Table 5 Summary of results: Themes, contradictions and suggestions for solution regarding the outpatient clinic

Introduction

•Records, referrals, patient lists, work-schedule, secretary help, booking system

•Lack of introduction

•Management decisions

Checklist for introduction period Upgrading introduction

‘Vision paper’

Preparation

•Lack of time

•Expectations

•Use of spare time (work-life-balance)

•Specialist training in a 37 h work-week

No solution found for extra time for preparation

‘Vision paper’

Pre-supervision session

•Lack of preparation

•Lack of participation

•Meeting time – different

•Taking time from something else (conference, formal teaching)

Full presence at 8 A.M.

ALL residents and supervisor participate, EVERY time

Structure

•Subspecialty or individual split

•Continuity vs. diversity in patients

•Specialist vs. broad skills

•Interruption of colleagues

•Production versus training

•Patient expectation of specialist treatment

Subspecialist structure continuous

Umbrella outpatient clinic

Extra time in between supervising specialist’s own patients

“Open door policy”

Resources

•Increased numbers of clinics

•Increased number of patients

•Staffing of other functions/tasks (e.g. rounds)

•Disengaging consultant for supervision

•Illness among staff creates vulnerability

•Lack of time – used on documentation and IT

Consultant responsible for medical education as scheduler and work planner

Follow-up on patients

•Brief employments/positions

•Availability of specialists/supervisors

•Responsibility for continuous patient care

•Medical specialist commitment is rewarded with “boomerang”/”rebound”

•Increased paperwork

•Failure to complete/discharge patients due to lack of decision support

‘Vision paper’ set out expectations of residents

Subspecialist available for feedback on progress