title: How do experienced GP trainers decide which of their trainees need to be referred to a more senior educator in the East Midlands Healthcare Workforce Deanery?
abstract: OBJECTIVE
  To identify experienced trainers' reasons for considering and/or discussing concerns about GP trainees with their local Training Programme Director (TPD).
  
  
  METHODS
  Interviews were carried out with fourteen trainers across Leicestershire and Northamptonshire who volunteered to assist in response to an email request sent out to trainers in these areas; twelve of these had more than five years' training experience. Grounded Theory Method (GTM), with a semi-structured interview process as suggested by Corbin and Strauss, was used to analyse the transcripts.
  
  
  RESULTS
  Experienced trainers find it difficult to explain their decision-making in keeping with the Dreyfus Expertise Model; they use their willingness to choose the doctor as their personal doctor, predating the UK Government's 'Friends and Family Test', as well as their experience in consulting and referring patients as concepts which help the decision. For less-experienced trainers, the Milton Keynes Traffic Light System was identified as a tool that might help decision-making.
  
  
  CONCLUSIONS
  Experienced trainers recognised underperformance and possible underlying causes. The triggers for discussion with TPDs were viewing the trainee either as someone 'they would not like to be their family doctor' or as 'a patient whose problem needed referral to a specialist'. This was done at an 'expert' level. It was sometimes difficult for the trainers to define the processes they used. Less-experienced trainers found that a tool such as the Milton Keynes Traffic Light System was a useful aid.
authors.affiliation: a Health Education East Midlands , GP Directorate, 1 Mere Way Ruddington Fields Business Park Ruddington, Nottingham , NG11 6JS.
authors.forename: Bevis
authors.initials: B
authors.lastname: Heap
mesh_terms: D002983:Clinical Competence; D003657:Decision Making; D004503:Education, Medical, Graduate / Q000379:methods*; D005180:Faculty, Medical / Q000523:psychology*; D058005:General Practitioners / Q000193:education*; D066296:Grounded Theory; D006801:Humans; D007407:Interviews as Topic; D010820:Physicians
keywords: GP trainee; GP tutors; Vocational training; educational supervision; professionalism