Table 5 Summary of the goals and processes of each educational role

Purpose

Demonstrate positive behaviours, such as

- Professionalism [55, 100, 108]

- Communication, collaboration and teamwork, management [55]

- Admitting to errors, lifelong learning, humanistic skills and the patient-physician relationship [55, 56, 63, 110])

Acquisition of standardized knowledge and skills, training for clinical competency [65,66,67,68,69,70,71], guided by formal teaching structure [66, 69]

Ensure trainees attain a minimum standard for safe practice with a focus on patient safety [93, 96, 98, 99, 104, 122, 123], good patient care [92, 93] and clinical conduct [93, 95, 99, 124]:

- Provision of effective training [92, 93, 96, 99, 104, 123] and monitoring,

- Personalized supervisor feedback [94, 99]

- Gradual independence of trainees [124] towards their professional growth and development [92, 93, 122]

Maximize the trainee’s potential in a highly specific skill [82, 84], involving complex objectives such as:

- Communication skills [75, 77,78,79, 87, 125]

- Psychological well-being skills [72, 73, 80, 81]

- Clinical skills [74, 82, 83, 85, 86, 88,89,90,91, 126]

- Use of evidence-based medicine [84]

- Self-regulated learning skills [127]

- Coaching pedagogy development skills [111]

Professional and personal development

Process

Role modelling by trainer (conscious/explicit or unconscious/accidental), pertinent to the role of a physician [55, 100, 107, 108]

1. Observation – Trainees observe the qualities and behaviour of role models [55, 100, 107, 108]

2. Reflection and judgement – Following observation, they make a judgement regarding whether the perceived behaviours are positive or negative [54, 59, 63, 100, 107, 108, 110, 128].

3. Emulation – The trainee then ‘imitates’ or ‘mimics’ actions deemed beneficial and suitable to his or he own role as a physician [53, 100, 109, 110, 112].

4. Experimentation – The trainee adopts an ‘iterative process’ to hone positive behaviour [64, 100, 110].

4. Assimilation by trainee – Trainees incorporate behaviour they have been exposed to shape their own unique identity [53, 55, 64, 100].

1. Initiation – time scheduling for lessons [67] and student selection [67, 68]

2. Preparation –Teaching resources [65, 105] and tutor/teacher training [65, 68]

3. Teaching – Experiential learning [65, 67, 69, 70, 106] and facilitated discussion and presentations [65, 70, 71, 106]

4. Feedback – Subjective tutor/teachers’ feedback for students [66, 67, 105], Objective student assessment [66, 70, 71] and Program Evaluation by student [65, 68, 69]

1. Initiation – usually assigned and mandatory

In most cases, supervision is initiated with the supervisor being assigned to oversee a particular junior doctor [96, 123, 129]. In some cases, supervision can be initiated by trainees and residents [129, 130].

2. Goal setting – Supervisors bear more responsibility in identifying needs of learners, with less emphasis on reflection by trainee compared to coaching as beginners need direction.

3. Observation/ Evaluation

The duration and nature of supervision varies across the various accounts given the lack formal frameworks in most programs [92, 98, 104, 123].

4. Feedback

The quality and efficacy of a supervisory relationship is assessed upon resident’s feedback [92], supervisor’s feedback [92, 95] and organizational evaluations [104].

Coaching tends to be voluntary, highly structured with targeted skills assessment and specific and individualized feedback [74,75,76,77, 79, 81,82,83,84,85,86,87,88,89,90,91, 111].

1. Initiation

2. Shared goals – either pre- determined by curriculum or by trainee

3. Observation

4. Individualized feedback and demonstration

Multisource feedback to complement the feedback from coaches and provide a wider insight of the trainees’ strengths and weaknesses, help develop specific goals and enhance strategies for improvement [79, 125].

5. Reflections

Four levels of reflections include cognitions (what came up into your mind?), emotions (what did you feel?), physical reaction (how did you feel?) and behaviour (observed verbal and non-verbal reaction) [75].

6. Practice

7. Repetition

To sustain the skills acquired, a critical part of coaching focuses upon ensuring that trainees monitor their practice, learn how to continue to improve and take responsibility for sustaining the gains made [85, 88]..

8. Improvement

9. Mastery

1. Initiation (assigned/matched)

2. Goal setting

3. Developmental process

4. Realignment

5. Friendship

Nature of process

- Formal and Informal

- Passive and active

- Conscious and unconscious

- Less intentional

- Professional goal specific

- Student-centric

- Formal, standardized

- Teacher-student dependent

- Supportive

- Evaluative

- Formal

- Supportive

- Evaluative

- Formal

- Supportive

- Evaluative

- Formal

- Intentional

Problems faced

While good teaching skills correlates well with positive role modelling, it does not always indicate efficacious role model status, which emphasizes on specific nature of role modelling [101, 107, 131].

1. Lack of intentional role modelling by trainers [53, 56, 58, 59, 62, 100, 107, 108], with good self-awareness

2. Ineffective training on role modelling to address incompatible personal traits of trainers and trainees [52, 58, 63]

3. Poor self-awareness of trainees [59, 64, 100, 107, 110], prone to emulating negative behaviours without careful judgement and reflection [59, 64, 100, 107, 110]

1. Poor program structure with inconsistent teaching guidelines [65], teaching qualities [69] and a lack of formal structure of tutoring [106]

2. Individualized learner’s needs are unmet due to inability to accommodate to variable student personality, knowledge and skills [65, 66, 68], and dissonance in teacher-student learning needs [70]

3. Inaccurate program evaluation

Self-rated outcomes and teaching rates are not predictive of students’ performance [67, 68]. There is a paucity of objective measure of learning behavioural competencies [68, 70].

1. Inaccurate program evaluation and poor program structure [93, 122] due to diverse perceptions of supervision practices [92, 98, 99, 104, 123, 130], inaccurate assessment of trainee’s needs and skills [93, 104, 122], lack of consistent, validated and objective outcome measures [92, 99, 104]

2. Lack of supervisor training with difficulty relating to the learners, and meeting their specific needs [92, 122].

3. Supervisor burnout with lack of protected time, interest, and presence of competing commitments [122].

4. Suboptimal learning environment [92, 99, 123, 129, 130] with lack of supervisory feedback [132], fear of supervisory judgement, or loss of autonomy over learning [95]

1. Unsupportive coaching environment with conflicting educational roles as a coach, teacher, guide, and evaluator, deterring trainees from being genuine with their concerns [90].

Role of Host Organization

1. Developing role modelling-specific faculty development programs [53, 55, 56, 62, 63, 107, 110, 115, 131]

2. Gathering feedback from trainees (such as through RoMAT questionnaire) to improve trainer’s status as role model [54, 128]

1. Developing structured and specific training program with established training process [96, 123, 129] to ensure oversight of clinical training [95].

1. Creating individualized safe environment to facilitate honest sharing [90] of weakness by matching with coaches of complementary characteristics with trainees [91] without any involvement in evaluating trainees [73].