Individual Development of Professionalism in Educational Peer Group Supervision: A Multiple Case Study of GPs

Table 3

Summary of analysis.

Cases	Expected individual learning goals and professional challenges at the start of the project/learning goal of the overall project	Status regarding expected individual learning goals and professional challenges and eventual new challenges. Half way through the project/learning goal of the overall project	Status regarding the development of the professional challenges, during the 2-year project period. Postproject/learning goal of the overall project	Analysis based on the revised taxonomy
Ann	(A) To know in what ways it is possible to refer children to the social sector and what this sector can offer the child and family/intervention or referral.	(A) Ann has not referred any children to the social sector during the past year. However, this is still her main worry, and Ann describes cooperation between sectors as the most difficult and urgent issue/intervention and referral.	(A) Ann has had no genuine collaboration with the social sector during the 2-year period. At one time she considered this, but the child’s youth club took the initiative first. Ann was oriented via the mother, not the social sector. She now feels that she understands how limited the offers to families are in the social sector/intervention and referral (same goals but not obtained).	(A) Ann set out to gain the application of procedural knowledge but remained on the level of understanding and gaining factual knowledge concerning specific details and elements regarding the services in the social sector. Is moving backwards in the taxonomy.
	(B) To become better at judging and spotting potential cases “little things and minor problems” before they develop, and gain the courage to bring this up in the consultations with the families, engaging better with them in a more direct manner/identification and intervention.	(B) Ann finds the supervision in the project and the learning tools to which she has been introduced relevant and sees their potential as a structure for working with families. She has not used the tools systematically but has experienced success by communicating more directly about factual or potential problematic issues/intervention.	(B) Looking back Ann now realizes the barrier was inside herself and that children and families have reacted positively when she has brought up even very delicate and problematic issues. Ann indicates participation in group supervision with colleagues with similar challenges as the primary reason why she has overcome this barrier/referral.	(B) Ann’s aim was to learn how to apply metacognitive knowledge she achieved this midterm and in the last year she has moved to the analytical level of metacognitive knowledge. However, she does not use this metacognitive knowledge systematically. Her analysis of the challenge is that the barriers were inside herself.
Brian	(A) To gain more courage to bring up difficult issues without overwhelming the patients/intervention.	(A) Brian feels he has gained more tools to deal with this even though it is still difficult and he feels he is practicing. His experience is that families are happy when they discover that he, as a GP, cares about them/intervention.	(A) Brian has gained the confidence to bring up difficult issues to handle difficult issues, just as he had hoped. The patients have become happier and Brian feels more comfortable among his child patients/intervention.	(A) Brian sets out to learn how to apply procedural knowledge. Half way he gains the ability to analyze at a metacognitive knowledge level, and at the end of the project he evaluates the gains of procedural knowledge.
	(B) To gain more knowledge about the local resources for children/referral.	(B) Participating in the project has made it clear that coordination is lacking between the social sector and primary care and that there is a lack of offers to families/referral and intervention.	(B) Brian has come to realize that the social services department deals with very heavy cases, far heavier than those he meets in his surgery. He is disappointed with the limited contributions from the social system but would still like to contribute to the development of more interdisciplinary work around children in need. Brian has become more aware of his own role and prefers to communicate with other doctors rather than social workers for instance/referral and intervention.	(B) Brian’s aim was to gain factual knowledge half way along he begins working with the understanding of conceptual knowledge and ends up evaluating on a metacognitive level.
Claire	(A) To utilize the public preventive healthcare program (GPV) in order to find the cases with children/identification and intervention.	(A) Claire has become more focused at GPV consultations. She now sees parents as having specific expectations of her medical role and analyzes this as a ritual she must perform before she can get to the “other” issues/identification and intervention.	(A) Claire has worked hard with this challenge and has utilized the GPV/identification and intervention.	(A) Claire’s aim was to be able to apply procedural knowledge. Midterm she has analyzed and categorized her experiences at a metacognitive level. At the end of the project she has created and tested new knowledge at a procedural level.
