By Dr Bruce Willett
In my first post about registrars who experience problems in general practice, I talked about the common factors that can become problems. Here are some thoughts on how you can address these problems before they get to the stage where formal intervention is required.
Nurture your relationship with your registrar
From the get-go, develop a therapeutic relationship with your registrar just as you would with a patient. Ensure they know it’s a ‘two-way street’ in terms of ongoing communication and learning.
There are a number of ways to do this. Informal chats about family, friends, career plans and emotional reactions to patients are all important. These discussions constitute an essential part of training both for you and your registrar.
Make sure the expectations about pay and so on, (what I term the “industrial stuff”) are agreed upon in writing before the term starts. Nothing clouds a relationship with a registrar like starting a term with a dispute over pay and conditions.
A minor dispute about these things at the start spends valuable relationship capital. There may not be much left for difficult discussions if your registrar is struggling at a later stage. Any advice provided about their struggle could be viewed as an extension of the initial industrial dispute.
Take some time to also explain what to expect from one another in terms of relationships, practice guidelines and feedback at the beginning of the term.
Monitor your registrars closely early in their term
Early detection of potential problems may save you a lot of time and worry. A really important way to do this is to carefully monitor your registrar’s clinical performance. Sitting in – or better yet, videoing and reviewing consultations – is essential. Continue to do this until you feel confident your registrar is practising safely and that they seek help when appropriate.
Let registrars know feedback is normal
I tell my registrars that I will always try to say something about their performance. If I don’t, I’m not doing my job properly. If they feel I’m being nit-picky or difficult to please, that’s just a sign they are doing really well.
My high performing registrars always get feedback too. It’s easy to fall into the trap of just saying “you’re fabulous” but they deserve specific feedback as a part of their training as well.
Tell your registrars they will receive performance feedback from the rest of the practice team too. This includes reception staff, nurses and patients. This helps to detect problems but also provides a sense of objectivity to any remarks you make.
In my practice, we conduct regular 360 analysis on all the members of the practice staff. This normalises the feedback processes and helps registrars feel they aren’t the only ones being observed.
When things go wrong
Unfortunately, things go wrong from time to time. When they do, first ask yourself, “Does this really matter?” Be honest. Perhaps the registrar is just doing things in a different way to you? If so, that’s fine. Make peace with that as your registrar needs to learn to practise in a way suited to them and their patients.
However, if the issue is more than that, the next question to ask is “Can they normally do it?” The inability to perform to the required standard is usually a “diagnosis of exclusion” and requires some attempt to correct the behaviour deficiencies.
The third thing to ask is, “If they can do it, why aren’t they now?” Consider all possibilities to do with personality, behaviour, culture, practice or clinical performance issues. Once identified, these issues can be addressed and usually overcome.
Turn to GPTQ for further support
GPTQ’s main goal is to support registrars and the supervisors who teach them. They have a number of avenues of support available, from the District Medical Educator to District Supervisor Liaison Officers. Contacting them at an early stage for advice may avoid further formal intervention.
It may also be helpful to encourage your registrar to contact their GPTQ Registrar Liaison Officer. They can be an important touchstone and support for registrars experiencing difficulties.
Taking it further
If issues cannot be resolved quickly, document what has happened and what actions have been taken.
General Practice Supervisors Australia (GPSA) have an extensive guide on dealing with a registrar in difficulty. It is specifically designed to help the registrar understand what he/she is being asked to do.
Supervisors should also be mindful of their mandatory reporting requirements as required by the medical board.
The final word
Remaining alert to the times that things may go wrong is imperative. As long as you have a mechanism in place to deal with them, things should work out well.
In closing, keep these quick tips in mind to help you deal with a registrar experiencing problems:
- Be vigilant, particularly early in the term
- Establish procedures to deal with common problems registrars face
- Use your whole practice team and GPTQ to help both you and your registrar
- Seek further advice using the GPSA guide.