Supervisory clinics in undergraduate GP placements: embodied learning through active participation

Problem

Supervisory clinics or ‘parallel surgeries’ are a widely-used teaching tool in primary care medical education for both undergraduate and speciality training. In undergraduate placements students independently consult then debrief with the GP; usually before the patient leaves. Though this teaching format is a mainstay of clinical supervision in the UK there is no literature that studies its use in medical education. The aim of this study is to explore what aspects of the clinical debrief interaction cause students to embody the structural characteristics of GP communities of practice, and to explore how GP facilitation shapes these interactions.

Approach

We used a mixed methods qualitative approach, drawing upon Lave and Wenger’s situated learning theory, and making learning visible using the theory of body pedagogics and embodiment. Sampling was purposive, and interviews of 5 students, 4 GPs and 14 patients were recorded and transcribed. Videos of their debrief interactions across multiple clinical consultations in four different GP surgeries were obtained. NHS ethics approval was granted. We considered Lave’s proposal that the unit of analysis must be a textured landscape of participation. Our units of analysis therefore were the subjective experiences of the participants and our qualitative interpretation of the embodied knowledge shown by the video subjects. The analysis process was iterative with video and interview data analysis running in parallel. Interviews were categorised and interpreted using framework analysis. We used preliminary themes from the interviews to guide a ‘whole to part’ inductive approach to video analysis. This involved multiple viewings by multiple researchers and agreement on major events and themes. Interview and video findings were synthesised to generate final themes.

Findings

Active participation emerged as the key agent for learning, and when students acted in the role of the doctor during the encounter they showed embodied knowledge of the role of a GP in their community of practice. Within these clinics the four features that had the greatest impact on active participation by the learner were: session structure and timing, legitimacy and building trust, facilitation during the consultation and safety and challenge.

Consequences

This study begins to explore the relationship between legitimate peripheral participation and embodiment of knowledge, and the video footage helped us to explore the practical aspects of situated learning. A deeper understanding of the complex interactions that take place during workplace supervisory encounters can inform GP teachers’ decision-making, improve preparation and delivery of workplace-based teaching, and maximise opportunities for patient-based learning in this setting. Many of the informal edges of the interaction that were valuable in face to face teaching can also be important to contextualise the supervisory relationship and structure of teaching when dealing with telephone consultations.