Positioning, power and agency in postgraduate primary care supervision: a study of trainee narratives
Abstract Background Postgraduate supervision takes place within complex training environments, where experiences are shaped by the socio-cultural context and wider profession, and where tensions permeate. Bordin’s working alliance-based model of supervision suggests that quality relationships encomp...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-11-01
|
| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12909-023-04826-9 |
| _version_ | 1797558971058356224 |
|---|---|
| author | Dawn Jackson Josephine Brady Donna Dawkins |
| author_facet | Dawn Jackson Josephine Brady Donna Dawkins |
| author_sort | Dawn Jackson |
| collection | DOAJ |
| description | Abstract Background Postgraduate supervision takes place within complex training environments, where experiences are shaped by the socio-cultural context and wider profession, and where tensions permeate. Bordin’s working alliance-based model of supervision suggests that quality relationships encompass agreement on the goals and tasks of supervision, in the context of an emotional bond. However, as trainees and their supervisors navigate the demands of providing safe clinical care, alongside educational support, disagreement on expectations for supervision may emerge. By applying a critical lens, this research draws on positioning theory to explore General Practice trainees’ experiences of supervision. Methods In 2017–2019 a series of narrative interviews were undertaken with 13 General Practice trainees in the United Kingdom (UK). Participants were purposively sampled based on end-of-year performance, gender, training location and training status. Interviews were analysed using Brown and Gilligan’s Listening Guide, which was adapted to incorporate an exploration of positioning, power and agency. Results Trainees appeared to hold variable positions, such as ‘insiders’, ‘outsiders’, ‘peers’ and ‘problem trainees’. Supervisors, through talk and the degree of access afforded, contributed to this positioning. Some trainees viewed their supervisors as brokers and guides as they navigated their training, whilst others were suspicious of the supervisor role. For trainees who raised concerns about their supervisor through formal channels, results were not often satisfactory. Others chose to navigate difficulty in supervision through informal means. This typically involved mastery of artefacts of training, such as the electronic appointment book or training portfolio. Conclusions This paper builds on Bordin’s model of supervision to encourage greater clarity in supervisory discussions, exploring assumptions, and recognising the influences of environment, power, positioning, and agency. We have developed a Model of the Supervisory Alliance in Postgraduate GP Training (MSA-GP) to serve as a springboard for discussion for trainees and their supervisors. |
| first_indexed | 2024-03-10T17:38:57Z |
| format | Article |
| id | doaj.art-bfd44b6e88664ffebf5bbfd56bdfe227 |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-03-10T17:38:57Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-bfd44b6e88664ffebf5bbfd56bdfe2272023-11-20T09:47:03ZengBMCBMC Medical Education1472-69202023-11-0123111310.1186/s12909-023-04826-9Positioning, power and agency in postgraduate primary care supervision: a study of trainee narrativesDawn Jackson0Josephine Brady1Donna Dawkins2College of Medical and Dental Sciences, University of BirminghamMary Immaculate CollegeSchool of Education, University of BirminghamAbstract Background Postgraduate supervision takes place within complex training environments, where experiences are shaped by the socio-cultural context and wider profession, and where tensions permeate. Bordin’s working alliance-based model of supervision suggests that quality relationships encompass agreement on the goals and tasks of supervision, in the context of an emotional bond. However, as trainees and their supervisors navigate the demands of providing safe clinical care, alongside educational support, disagreement on expectations for supervision may emerge. By applying a critical lens, this research draws on positioning theory to explore General Practice trainees’ experiences of supervision. Methods In 2017–2019 a series of narrative interviews were undertaken with 13 General Practice trainees in the United Kingdom (UK). Participants were purposively sampled based on end-of-year performance, gender, training location and training status. Interviews were analysed using Brown and Gilligan’s Listening Guide, which was adapted to incorporate an exploration of positioning, power and agency. Results Trainees appeared to hold variable positions, such as ‘insiders’, ‘outsiders’, ‘peers’ and ‘problem trainees’. Supervisors, through talk and the degree of access afforded, contributed to this positioning. Some trainees viewed their supervisors as brokers and guides as they navigated their training, whilst others were suspicious of the supervisor role. For trainees who raised concerns about their supervisor through formal channels, results were not often satisfactory. Others chose to navigate difficulty in supervision through informal means. This typically involved mastery of artefacts of training, such as the electronic appointment book or training portfolio. Conclusions This paper builds on Bordin’s model of supervision to encourage greater clarity in supervisory discussions, exploring assumptions, and recognising the influences of environment, power, positioning, and agency. We have developed a Model of the Supervisory Alliance in Postgraduate GP Training (MSA-GP) to serve as a springboard for discussion for trainees and their supervisors.https://doi.org/10.1186/s12909-023-04826-9PostgraduateSupervisionNarrative |
| spellingShingle | Dawn Jackson Josephine Brady Donna Dawkins Positioning, power and agency in postgraduate primary care supervision: a study of trainee narratives BMC Medical Education Postgraduate Supervision Narrative |
| title | Positioning, power and agency in postgraduate primary care supervision: a study of trainee narratives |
| title_full | Positioning, power and agency in postgraduate primary care supervision: a study of trainee narratives |
| title_fullStr | Positioning, power and agency in postgraduate primary care supervision: a study of trainee narratives |
| title_full_unstemmed | Positioning, power and agency in postgraduate primary care supervision: a study of trainee narratives |
| title_short | Positioning, power and agency in postgraduate primary care supervision: a study of trainee narratives |
| title_sort | positioning power and agency in postgraduate primary care supervision a study of trainee narratives |
| topic | Postgraduate Supervision Narrative |
| url | https://doi.org/10.1186/s12909-023-04826-9 |
| work_keys_str_mv | AT dawnjackson positioningpowerandagencyinpostgraduateprimarycaresupervisionastudyoftraineenarratives AT josephinebrady positioningpowerandagencyinpostgraduateprimarycaresupervisionastudyoftraineenarratives AT donnadawkins positioningpowerandagencyinpostgraduateprimarycaresupervisionastudyoftraineenarratives |