Workplace culture and environment

A workplace culture and environment can have significant impacts on the ongoing professional development of both trainees and supervisors. The​y are factors that contribute to a trainee's ability to learn:

• balance of service commitment and learning
• leadership support
• physical environment
• recognition of their contribution to the workplace

Creating the right conditions for learning can be challenging, but it is an important aspect of a supervisor's role. Effective learning environments allow trainees to:

• be open to receiving and giving regular, constructive feedback
• feel confident to ask for assistance to address learning needs
• be involved as a valued member of the team
• feel safe and supported to be honest about their learning needs

Establish good working relationships

There are practical strategies supervisors can use to establish good working relationships with their trainees.

Provide an orientation – introduce your trainee to the team and physical space at the start of the rotation.

Set clear roles and responsibilities – ensure there is clear communication regarding the roles and responsibilities of everyone in the team.

Set goals and expectations – organise a time to meet your trainee early in the rotation and set mutually agreeable learning goals and objectives. Planning provides structure and context that can help orientate trainees to the practical and cultural aspects of the training site.

Promote collaboration – identify opportunities to work together. Be inclusive and encourage contributions from each team member, regardless of their level of knowledge or experience, as learning from each other is a powerful tool.

Provide emotional safety – promote a safe and supportive culture that is free from intimidation, discrimination, bullying and harassment. Encourage open communication and show mutual respect. An open dialogue allows trainees to be honest about their learning needs and helps build good working relationships.

Be an active role model – role modelling is integral to the process of developing trainee expertise and formation of professional identity. A supervisor’s attitude and behaviour can indirectly influence learning. Trainees seek role models who they can learn from and aspire to become. ​Positive role models are generally:

• optimistic, enthusiastic and compassionate
• reflective and analyse their own performance
• engaged in personal and professional development activities
• respectful to colleagues, patients and their families
• actively involved in improving workplace culture and values.

​Promot​e appropriate work-life balance – a good work-life balance means you have harmony between different aspects of your life, where benefits gained from each area can support and strengthen the others.

Bullying and harassment

The culture of discrimination, bullying and harassment in medical education, and its negative impact on trainee health and wellbeing, is well documented.

The learning environment needs to be free from fear and unnecessary anxiety. Trainees should learn from role models in a positive and friendly atmosphere. Supervisors should also empower trainees to look out for their peers and ​act.

While supervisors may not have direct control of the working environment, they play an important role in promoting a safe and supportive culture that is free from intimidation, discrimination, bullying and harassment.

All health professionals have a responsibility to take early corrective action to deal with bullying and any offensive, humiliating or intimidating behaviour.

Health and wellbeing

Many in the medical profession find joy and meaning in their work but there can also be significant difficulties associated with a medical life. These can include decreased autonomy, and increased professional responsibility and dysfunction in the workplace due to a complex and often changing health care system.

Long hours, shift work, continual exposure to disease, trauma, suffering and death – and associated compassion fatigue are other associated risks.²

Improving physician wellness will better enable us to meet the healthcare needs of our population by providing higher quality care for patients and populations, and reduce error.

Healthy doctors practise better and more safely, leading to better medical practice.

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² Riley G. (2004) Understanding the stresses and strains of being a doctor. MJA; 181(7):350-3.

Whether a trainee is joining you for a few days or starting a month(s) long rotation, you will both benefit from the opportunity to discuss and clarify roles and expectations. This will influence the trainees' motivation and engagement, and help them to feel safe and supported.

Orientation checklist

There are three components of an effective orientation:

• orienting the supervisor to the trainee
• orienting the trainee to the supervisor
• orienting the trainee to the learning environment

The supervisor should outline:

• what the expectations of the trainee and the rotation are
• when/how formal observations and assessment will occur including work-based learning and assessment tools, and reports
• how performance and progression will be monitored
• when/how feedback will be provided
• their availability and best contact method
• the learning opportunities available

Information the trainee should provide:

• level of training and experience
• prior learning experiences and rotations including key strengths and areas to improve on
• previous supervisor reports
• learning goals and objectives for the rotation
• Learning Needs Analysis/learning contract
• training program requirements and curriculum

Orienting the trainee to the environment:

