title: How best to assist struggling trainees? Developing an evidence-based framework to guide support interventions.
abstract: OBJECTIVE
  To gather rich, qualitative data on typical types and causes of problems faced by specialty trainees who have completed their foundation training, from people with experience of assisting them, as well as the different methods used to support individuals facing those problems.
  
  
  METHODS
  We conducted interviews with 20 individuals with experience of assisting struggling GP trainees in the East Midlands Local Education and Training Board (12 GP trainers and eight employees of the Training Support Unit). Interviews were audio recorded and field notes were made. Content analysis was conducted on the field notes, and a framework was developed to summarise the data. This framework was checked for accuracy and comprehensiveness by 32 GP trainers who did not take part in the interviews.
  
  
  RESULTS
  Our analysis identified four general categories of difficulties faced by trainees: (a) clinical skills and knowledge; (b) performance in exams or assessments; (c) effectiveness of consultations; and (d) engagement in training. Each of these categories contained between one and four types of specific difficulties faced by trainees. Up to three current sources of support were identified for each category including support from trainers, support from coaching, and other interventions.
  
  
  CONCLUSIONS
  Key mechanisms identified for assisting struggling trainees all involve increasing trainees' awareness of gaps in their knowledge and ways of communicating. These included timely and accurate feedback delivered sensitively, potentially from multiple sources. Once GP specialty trainees are aware of their learning needs they can then engage with further support from the local education and training board (LETB) and external specialists. Therefore, LETBs should consider the support they are able to give trainers to facilitate their work with trainees in difficulty.
authors.affiliation: University of Cambridge and Work Psychology Group, 27 Brunel Parkway, Pride Park, Derbyshire DE24 8HR, UK. f.patterson@workpsychologygroup.com.
authors.forename: Fiona
authors.initials: F
authors.lastname: Patterson
authors.forename: Alec
authors.initials: A
authors.lastname: Knight
authors.forename: Fleur
authors.initials: F
authors.lastname: Stewart
authors.forename: Sheona
authors.initials: S
authors.lastname: MacLeod
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004521:Educational Measurement; D005246:Feedback; D005260:Female; D058006:General Practice / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007858:Learning; D008297:Male; D008875:Middle Aged