Table 1
List of interviewed trainees.
| # INTERVIEW | GENDER (MALE/FEMALE) | MONTHS IN TRAINING |
|---|---|---|
| 1 | F | 12 months |
| 2 | F | 7 months |
| 3 | F | 20 months |
| 4 | F | 9 months |
| 5 | F | 9 months |
| 6 | M | 27 months |
| 7 | M | 16 months |
| 8 | F | 25 months |
| 9 | M | Recently finished |
| 10 | F | Recently finished |
Table 2
Interactions between EPAs and factors.
| EPA’S HELPING INFLUENCES | FACTOR | EPA’S HINDERING INFLUENCES |
|---|---|---|
| EPAs inspire to formulate learning goals and provide a framework to focus on relevant goals Interview 3: ‘So I thought it was nice in itself or something, if you don’t really know where your learning goals are, that you start looking at what are things?’ | Learning goal | Conflict with other personal learning goals distracts from personal needs Interview 4: ‘But I still had some other learning objectives. Discussing metacommunication, that was something I wanted to practise specifically. Yes, I couldn’t link that to an EPA like that much.’ |
| EPA descriptions provide a framework to find resources and guide study on relevant subjects Interview 4: ‘Well, I do go through the guidelines that are recommended for the EPA, yes. So I do a bit of self-study at home, anything I don’t understand or if I think I have done or seen very little, I look it up. Yes.’ | (Self-)study | More work in addition to other activities gives a feeling of overload Interview 10: Yes, and also when you see with some EPAs then hey, they say you have to do this and do that and read through that file and make this thing and then all in all you are, yes…. Yeah, that sometimes it’s too much..’ |
| EPAs provide a framework and content for in-depth debriefing of experiences from work. Interview 9: ‘That it [EPA] also gave inspiration with that, let me put it this way, to further explore certain issues or have extra attention to that in a debriefing session.’ | Debriefing session | Feeling the need to discuss EPAs hinders spontaneity and the ability to respond to daily encountered problems. Interview 3: ‘Especially in the first six months of training, there is so much going on that there is not much room for it [EPA]. Then you are actually mostly busy with, yes, just letting it happen to you.’ |
| Collecting entrustment decisions gives a feeling of progress towards becoming entrusted professional. EPAs that provide clear and relevant goals motivate to discuss and study. Interview 6: ‘At least that my trainer has confidence in me that apparently I can do that bit well. That does feel like a confirmation or a completed part, there is apparently a requirement or a feature of a GP and I possess it. That does feel like something positive.’ | Motivation | Amount of work, and scholastic feel of externally imposed assignments frustrates motivation, especially in the first year where trainees experience less room to make personal choices Interview 6: ‘Surely it was a bit the must, must character, more the scholastic character. And therefore the feeling, we have to add that too. While it already felt very much at the beginning, we already have to do a lot, …. I did think that was the negative character..’ |
| EPAs provide a framework to actively search for specific patients and problems. Trainees use EPAs to schedule specific patients during consultations and visits Interview 3: ‘Yes, it is good to be aware of the different patient categories that you need to know about. Because if you just do your consultations, I discovered that very large groups are underexposed..’ | Patients/case mix | Impossibility to find/schedule specific patients, based on EPAs hinders planning. Interview 4: ‘But at the same time, I also think, it just depends on what comes your way. You can think, I want to complete this EPA this year, and then have the misfortune not to come across such a case, not in practice at any point. That makes it a bit more difficult..’ |
| Trainees use EPAs to draw attention to specific learning goals which helps the supervisor to create opportunities and to focus and provide task-oriented feedback. Interview 6: ‘In the first year, I just really literally had a diary that I kept online by which I kept track of topics for debriefing sessions, which she could also see. So she could then also prepare for that.’ | Supervisor | Supervisors that are insufficiently informed about EPAs or unwilling to use EPAs at the workplace do not respond adequately to cues from trainee, which is frustrating. Interview 10: ‘… I also notice some resistance on the part of the supervisors, more like they don’t quite know what to do with it and what the point is.… Yes, it’s not that it’s something they, uh, it has to come from you too, of course, but it’s not that they say, oh, shouldn’t we have another go at the EPAs, there’s not an intrinsic motivation there, at least among my supervisors.’ |