• roles and responsibilities, primary focus and goals of the unit
• team introductions including nursing staff, administrative staff and other trainees
• facilities – locker, washroom, kitchen
• protocols, policies and guidelines, for example, the procedure for ordering and following up tests, investigations and consults, or issue escalation
• support mechanisms available, for example, the Employer Assistance Program

When planning for learning:

• set the expectations of what should be achieved during a rotation
• planned learning helps motivate trainees
• SMART goals ensure learning goals are clearly written and achievable

Planning for learning ensures that the time available for learning is optimised throughout the rotation/training period. Having a plan also ensures:

• teaching and learning is tailored to the individual learning needs of the trainee
• expectations of the supervisory relationship are clear at the outset and commitment to learning is secured
• the trainee’s motivation to learn and improve is increased
• activities are planned to reach the identified goal(s)

SMART goals

Trainees are more likely to achieve their learning goals when they are SMART – Specific, Measurable, Attainable, Realistic and Time-limited. Example of SMART learning goal:

• Analyse two articles about the positive and negative effects of combining Glipizide and Metformin to increase knowledge of the management diabetes in an out-patient setting and present to my supervisor at the July meeting.
• Develop and show collaboration and team work skills with my multi-disciplinary team by setting up regular meetings to discuss long-term patients during this rotation.
• Complete the RACP's online 'Communication Essentials' eLearning module by the end of Quarter Four to improve communication and negotiation skills used in team work environments.

Developing an effective learning plan

1. Assess learning needs

• Evaluate the trainee's level of skill, knowledge and competence.
• Identify any gaps against the skills, knowledge and competencies defined in the curriculum.
• Identify the training program requirements that need to be met.
• Review previous progress reports, assessments and feedback.

2. Develop SMART goals

Create goals that are specific, measurable, attainable, realistic and time-limited.

3. Link goals with activities

Identify learning methods, activities and resources to achieve the goals – ensuring that learning is comprised of 70% work-based experience, 20% learning from others and 10% formal learning.

4. Plan assessment methods

Identify a mix of assessment activities with methods that are matched to the goals of the trainee and aligned to the curriculum standards (this gives a more complete picture of competence).

5. Set dates for regular progress review and feedback

• Use your email or phone calendar to set reminders to review or meet with trainees.
• Schedule enough time for feedback to avoid distractions and meeting conflicts.

6. Document the learning plan

• Use the RACP Learning Needs Analysis Tool or the Learning Contract (AFPHM) to document goals, learning activities and outcomes.
• Keep copies of trainee learning plans handy for quick reference.

Trainees and their competency level

When planning learning activities, it is important to ensure that the trainee’s performance expectations match their level of training and competence. Holding back entrustment decisions too often may hamper the trainee's development toward unsupervised practice, however, carelessly made decisions can jeopardise patients and/or populations.

The Entrustment Decision Scale³ can assist in the decision-making process — determining if the trainee can be trusted to perform a specific activity independently.

Entrustment Decision Scale
1	Be present and observe In early stages of training, it is the privilege of the trainee to be present and observe what they will be expected to do in the next stage. Gradually the trainee can start doing parts of the activity.
2	Act with direct supervision The trainee may carry out the full activity by themselves. The supervisor is in the room watching and can intervene or take over at any time deemed necessary.
3	Act with indirect supervision At this stage the trainee may carry out the full activity by themselves with a supervisor not present in the room but available by phone for advice.
4	Act with supervision at a distance At this stage the trainee may carry out the full activity by themselves with no supervisor available on short notice. The trainee reports post hoc the same or next day. This stage marks the degree of trust that allows the trainee to be entrusted with an activity.
5	Provide supervision This level is awarded when a senior trainee may act in a supervisory role for trainees more junior than themselves.

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³ Ten Cate, O, Hart, D, Ankel, F, Busari, J, Englander, R, Glasgow, N, Holmboe, E, Iobst, W, Lovell, E, Snell, L, Touchie, C, Van Melle, E, Wycliffe-Jones, K. (2016). Entrustment decision-making in clinical training. Academic Medicine, 91(2).

Bedside teaching is an essential method of clinical teaching. There are many skills that cannot be taught in a classroom and require the presence of a patient.

When teaching at the bedside remember to:

• ask permission from the patient
• introduce yourself and the team to the patient
• leave time for questions and clarifications
• start your preparation for the next encounter

A trainee's history taking, examination skills and knowledge of clinical ethics can be improved through bedside teaching – along with teaching them professionalism, and fostering good communication and role modelling skills.