	(B) To gain courage to put words to problems not brought up directly/identification and intervention.	(B) This issue is Claire’s main challenge and she returns to it several times. She still does not feel equipped and is afraid of pushing the families too hard. She lacks confidence in her ability to formulate herself/identification and intervention.	(B) One of the “gold coins” for Claire has been to use the word worry. By asking “are you worried? or saying “I am worried” she signals interest, care, and eagerness to help, instead of signalling judgement. However, Claire still feels there is much work left, and participating in the project has not solved the basic problems/identification and intervention.	(B) The aim was to be able to apply procedural knowledge; at the end of the project Claire’s analysis is that she has gained parts of the desired procedural knowledge, and she is aware that she is still has much to learn.
	(C) To understand if there really is any need for GPs in children cases. Claire has never reported a child or family to the social authorities/referral.	(C) Claire has never experienced any concrete cases and believes this is because her clients are mainly “well functioning, middle class, surplus clientele.” She is frustrated over the lack of contacts between the sectors and feels that they operate under two totally different cultures with different rules and languages. She has become aware of a lack of opportunities/referral.	(C) Claire thinks of her role in cases with children as one who can act as “a backup for the parents.” She is aware of her many facets as a GP and of the importance of knowing the child and family outside the institutions. She is very frustrated by the lack of success in establishing cooperation with the social sector. Claire has not reported any children or families to the authorities after two years/referral.	(C) Claire’s aim was to understand conceptual knowledge, half way, she has begun to analyze the contact between the sectors/procedural knowledge, and at the end of the project she is evaluating her own role at a metacognitive level.
David	(A) As a new GP to learn to handle and discover relevant cases/identification and intervention.	(A and B) After 1 year in practice, David has not yet had any cases so the two challenges identified at the beginning are combined. David enjoys listening to his more experienced colleagues and hopes he can use a phrase or two from them. “But the actual experiences one must get oneself” he believes/identification and intervention	(A) After 2 years as a GP, David’s number of contacts with children and families has increased, and he has brought several cases to the group sessions. David feels like a novice and finds it much more difficult to communicate with the children than with adults. He has become more aware of what he calls “banal signals” from children like not wanting to go to school, fear of separation, and restlessness in the school/identification and intervention.	(A) David’s aim is to gain procedural knowledge at an application level. He does not obtain his aim, but at the end of the project he understands part of the procedural knowledge he set out to gain.
	(B) To learn from more experienced colleagues how to handle the cases/intervention.		(B) David thinks it has been a challenge to bring up cases in the group as a young GP among more experienced colleagues/intervention.	(B) David’s aim was to apply knowledge regarding procedural knowledge. After one year, he recognizes parts of the procedural knowledge but knows at the end of the project that he has not succeeded in obtaining his goal.
Erica	(A) To learn to become better at spotting families with problems and children in need/identification.	(A) After one year Erica has become aware of the need to develop a more professional language, including using more theoretical concepts in order to communicate more clearly and precisely with colleagues from other disciplines. She often feels she lacks the “right words” to describe difficult situations. Participating in the project has made Erica more attentive to her patients and she has “found” cases she did not see before. Erica has also noticed an increased attention among her GP colleagues towards children and families in the surgery and feels she finds herself more competent in the topic in discussions regarding children and families.	(A) This professional challenge has improved significantly for Erica; her awareness regarding children and children’s cases has increased. However Erica does not feel she has developed enough regarding this challenge; she has not gained the language or concepts she found necessary in order to move on in this part of her professional development. The large textbook the project participants were handed out at the beginning of the project probably does contain all this, but Erica feels it was too overwhelming and unsuitable for GPs.	(A) Erica’s aim is to gain conceptual understanding of the cases. Half way she is analyzing her learning at a metacognitive level. At the end of the project she is using her experience to evaluate at a metacognitive level.
	(B) To become better at communicating with families with problems/intervention.	(B) Erica now thinks of families with problems as divided into two categories: one category of heavy cases requiring action from the social authorities and another category of cases which she used to think were somebody else’s business. In the second category, Erica has become much more active and she now takes up conversations with adults and children and finds she has much more to offer than she was aware of earlier. Erica would like to train communication with families and children more and become even better at it. She has experienced that it is not quite as difficult as she imagined and she has been restrained by her own prejudices. She finds her patients appreciate the attention she gives them by asking questions regarding actual or potential problems/identification and intervention referral.	(B) The setup of the learning strategies/repeated meetings with colleagues over time has maintained the awareness of this subject and has strengthened Erica’s attention to include children and families in her everyday work as a GP. This professional challenge has improved significantly for Erica, and she feels she is well on her way/intervention.	(B) At the beginning the aim is to apply procedural knowledge. Half way Erica is evaluating her new skills at a metacognitive level. Finally Erica has generated new ideas and ways of viewing the procedural knowledge she set out to gain. Erica searches for communication skills and obtains insight, competence, and confidence based on an analysis of her patients into two overall groups that she can act differently towards.
