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Solving relationship problems with your trainer

A good relationship with your trainer will have a positive influence on your career for years to come – so what do you do when things go wrong? Dr Tanvir Jamil discusses

So you've done all your hospital jobs and are about to join your trainer for a year in general practice. It all seems plain sailing from here. Record the videos, run the audit, pass the MRCGP, get a decent trainer's report and you are well on your way to a decent salary, seven weeks holiday a year and two half days a week, right?

Hopefully you will develop a close working relationship with your trainer, built on trust, respect and friendship, that will have a positive influence on your career for many years to come. However, on occasion, things can go wrong.

The majority of difficulties arise from problems with knowledge (such as prescribing, emergencies, surgery protocols, team roles), skills (communication, consulting and practical procedures such as minor surgery) and attitudes. Knowledge and skills can often be remedied as long as the trainer and registrar want to sort the problem out. It is usually a matter of arranging tutorials, problem case analysis and extra teaching from experts (say, other GP partners).

Problems arising from attitudes are more difficult to resolve as these usually stem from personality traits. Examples include:

• poor time-keeping (either party)

• trainer thinks registrar lazy, or vice versa

• registrar thinks they are being abused by the practice or trainer

• poor or no attendance at day release by registrar

• registrar not getting on with practice staff

• registrar not feeling supported by trainer

• trainer thinking the registrar dresses inappropriately.

A trainer who arrives late and unprepared for every tutorial is just as lazy as a registrar who fails to prepare for the tutorial or do the 'homework' set in previous weeks. A registrar might feel aggrieved that they are seeing patients over a three-hour surgery whereas their registrar colleagues at the day release start later and finish earlier. Some registrars might be tempted to skip the day release regularly. And why is it that cars break down and dental appointments always happen on day release days?

What about dress? Most people would agree that dirty jeans are not acceptable while seeing patients. There is an anecdote about a registrar who had to change his practice because his trainer could not bear the registrar arriving each morning at the surgery on a motorcycle wearing leathers. Determined not to have the same problem, and having sold his motorbike and exchanged the leathers for a suit, he turned up at his new training practice in a car. His new trainer arrived on a motorbike...

One of my former registrars would arrive five minutes late every day. I had a friendly chat with him at first, then when he kept doing it I was slightly firmer. This led to a written warning. After that he was never late. The problem was apparently resolved by a haircut – he could now save five minutes by not having to dry his hair every morning!

It's common sense to bring all problems out into the open – good communication will solve most trainer–registrar problems. How do you go about resolving issues? You could try breaking down the problem:

• What is the problem?

• Who is it a problem for?

• What is the effect of the problem?

• Does the registrar/trainer accept there is a problem?

• Is there an underlying reason for the problem?

• What changes are we trying to negotiate?

• What are the consequences if changes agreed/not agreed?

• What options are there for addressing the problem?

• Who should deal with the problem?

• Is the registrar/trainer happy with the outcome?

• The consequences

• How can the resolution be monitored?

It's difficult as a registrar if your trainer does not recognise a problem or is not willing to help. Who can you turn to? An obvious choice might be other partners in the training practice. If that does not work, try your course organiser – remember they will be on your side and whatever you say to them will be confidential. You could also talk to a previous consultant or educational supervisor, fellow registrars or VTS admin staff. If all fails you may even want to talk to your associate director for your region.

As a last resort, if you really cannot stand another week with your trainer (or vice versa) you can request to move practice. A difficult decision to make, considering how future prospective employers might view this – wondering if you are difficult to work with. Should you just keep your head down and finish your training year – and risk your trainer giving you a bad reference?

Your best bet is not to let yourself get into that situation in the first place. Remember most problems can be resolved amicably with open and honest communication,

especially if they are nipped in the bud.

Tanvir Jamil is a GP trainer in Burnham, Buckinghamshire

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