Planning a bedside teaching encounter

It is important to draw a rough road map of what you plan to achieve with each bedside encounter. Points to consider are:

• plan activities to keep everyone engaged and involved
• select patients who make good cases for bedside teaching and learning
• assign roles to each member of the team to prevent chaos and confusion that can sometimes invade a bedside encounter
• establish some ground rules for the team

Planning for the encounter with the patient is crucial as it allows the supervisor and trainee to prepare for the session and it provides a basis for the feedback session afterwards.

Tips for planning a successful teaching session

• Estimate the amount of time that you will need for listening to presentations, making decisions and talking to patients/clients – then work out how much time you have for teaching.
• Send a trainee to assess a new admission on the ward round or request a trainee review a specific issue so that time can be spent on a detailed study and discussion – rather than a superficial skim of many patients or issues.
• Request the trainee explore a patient's understanding of their condition and its management. Follow up with the trainee after the ward round to discuss the encounter.
• Structure the session by ensuring all participants are clear on the goals and the trainee activities are planned.
• Speak to the relevant teams beforehand to identify patients for presentations or specific issues which might allow a focused teaching point for example: history, physical examination, patient/population management and specific conditions.

Planning a program of learning and assessment

It is important to consider that each single teaching and learning encounter builds a picture of trainee performance over time. A program of learning and assessment is the planned and deliberate use of learning activities and assessments, rather than an arbitrary selection of tools and content.

While single assessments provide only a snapshot of the trainee's competence, in a situation at a certain point in time, repeat observations and assessments from varying contexts and supervisors help you to form an overall view of the trainee's competence.

Planning a program of assessment involves selecting a variety of assessment methods that sample as many situations as possible. Assessments should ideally provide feedback on a variety of aspects of practice, such as medical knowledge, communication, and quality and safety. They should also be undertaken across a range of contexts and use different teaching methods including direct observations, case discussions and written reflections.

By collecting assessment information across the breadth of practice, a complete view of the trainee's performance can be formed.

The information gathered will be vital when writing supervisors progress reports and making summative progress decisions.

Resources

See Supervisor's Toolbox for these teaching models: One Minute Teacher Model, the SNAPPS Model and the Activated Demonstration Model teaching models.

Feedback is the cornerstone of work-based learning and assessment. Whether it is about a task or overall performance, it is an essential part of facilitating a trainee's progress towards expert performance.

When delivering feedback:

• be timely and specific
• have a balance of both questioning and telling
• use the GROW framework to help you structure the conversation

It is important to ensure trainees are aware of how they are progressing in the training program as it allows them to know where they are doing well and what areas they need to improve on.

Effective feedback is:

Timely – delivered as soon as possible after the behaviour is observed. Don’t wait until the end of the rotation or training period.

Specific – includes instances where the feedback applies, backed by specific examples. For example: "When you met with Mrs Li to negotiate her treatment plan and talked about changing her medication, some of the language you used was technical, specifically: X, Y, Z"

Balanced – reinforces good behaviour while identifying areas for improvement. For example: "I thought your explanation and knowledge of the different drugs and side effects was excellent. You could have improved Mrs Li's understanding by..."

Contextualised – linked with learning goals, curriculum outcomes and/or assessment criteria. For example: "Communication is a vital skill and a fundamental part of the program curriculum."

Forward looking – suggests how to improve in future. For example: "In the future you could improve interactions with patients by..."

Planning the feedback conversation

To make the most of feedback opportunities and ensure that the information being delivered is meaningful, feedback should be planned and then discussed with the trainee in an appropriate setting. Ensure that you have scheduled adequate time for the meeting and choose a quiet location, away from distractions.

Questioning and telling

Good feedback uses a mixture of questioning and telling. Questioning prompts self-reflection, while telling provides clear and specific points of feedback and guidance. See the following examples:

Questioning	Telling
What do you think you did well?	You interacted with the patient well, using good eye contact...
What areas would you like to improve?	You should try this next time...
Where are you now in relation to your goal?	You are developing excellent communication skills by...

The GROW Model

The GROW Model is used extensively when working with elite performers to improve their practice. By using this model, supervisors can facilitate change and growth in trainees, and encourage them to come up with a plan to meet their goals.

