"Educational Tools for Dealing with Trainees with Difficulties"

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Some Traps for Teachers

The temptations of each teaching style.

The temptation for the Stage 1 teacher is to be authoritarian in a punative, controlling way that stifles initiative and creates resistance and dependency.

The temptation for the Stage 2 teacher is to remain on center stage, inspiring all who will listen but leaving them with no more learning skills or self-motivation than when they began.

The Stage 3 teacher can disappear into the group and demoralize students by "accepting and valuing almost anything from anybody" (Fox, 1983, p. 162).

The Stage 4 teacher can withdraw too much from the learning experience, lose touch, fail to monitor progress, and let students hang themselves with rope they are not yet accustomed to handling. Alternately, a misguided Stage 4 mentor can insidiously infiltrate all aspects of an advanced student's life (Bishop, 1988).

In each instance, the teacher may falter in the immensely difficult juggling act of becoming vitally, vigorously, creatively, energetically, and inspiringly unnecessary. Don't underestimate how difficult it is for a teacher to move from being a requirement to being just one among many choices in how to learn.

The false Stage 4 learner.

A certain kind of student gives the appearance of being a Stage 4 self-directed learner but turns out to be a highly dependent student in a state of defiance. The one who shouts loudest, "NO! I'll do it MY way!" is likely to be a "false independent" student who may resist mastering the necessary details of the subject and try to "wing it" at an abstract level.

Such students may apply for early admission to graduate seminars, for example, before they have the background knowledge or learning strategies to handle Stage 3 and Stage 4 learning situations. False independents need to have their knowledge and skills brought up to the level of their self-concept. They may well need to learn how to learn productively from others. They may benefit from a strong-willed facilitator who challenges them to become not only autonomous but also effective.

Dependent, resistant learners as a product of the educational system.

Some learners get caught up in resisting direction. A group of highly resistant learners can coerce teachers into an authoritarian mode--and then frustrate them. This game is played out daily by millions of school kids, with the help of their teachers.

The resistant form of Stage 1 is probably not a natural condition. Most preschool children seem naturally to be Stage 3 or 4 learners when undirected. Even when taught in a directive manner, they are generally available, interested, excitable, and have a spontaneous creative energy that they are willing to direct into satisfying projects under the guidance of a capable teacher. Many of us wonder why that magnificent desire to learn cannot be cultivated continuously throughout schooling.

Resistant dependent learning may well be a product of culture, upbringing, and the public education system. Students do not naturally arrive at high school, college, or adult education programs at once dependent upon teachers and resentful of being taught. They become that way as a result of years of dependency training. And they continue resisting with the implicit cooperation of teachers. Quigley [1990] describes sources of resistance in adult basic learners, including threats to cultural identity. We need a better understanding of dependency in context, and we will have to face the possibility that certain forms of help only make the problem worse.


What is it good for? It helps us understand transition particularly between jobs and expect it will take 18 months for integration into a full time post.

How to use it? The change from hospital to General Practice is a huge transition. Use the curve to help with recognition of how these stages influence confidence at different times of the year. Discuss this at induction since most trainees think they are the only ones suffering difficulties.

Reference The Lewis-Parker 'Transition Curve' model approaches personal change from a different perspective to the Fisher model, and is represented in a seven stage graph, based on original work by Adams, Hayes and Hopkins in their 1976 book “Transition” (Fisher also offers a similar – but different transition curve)

Stage 1 is common as the flood of information, new people, new systems and ways of doing things threatens to overwhelm.

Stage 2 is resorting to previous successful behaviour. So for example the trainee who was a good efficient consulter in out patients persists with a hospital disease model forcing it to work even though it’s not right for General Practice. There is a level of unconscious competence here but it does not match the competencies required for GP situation and it needs to be challenged.

Stage 3 is an awareness of difficulties but a level of conscious incompetence that frustrates and confidence can become low. In hospital trainees often don’t see patients after their initial assessment. Now in spite of trying their best some patients are coming back no better. In other words the “November Blues” You can buy them a light box but it is better to move them on and to accept that change is hard but necessary.

Stages 4 and 5 Moving them on sounds easy but there is often a rollercoaster of success and failure during this conscious competence phase. Watching a trainee video where they have tried to think about all the COT competencies can look very clunky and it takes a lot of practice with good feedback to move onto Stages 6 and 7.


Perceived Needs

These are in the two left boxes.The façade is explored by disclosure from the trainee and the trainer can encourage this by creating an open and honest training environment. So for example the trainer shares their own difficulties with the trainee and demonstrates reflective practice. Also there is active audit and significant event analysis. The trainee identifies needs through self rating scales or PEP for example and engages with active reflection in the e-portfolio

Known to self

Unknown to self

Unperceived Needs

These are in the two right boxes.

The Blind Spots box contains the area that the Trainer traditionally opens by giving constructive feedback. The evidence now mainly comes from the WPBA tools.

The Unknown box, however, gets opened up by joint exploration between Trainer and GPR. It is helped by the trainer’s ability to ask telling questions and a curiosity and interest in the trainee’s development.

Known to others


- by definition, doesn’t need exploring


- explored by feedback

Unknown to others


- explored by disclosure


- revealed by joint exploration
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