Background
Work-related intraprofessional learning
Facilitators of and barriers to workplace learning
Research questions
Methods
Study setting
Participants
Professional role | Age | Gender | Year of training | |
---|---|---|---|---|
1 | GP‛ trainee | 34–36 | F* | 3rd |
2 | GP trainee | 31–33 | F | 3rd |
3 | GP trainee | 28–30 | M^ | 3rd |
4 | GP trainee | 28–30 | F | 3rd |
5 | GP trainee | 34–36 | M | 3rd |
6 | GP trainee | 28–30 | F | 3rd |
7 | Specialist trainee: surgery | 28–30 | F | 2nd |
8 | Specialist trainee: surgery | 28–30 | M | 2nd |
9 | Specialist trainee: surgery | 28–30 | F | 3rd |
10 | Specialist trainee: internal medicine | 28–30 | M | 2nd |
11 | Specialist trainee: internal medicine | 34–36 | M | 4th |
12 | Specialist trainee: internal medicine | 34–36 | F | 6th |
Data collection
Theme | Example question |
---|---|
Forms of intraprofessional collaboration | At what moments in time and in what ways did you interact with medical specialistsa during your training? |
Formal and informal learning activities during intraprofessional collaboration | Do you encounter learning opportunities during your interactions with other specialists, and can you give examples? Does this influence your actions? |
Learning outcomes of intraprofessional collaboration | What does collaboration with other specialists give you? |
Barriers and facilitators | What hinders or prevents you from collaborating with a specialist (in training)? |
Design and procedure
Data analysis
Ethical considerations
Results
Intraprofessional collaboration between trainees
I call when I have additional questions when there is a dilemma … a patient is in a palliative process within terminal care … then I also call. … I am unsure whether that would be called often or not, I think not very often.
Formal and informal learning
Yes, when I am very sure … they are very inclined to follow my judgement. But when I start the conversation with a question [such as] ‘I would like to discuss this with you’, that is another approach, then I do learn for sure.
… patients who are reluctant to change to tablets, when they have been told by a specialist that they should be given injections. And therefore I just called a specialist once [and asked] ‘How would you proceed with these patients because we have these patients coming from you and in our guidelines it is said that … What is your advice?
You have a lack of knowledge sometimes and they teach you.
When you have referred a patient and you receive a letter explaining what was the matter, yes, well, of course you learn whether you were right or wrong.
When you are in a difficult situation, then it is just very nice to talk with the GP about it. I had a patient with a wish for euthanasia for example. Then it is a real comfort to talk about this with the GP who knows that patient incredibly well … whether they think the wish is sincere at that moment or that other factors are at play.
Sometimes we are not sure whether a patient needs to come to the hospital immediately or whether a regular consultation is OK. With acute vascular disease this occurs very often … this is something you discuss, and together you come to the best solution.
Well, the GP’s referral with the prior history of that patient. And what the GP has done already, yes, that may very much guide you.
Outcomes of learning
Good medical care is about crossing borders. When the GP is not informed about the actions of the specialist, you as a GP are not able to provide good patient care. And at the same time, a specialist needs to know from the GP what other issues have to be considered. This is very important, especially for more complex problems.
Which situations may or may not become problematic. What does or does not relate to the disease and what is to be expected. … Things you rarely see as a GP, but a specialist [sees] more often.
For example, that you should start with a specific question and start your story afterwards. Instead of letting them hear the whole story, without them knowing where to focus, and then ask your question at the end. So I learned a bit about the way to do this – what is the most optimal way of communicating.
In communication with a GP I have a lot to learn. The questions I asked, the answers I received – in the beginning they didn’t match. I have found my way now. Little by little I have learned from and with those GPs how I should do this.
… some GPs are very versatile in small operations or have a background in surgery. Yes, that is nice to know because you have a completely different conversation then.
Facilitators of and barriers to IPL
Supervisors will say very readily ‘Consult a specialist then’. They do not want you to struggle on your own.
In recent years I have noticed that my supervisors are very keen on good communication with GPs. They say: ‘Send a letter to the GP’ or ‘Mention this to the GP’, we get that kind of remark very often.
When you have a pager, you are called very frequently … you just do not have the time to really think about what someone is saying.
Then they do not really have the opportunity to talk with you. It hinders you sometimes. You get the feeling they are not giving their full attention to the conversation.
A hospital is a kind of world of its own and all the people within the hospital communicate with each other very easily. Here in X, everyone knows one another from meetings, but GPs, well, they are a group from outside. You do see GPs in the emergency departments, but actually we are in different worlds. And we rarely see GPs face to face.