When delivering your feedback using the GROW Model, the conversation can be conveyed by asking the following questions:

Goal: Where am I going?

• What are the performance goals or outcomes?
• What are the planned goals for the training period or the expected outcomes of the overall training program?

Reality: How am I going?

• What have you observed?
• What have others observed?
• What information is available from completed work-based assessments?

Options: What else can I do?

• What options are there for growth and improved performance?
• What does the trainee think they can do to improve?
• What steps can the trainee take to improve?

Wrap Up: Where to next?

• Do new or amended goals need to be set?
• What will help the trainee continue to progress towards expert practice?

During the feedback conversation

It is important for the supervisor to engage in active listening. Active listening is a structured way of listening and responding to others that shows presence and understanding. It assists the supervisor to interpret the meaning of what the trainee is saying, respond to verbal and non-verbal cues, and seek clarification.

When completing progress reports remember to:

• provide meaningful and specific comments to allow future development
• meet with the trainee to discuss the feedback in the written report
• summarise the verbal feedback delivered throughout the rotation

Progress reports form the basis for Training Program Directors and RACP education committees to assess a trainee's progression through the program and certify their training. They also facilitate regular feedback and communication between supervisors and trainees.

The purpose of progress reports is to:

• provide meaningful guidance to enable further progress
• assess a trainee’s strengths and areas for improvement
• assess a trainee’s progress as measured against expected standards for their stage of training
• assess whether a trainee’s educational achievements so far are satisfactory or unsatisfactory
• facilitate the identification of trainees encountering difficulty and the provision of appropriate and timely support as required

When making judgements about a trainee's performance it is important to have a programmatic approach rather than viewing each individual assessment in isolation. This means synthesising all of the information collected over a rotation to build a comprehensive picture of the trainee.

Quality written feedback is:

Understandable – logical, structured and easy to understand

Non-judgemental – based on learning goals and performance

Selective – focused on no more than two or three things the trainee can improve on

Transferable – concentrated on processes, skills and self-regulation, not just on knowledge acquisition

Contextualised – linked with learning goals, curriculum outcomes and/or assessment criteria

Tips on formulating progress reports

• Make informed decisions – use authentic assessment across a range of domains to inform progression through training.
• Reflect on performance – what has the trainee achieved during their rotation/time at the setting?
• Use evidence from multiple sources – gather evidence from multiple assessment points, including formative assessments and feedback from other assessors. Single assessments provide only a snapshot of the trainee's competence in a situation and point in time.
• Use specific examples – provide detailed, specific and behaviour-based comments, supported by observed examples.
• Provide feedback on progression decisions – provide feedback for trainees and state the reason for the final judgement.
• Ensure no surprises – the feedback contained in progress reports should support the verbal and written feedback provided to the trainee throughout the rotation and should not include new or different information to what the trainee has been told.
• Keep it balanced – include strengths as well as areas for improvement.
• Think about the future – suggest how to improve in future.

When something isn't quite right...

• start support as soon as you notice a trainee is struggling
• give feedback – it’s a tool which helps trainees learn and grow, even when it is difficult to accept
• use the Training Support Pathway – it is there to help get trainees back on track as quickly as possible

Supporting trainees who are struggling

It is common for trainees to experience some degree of difficulty in meeting the challenging demands of RACP training. A struggling trainee is a trainee who is not making the expected progress or who is struggling with certain elements of their training and needs extra support to get their training back on track.

If you are concerned about the mental health of a trainee refer to supporting trainees with mental health problems.

Trainee in difficulty support process

The Training Support Pathway is a framework to support trainees who are struggling. Support starts at a local level and can be initiated by anyone who becomes aware that a trainee is experiencing difficulties, including the trainee themselves.

When supporting a trainee who is struggling remember:

• Early identification and intervention is a crucial step in preventing minor issues from escalating into more.
• serious problems that could pose a greater risk to the trainee, patients and/or the organisation.
• Issues should be resolved informally where possible, in collaboration with the trainee. Often the issue can be resolved informally by meeting with the trainee to provide initial feedback and support to address the issues.
• Patient and trainee safety take precedence over all other considerations.
• Check your local human resources policy and find out about any additional employer support, such as Employee Assistance Programs.

