title: GP trainers' experience of managing a trainee in difficulty: a qualitative study.
abstract: BACKGROUND
  There is increased awareness of the consequences of poor performance amongst healthcare professionals on patient care. Understanding the experiences and needs of GP trainers involved in the management of trainees in difficulty (TiDs) is important in ensuring a successful outcome for trainer, learner, and patient care. However, there is a paucity of empirical data in this area.
  
  
  OBJECTIVE
  The aim of this study was to explore the perceived responses of GP trainers involved in the management of TiDs. We also sought to explore the strategies that GP trainers used in managing these responses, and the support they accessed.
  
  
  METHODS
  Semi-structured interviews were conducted with a purposive sample of 11 GP trainers involved in educational supervision of a TiD in London.
  
  
  METHODS
  Semi-structured face-to-face interviews were undertaken. These were recorded, and transcribed verbatim. Data were handled using NVivo. Thematic analysis was undertaken by a team of clinical educators.
  
  
  RESULTS
  GP trainers managing TiDs expressed significant anxiety as a result of concerns about patient safety, frustration at the lack of progress made by TiDs, and being seen as a failing trainer. GP trainers described the impact that TiDs had on themselves, their patients, practices, and on the trainer-trainee relationship as well as the strategies they used to manage these impacts. GP trainers used well-honed skills for identifying their own emotions, reflection and support (from peers and trainers' workshops) to manage these emotions, and steer the trainer-trainee relationship in a constructive direction.
  
  
  CONCLUSIONS
  This study is one of the first to explore the impact on GP trainers of managing a TiD. It highlights the challenges faced and strategies used by GP trainers in helping TiDs. The use of experiential and peer-learning strategies is an important part of the approach for GP trainers in supporting TiDs as well as managing their own emotions. Providers of medical education need to ensure that trainers are adequately supported in managing such trainees.
authors.affiliation: Watling Medical Centre, Watling Medical Centre, 108 Watling Avenue, London HA8 0NR, UK. peemac30@hotmail.com.
authors.forename: Paula
authors.initials: P
authors.lastname: McLaren
authors.forename: Anita
authors.initials: A
authors.lastname: Patel
authors.forename: Penny
authors.initials: P
authors.lastname: Trafford
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Ahluwalia
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005180:Faculty, Medical; D058005:General Practitioners / Q000193:education*; D006801:Humans; D008611:Mentors / Q000523:psychology*; D036301:Qualitative Research