How do supervisors describe their talented postgraduate medical trainees? An interview study with GP and ECM supervisors.

Introduction
Teachers and trainers (hereafter supervisors) of the general practitioner (GP) or elderly care medicine (ECM) training program are not always able to recognize talented trainees (TTs) and support them in their development. This can lead to a loss of their work ethos and eventually lead to loss of role models. Trainees mainly learn at the clinical workplace. Several theories address workplace learning, such as the three stages of self-regulated learning. It is unclear why some trainees are earmarked as TTs and how they learn at the workplace. This knowledge is needed to better support TTs. Our research aim was to gain insight into the characteristics and workplace learning of TTs through the eyes of their supervisors. We also examined (the nature) of the supervision relationship.

Methods
We designed an exploratory study, adopting a constructivist paradigm, using semi-structured interviews with supervisors of GP and ECM training program. We asked the supervisors about their TTs. We did not provide them with a definition of talent beforehand. Supervisors could participate if they—in their view—supervised a TT. In order to interview as diverse a group of supervisors as possible, we used purposeful sampling. The interviews took place between January and September 2018. The interviews were recorded and transcribed verbatim. Two independent researchers analyzed the transcripts by thematic analysis in MAXQDA software and established the code tree. Through group discussion the researchers reached consensus on data sufficiency and the results.

Results
We interviewed 18 supervisors. They indicated that TTs are those who master the 'whole package' of competencies, without necessarily having to excel in all competencies. However, TTs must at least excel at medical expertise, communication and professionalism, in order to be considered talented. In addition, TTs were described as socially proficient, seen as strong interpersonal relationships with the team. According to supervisors, TTs could learn better than non-TTs, as they distinguish themselves in the following activities: preparing, identifying learning objectives, planning learning, reflecting, learning from presented opportunities and applying what has been learned. In addition, our participants reported that TTs wanted to develop continuously, and that they were more motivated than non-TTs. Supervisors often gave the label 'talent' to TTs at an early stage, after which this judgment did not change. They experienced supervising a TT as challenging and motivating. Supervisors often recognized themselves in the TT and quickly regarded them as an equal. They frequently were not able to mention any pitfalls of the TT and if they did, those pitfalls were often described as not disturbing. Finally, supervisors wondered whether they could teach and challenge TT sufficiently during the whole training period.

Discussion/Conclusion
Our findings show that supervisors describe their TTs as highly motivated, socially adept and excelling in at least medical expertise, communication and professionalism. These findings are very similar to those of our recently published systematic literature review on the characteristics of excellent physicians. In addition, compared to non-TTs, TT seem to be more capable of self-regulated learning in the workplace. Supervisors recognize TT quickly, recognize themselves in the TT, are not able to describe pitfalls of TT and quickly regard the TT as an equal. This raises the question if supervisors are able to assess their TTs, support them sufficiently and challenge them in such a way that the TT can develop optimally.