Initiating and providing support

The first step to supporting a trainee is determining what difficulty they are experiencing. Difficulties are categorised in four groups and in many cases a trainee is likely to have difficulty in more than one area. Use the table below to help identify the area(s) of challenge.

Types	Examples	Course of action
Supervisor/trainee relationship difficulty	The trainee does not feel respected or supported by their supervisor. The supervisor constantly berates them in front of their peers. The trainee feels humiliated and is not comfortable confronting their supervisor.	The trainee and supervisor attempt to resolve the issue locally with assistance from the Training Program Director or another supervisor. If unresolved, the matter can be referred to the RACP Training Support Unit in Australia or New Zealand.
Trainee performance or progression difficulty	The supervisor has witnessed the trainee having problems communicating with patients and carers. Patients have complained about the trainee’s attitude and inability to answer questions without using complex medical jargon. The supervisor has also received complaints from nursing staff about the trainee’s “short-temper”. The supervisor has raised these issues with the trainee both formally and informally.	The supervisor and trainee jointly develop an Improving Performance Action Plan (IPAP). The supervisor supports the trainee through the process and assesses the IPAP at the end of the agreed period. If the trainee has not made satisfactory progress, the IPAP may continue onto the next rotation or the trainee can be referred to Stage Two of the Training Support Pathway.
Training setting difficulty	The trainee is working in a remote community. In the last few weeks a few colleagues and patients have complained about their accent and asked for an 'Australian doctor' instead. The trainee has reported that they are not receiving guidance or assistance when they ask for it. The trainee has described ​several incidents in which they were treated in a disrespectful manner. They are feeling very isolated and unsafe.	The supervisor attempts to resolve the issue locally with reference to the Accreditation of Training Settings Policy. If unresolved, the matter can be referred to the Training Support Unit in Australia or New Zealand.
Workplace and employment difficulty	The trainee is having problems at home and has arrived late on several occasions. Despite progressing well in medical competence, the trainee is struggling to fulfil roster requirements. It is impacting on other trainees who are staying back to fill the shortfall.	Workplace and employee performance issues are dealt with by the employer in accordance with the employer's human resources policies.

Documentation

Thorough documentation is essential for continuity of management when a trainee changes rotation and supervisor.

The RACP has developed the Improving Performance Action Plan (IPAP), which you can work through with the trainee to set agreed learning actions and expected outcomes. Support through the IPAP is usually offered for up to six months and then a review is conducted to ascertain if the objectives of the IPAP have been achieved.

Keep records of all meetings held with trainees on the Training Support Pathway using the RACP Record of Meeting template.

​More Information

RACP eLearning module: Training Support: Helping trainees get back on track.

More eLearning resources can be accessed at the RACP eLearning website.

Conversations about performance, conduct, or personal issues are potentially challenging and require forethought and planning.

When faced with delivering feedback in challenging situations, prepare for the conversation by:

• recognising and clearly describing the issues you wish to discuss
• focusing on behaviour rather than personality
• setting clear outcomes for the conversation
• identifying specific examples and gathering documentation (if available) to verify the feedback

Planning the conversations

Feedback should be treated as a conversation with the trainee in which the supervisor seeks to understand not only the trainee’s perspective, but also the meaning of the task to the trainee.

Ensuring the trainee can respond may help to resolve issues before they progress any further. In most cases, speaking with the trainee will be the most effective method to resolve problems.

When planning conversations:

• choose an appropriate time and location
• display respect and empathy
• put the trainee at ease and establish rapport
• set objectives and clear outcomes
• document and set clear plans and time frames which are mutually agreed
• focus on observable facts and behavioural evidence
• use active listening skills (empathy, questioning and open body language) and show genuine interest when trying to find out the cause of the issues

Informal courageous conversations

The following steps give you a useful framework for dealing with challenging conversations in an informal way. If instances where the behaviour is more serious in nature, refer to the Formal Conversations tips.

