Australian general practice trainees typically consult with patients from their first week of training, seeking in-consultation supervisory assistance only when not sufficiently confident to complete patient consultations independently. Trainee help-seeking plays a key role in supervisor oversight of trainee consultations. This study used focus groups and interviews with general practice supervisors to explore their approaches to trainee help-seeking and in-consultation supervision. Supervisor approaches are discussed under three themes: establishing a help-seeking culture; perceptions of in-consultation assistance required; and scripts for help provision. Within these themes, three interwoven entrustment processes were identified: supervisor entrustment; trainee self-entrustment; and 'patient entrustment' (patient confidence in the trainee's clinical management). Entrustment appears to develop rapidly, holistically and informally in general practice training, partly in response to workflow pressure and time constraints. Typical supervisor scripts and etiquette for help-provision involve indirect, soft correction strategies to build trainee self-entrustment. These scripts appear to be difficult to adapt appropriately to under-performing trainees. Importantly, supervisor scripts also promote patient entrustment, increasing the likelihood of patients returning to the trainee and training practice for subsequent review, which is a major mechanism for ensuring patient safety in general practice. Theories of entrustment in general practice training must account for the interplay between supervisor, trainee and patient entrustment processes, and work-related constraints. Gaps between entrustment as espoused in theory, and entrustment as enacted, may suggest limitations of entrustment theory when extended to the general practice context, and/or room for improvement in the oversight of trainee consultations in general practice training.

中文翻译：

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全科培训中的临床监督：监督者、受训者和患者委托与临床监督、患者安全和受训者学习的交织

澳大利亚全科实习生通常从培训的第一周开始咨询患者，只有在没有足够信心独立完成患者咨询时才寻求咨询监督协助。实习生求助在主管监督实习生咨询方面发挥着关键作用。本研究使用焦点小组和与全科实践主管的访谈来探索他们的实习生寻求帮助和咨询监督的方法。在三个主题下讨论主管方法：建立寻求帮助的文化；对需要的会诊协助的看法；和提供帮助的脚本。在这些主题中，确定了三个相互交织的委托过程：主管委托；学员自我委托；和“病人的委托” （患者对受训者临床管理的信心）。委托似乎在一般实践培训中迅速、全面和非正式地发展，部分原因是为了应对工作流程压力和时间限制。提供帮助的典型主管脚本和礼节涉及间接、软性纠正策略，以建立受训者的自我信任。这些脚本似乎很难适当地适应表现不佳的学员。重要的是，主管脚本还促进了患者的信任，增加了患者返回受训者和培训实践进行后续审查的可能性，这是确保一般实践中患者安全的主要机制。一般实践培训中的委托理论必须考虑主管、受训者和患者委托过程之间的相互作用，和工作相关的限制。理论上支持的委托与已颁布的委托之间的差距，可能表明委托理论在扩展到一般实践环境时存在局限性，和/或在一般实践培训中对受训者咨询的监督有改进的余地。