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Table 1 Summary of findings

From: The development of clinical thinking in trainee physicians: the educator perspective

Themes Actions Methods Quotes
An educationally minded culture Regular discussion of physicians in training Discuss physicians in training at departmental meetings. Have other frequent discussions between senior educators in the team. ‘Once a week, at our consultant or our senior meeting, we do a formal, we call it a trainee run-through. We discuss each trainee in turn...’ (P3)
All team members are responsible for education Listen to feedback about physicians in training from other members of the multidisciplinary team, for example senior nurses. Have an expectation that these team members can contribute to physicians in trainings’ education. ‘…we’ve got nurse practitioners so they get some information and guidance from them.’ (P5)
‘…there’s always actually quite a lot of people more senior around, not only doctors but nurses as well.’ (P10)
Patient safety Education and patient safety are seen as co-dependent. Physicians in training can be supported for longer period if required. ‘…we are aware that we have to be good sessional supervisors for the patient’s safety.’ (P4)
Proximity of educator to physicians in training Working side by side Working within the same space as the physician in training. Frequent formal and non-formal interactions fostering a rapport and sense of collegiality. Safe learning environment. First name terms. ‘…often we’ll be working by their side, looking after the patient as a team and we’ll be learning off each other.’ (P1)
‘Very much it’s first names to the physicians in training and consultants.’ (P2)
‘It’s almost like family.’ (P3)
Observation Allowing the physician in training to witness clerking and interactions between educator and patient. ‘I will role-model…so that the next time they might have done that process before they come and speak to me.’ (P11)
Verbalisation of educator thought processes Thinking about decision making aloud. Educator being open about their own fallibility and often themselves needing to seek further advice or information. ‘…do it aloud [decision making], weighing up the pros and cons…you’re teaching the junior doctor…’ (P12)
Verbalisation of the physician in trainings’ thought processes Ask physicians in training to verbalise their thought processes. Ask for the physician’s in training opinion. ‘…when they come and speak to me about a patient, I ask them to verbalise what their thinking is and then, [ask] okay, so what could it be if it’s not that?’ (P9)
Trajectory of the physicians in training The beginning/Induction Well-structured induction. Physician in training meets all team members. Role, responsibilities and expectations clear to physician in training. Close supervisor contact during this period. ‘during induction we ensure they understood…what’s expected of them in their role, how to access senior help, in hours and out of hours, who to go if they’re having difficulties, in or out of work…there’s several layers to the induction.’ (P4)
Further On/Learning Arc Multiple informal assessments. Allow more autonomy as physician in training gains experience and confidence. Allow more autonomy as you start to trust the physician in training. Accept mistakes will happen. ‘Gradually we encourage them, we sort of say, ‘No, you’re getting it right’…you can [have] more autonomy in the decision-making process…’ (P11)
Individually Tailored Experience Allow physicians in training more freedom in areas of experience. Give physicians in training support in areas of weakness. Maintain close supervision for longer if necessary. ‘…for the trainee who’s struggling, making sure they’re a bit better supported….that’s the trainee you keep on your ward round…you let one of the other trainee go off and be a bit more independent.’ (P13)