Open the conversation
Outline why you want to have the conversation and the issue you want to discuss. Approach using same principles as for sharing bad news – maintain trust and respect.	“Do you have a few minutes to talk about…?” “I wanted to discuss with you some things I have noticed…” “I have received some feedback about…”
Describe the situation
Describe the behaviour/action/incident that you want to discuss. Avoid “you”. Use “I” statements. Be specific about what the individual did and focus on observable facts. Explain the impact of the incident on you/others. Avoid downplaying the seriousness of incident(s). Connect to values, standards, responsibilities and expected behaviours.	“Yesterday, I observed a situation where…” “I feel that this incident may have impacted the team morale.” “As supervisors we are responsible for ensuring that trainees…” “As role models we are expected to…”
Pause and reflect
Provide the opportunity for the trainee to reflect and respond. Be willing and open to listen to the perspective of them. Demonstrate empathy.	“Is this your perception of the situation?” “I’m interested to hear your views on the situation…” “I understand the situation…”
Close the conversation
Encourage the trainee to reflect on the situation and identify ways to minimise the impact of the incident. For example, apologising to affected parties. Show appreciation.

Adapted from the Advisory, Conciliation and Arbitration Service, Challenging Conversations and how to manage them (July 2014).

Formal courageous conversations

Open the conversation

• Begin the conversation by explaining the purpose of the meeting.
• Set out the structure of the meeting.
• If the meeting will be recorded or documented, notify the trainee of this and of how it will be done.
• Advise the trainee that full confidentiality may not be able to be observed as relevant parties may need to be informed and/or consulted in the resolution of the matter.

Describe the incident

• Outline the problem, using your knowledge of the situation.
• Give specific examples and refer to dates, documents, specific interactions or feedback that you have received.
• Explain the impact of the problem on the individual, the team and the organisation.

Explore the issue

• Provide the opportunity for the person to reflect and respond.
• Listen to the perspective of the other person.
• Demonstrate empathy – acknowledge their position and any mitigating circumstances.
• If new evidence emerges, explore this further.
• Take notes as required.

Agree a way forward

• Explore the options and agree an improvement plan.
• Explore any support or training required.
• Document what has been agreed in writing and give the recipient the opportunity to review and confirm that the document reflects their understanding of the agreement.
• Outline any consequences if the agreement is breached.
• Set a date to review progress against the agreed standards.
• Monitor and feedback on progress and provide ongoing support.

Next steps

• If new evidence has emerged, take further action to explore this. This may change how the situation is dealt with, it may be necessary to meet again.
• Document any additional meetings with the individual or other parties involved.
• If necessary, notify the trainee that action has been taken and notify their manager or employer.

Adapted from the Advisory, Conciliation and Arbitration Service, Challenging Conversations and how to manage them (July 2014).

When supporting trainees with a mental health condition remember to:

• provide support at an early stage
• find out about the support services available
• encourage them to see a general practitioner (GP)
• be open and honest about mental health and encourage them to do the same
• support them to engage proactively in self-care and wellbeing

Mental health conditions can be common in trainees. In almost every case, a mental health condition does not prevent a trainee from completing his or her course and continuing a career in medicine.

It is not your job to treat the trainee and you must not attempt to do so. The most appropriate way of handling a trainee with a mental health condition is through supportive measures.

In ​most cases, the appropriate course of action is to encourage the trainee to seek help from their GP.

Warning signs of a trainee in distress

It is important to recognise the early signs of mental health conditions and initiate support. Common signs and symptoms of someone experiencing mental health problems include:

• low confidence
• tearfulness, nervousness or irritability
• inability to make decisions
• difficulty concentrating
• poor appetite
• lack of interest in activities they normally enjoy
• arriving late to work
• missing for long periods
• poor attention to physical appearance
• avoidance of certain situations

Helping trainees with a mental health condition

When you are aware there is an issue it is important to act. Waiting and hoping a trainee will come to you for help will delay support. If a trainee is reluctant to speak to you give them information about organisations or people they can reach out to.

Responding in a crisis

People with mental health conditions sometimes experience a crisis, such as breaking down in tears, having a panic attack, feeling suicidal or experiencing a different reality. There are some general strategies you can implement:

• assess the immediate risk
• ask what support they have and who is aware they are struggling
• listen without making judgements and concentrate on their needs in that moment
• ask them what would help them
• reassure and direct them to practical information or resources
• ask if there is someone they would like you to contact
• encourage them to seek appropriate professional help

Support available

If immediate support is required – call 000 (Australia) or 111 (New Zealand).

