Table 2 Ten clusters with names, definitions and sample statements for each

1

Organisation and conditions of work – relating to the tension between providing service in busy environments and needing time to reflect and learn

Barrier: Clinical areas are too busy and this acts as a barrier to residents’ learning.

2

Time to learn with senior doctors during patient care - relating to the way that residents learn from work alongside senior doctors as they follow the patient pathway

Barrier: Time pressure at work has meant that the mentorship/apprenticeship role is lost and residents no longer have the time/opportunity to discuss a case in-depth with a Senior Doctor.

3

Management and facilities - relating to the way in which hospital management values and facilitates training and the provision of facilities to support training at hospital sites

Barrier: A lack of commitment by hospital management teams to training. Management support for the training element of the workplace is inadequate - seen as very secondary to workload.

4

Workplace culture - referring to the way in which learning and residents are valued in the workplace

Facilitator: Culture of the clinical site values residents, listens to their views and takes appropriate action in response.

5

Trainer (Senior doctor) skill and support - referring to who does the training and how they are supported

Barrier: There is an unwillingness to accept that education and training programmes can be delivered by people other than full time attendings.

6

Interaction and feedback in clinical teams- relating to team dynamics including the provision of feedback to the resident while working together

Facilitator: Residents learn best when they are challenged to state what they should do with regard to patient management and are affirmed and supported in their choices.

7

Content, assessment and continuity of training - relating to learning and assessment rooted in clinical practice with effective communication between senior doctors about performance

Barrier: Poor communication between supervisors for different clinical placements.

8

Motivation and morale- relating to morale within the healthcare system and its impact on the motivation and attitude of learners and other staff

Barrier: Low morale amongst all staff as they are over worked and leading to stress and tense staff.

9

Resident support - referring to reception of the doctor-in-training into team, collegiality, respect and support to work within scope of practice and to challenge constructively.

Facilitator: The resident is encouraged to work within his/her scope of practice to safely develop skills under supervision.

10

The role of patients in doctors’ learning - referring to patient expectations of care, willingness and provision of feedback

Facilitator: Patients more informed in relation to care provision and willing to challenge those delivering care.