. .. from a community setting, I think it’s useful. And there was maybe just a little bit of pushback there about something that they felt was an obvious answer FG2P2