RACP Support Helpline
Converge International is a professional and confidential counselling service, available to all RACP members, 24 hours a day, seven days per week, 365 days a year. To make an appointment, or to speak with a consultant, call 1300 687 327 (Australia) or 0800 666 367 (New Zealand).

Lifeline (Australia) – call +61 13 11 14.

The National Telehealth Service (New Zealand) – call or text 1737.

RACP 'Physician Self-care and Wellbeing' eLearning module
​Providing advice on supporting physicians to proactively engage in self-care and wellbeing.

RACP Trainee Mental Health Brochure (PDF 852KB)
This brochure includes useful guidance on how to recognise warning signs, appropriate action that can be taken, ways to promote wellbeing in the workplace, and information on support available from the RACP.

The Australasian Doctors' Health Network
This service is designed for doctors and medical students, and for the families and colleagues of doctors in Australia and New Zealand.

The one-minute teacher approach is useful for targeted instruction.

Step 1: Getting a commitment	Encourage the trainee to process further and problem solve by asking questions like: "What do you think is going on here?" "What would you like to do next?"
Step 2: Probing for supporting evidence	Assess the trainee's knowledge and thinking process by asking questions like: "What factors support your diagnosis/assessment?" "Why did you choose that treatment/management/response?"
Step 3: Teaching general rules	Link the teaching episode to a general rule, targeted to this incident, but also generalise to other cases which might be similar. "Remember 10 to 15 per cent of people are carriers of strep, which can lead to false positive strep tests."
Step 4: Reinforcing what was done well	Describe specific behaviours and likely outcomes. "I liked that your differential considered the patient's age, recent exposures, and symptoms."
Step 5: Correcting errors and making suggestions	Provide constructive feedback (be specific), including what and how to correct it for the future. "When you discussed the treatment plan with the patient, some of the lan­guage you used was very technical, specifically X, Y, Z. You could improve the patients understanding by... " "When you discuss that situation with the community, some of the language that you used was very technical" "What could you think about doing next time?"

The hospital bedside is a great location for effective and efficient teaching. The key to this model is ensuring the trainee is well prepared and the patient is comfortable and aware they will be talked about, and to not be alarmed or frightened. It is also a great opportunity to use the patient as a teacher. Here is a scenario:

Supervisor: “Sue (patient) this is Dr Smith. We are going to be talking about you for a few minutes, we may check some things with you along the way, and if something doesn’t sound right please say something.”

Trainee: **Presents case to supervisor in front of patient**

 Supervisor, patient and trainee: **Discussion about missing information, decisions that need to be made, asking questions**

Summarise, Narrow, Analyse, Probe, Plan, Select

After the trainee has seen the patient, they can follow these six steps for self-directed learning.

1. Summarise – the client/situation history and current status	Trainee provides brief and concise summary of relevant client/situation information.
2. Narrow – the hypothesis to two to three relevant cases	Trainee identifies hypotheses before engaging the supervisor. This requires the supervisor to foster a risk free, friendly learning environment.
3. Analyse – the issues by comparing and contrasting the possible hypotheses	Trainee verbalises thinking and reasoning process (evidence, rationale and reasoning).
4. Probe – the supervisor asking questions about uncertainties, difficulties or alternative approaches	Trainee identifies areas of confusion or knowledge gaps. Trainee interacts with supervisor as a knowledge resource.
5. Plan – the intervention and approach	Trainee creates an intervention plan or suggests alternatives (supervisor may also make suggestions).
6. Select – a case/situation related issue for self-directed learning	Trainee identifies a specific learning point in conjunction with the supervisor. Trainee follows up with learning and shares their learning with their supervisor at an agreed date soon after.

Activated demonstrations are useful if the problem is unfamiliar to the trainee.

Step 1: Ask the trainee to observe something specific

Supervisor: "Ok, I want you to watch and listen closely how I ask critical questions about alcoholism and abuse. We can then discuss my approach afterwards."

Step 2: After the demonstration, find out a description of what was observed/learnt

Supervisor: "What did you notice about how I asked questions? What did you observe me do? Can you describe the encounter?"

Step 3: Supervisor and trainee have a discussion and a rationale for actions is examined; encourage independent study

Supervisor: "I asked the questions in that way because..."

Supervisor: "Can you do some research into questioning patients about sensitive issues and we will discuss this before our next ward round."