	(C) To become part of multidisciplinary efforts regarding families with problems. Erica has never reported a child or family to the authorities in her 8 years of practice/intervention.	(C) Erica is becoming increasingly frustrated regarding this challenge. She has taken the initiative to participate in meetings with the social authorities regarding children’s cases but is surprised at how easily the social authorities give up if families resist a little. She does not see the legislation as helping to solve this problem. She realizes that solving this problem calls for “new thinking”/intervention.	(C) The frustration regarding this challenge has decreased significantly as Erica’s group has managed to set up meetings with the local authorities and Erica feels a dialogue has begun. Erica has now reported several cases to the authorities/intervention and referral.	(C) The aim is to gain procedural knowledge at an application level. Half way she is analyzing the needs to obtain her objective at a metacognitive level. At the end of the project she is viewing things in a new way at a metacognitive level. Erica searches for skills to work in a more multidisciplinary way and the insight she gains is causing frustration. However Erica acts and gets more insight into the barriers decreasing the frustration, and her actions bear fruit and make her overcome some of these barriers.
Fred	(A) To become better at registering warning symptoms without becoming personally overwhelmed/identification.	(A) Before the project started, Fred had a feeling of having overlooked many problems in families and children. During the last year he has made notes every time he has had any suspicion and it turns out not to be as many as he thought. To get this overview combined with the other tools offered in the project, the issue does not feel quite as overwhelming as before/identification.	(A) Fred has become much better at registering warning signals, and he believes this is thanks to listening to and learning from his colleagues in the group. He still sometimes becomes personally overwhelmed by the cases and hopes that he can work with this if the group continues when the project ends/identification-goal reached.	(A) At the beginning the aim was to gain understanding of procedural knowledge. Half way he is analyzing his cases at a procedural knowledge level; at the end of the project he evaluates his learning at a metacognitive level.
	(B) To become better at involving and communicating with children and families with problems. Until now Fred has often reported families to the social authorities without telling them so directly/intervention.	(B) Fred has begun to involve the families more in his concerns and finds this a much more fruitful strategy. He feels that he is learning much from his older and more experienced colleagues in the group and is full of respect when they also share their professional worries. Fred has not had many experiences with communicating with children but finds the shared cases in the supervision helpful and inspiring/intervention.	(B) Fred still misses what he calls “personal level tools” to tackle problematic communication concerning children in need. He feels the supervision sessions sometimes become too abstract or theoretical/intervention.	(B) The aim is to apply procedural knowledge; half way he is applying his knowledge and working with it at a metacognitive level. At the end he is evaluating his gained knowledge at a metacognitive level. Fred is searching for better communication skills, and he gains insight by experimenting with a strategy that includes his patients more. However at the end of the project he is disappointed because he hoped to gain mores skills. His explanation for this is that he has not managed to transform the group learning to his own daily practice.
	(C) To become better at handling the practical issues regarding collaboration with the social authorities and to become more courageous in this cooperation/intervention and referral.	(C) Fred has adjusted his expectations towards possibilities for cooperation with the social sector at a lower level and is doubtful as to whether it is possible at all/intervention.	(C) Fred feels he has an overview of the possibilities and limitations in the local environment. The consequence of his strategy of communicating more directly with his patients has meant that he now involves them more before contacting the authorities/intervention.	(C) The aim was to apply procedural knowledge; half way he is evaluating the possibilities within the gained procedural knowledge. At the end of the project he has created new ways of working with the help of strategic knowledge.
	(D) To get a little bit more self-confidence in his professional expertise in cases with families in general/interventio.	(D) Participating in the project has given Fred more clout, and he feels he is developing his relationships with the families in his practice/intervention.	(D) Via the work in the supervision group, Fred has become more aware of his own role as GP, and he feels he has developed a professional language/intervention.	(D) Aim is to apply strategic knowledge at a metacognitive level. Half way he is evaluating his gained knowledge at a metacognitive level. At the end of the project he has created knowledge regarding his own role at a metacognitive level.