How do Surgical Trainees Learn in Outpatient Clinics? Making Learning Visible Through Video-Reflexive Ethnography

Outpatient clinics form a significant workload within surgical practice for consultants and trainees. Though learning is visible in other areas of surgery, it is less apparent in outpatient clinics as work is generally more independent. While learning in outpatient clinics has been investigated, research lacks focused exploration of in situ learning by observing trainees in outpatient clinics; therefore, this research aimed to consider the elements that influence surgical trainees’ learning in the surgical outpatient clinic. Working within a constructivist paradigm, I utilised video-reflexive ethnography (VRE) to explore how trainees learn within outpatient clinics using three methods. First, I employed video ethnography to investigate the culture of outpatient clinics (38.5 hours) with the support of filming (12 trainee clinics). Second, Interviews with consultants and trainees (n=11) allowed surgeons to view their recordings and consider learning within clinics and their role in trainees’ learning. Then in team-based reflexive sessions (n=6), the wider surgical team (n=18) discussed selected video clips from the video ethnography, considering broader influences on clinic practice and learning. Additionally, participants considered steps to ensure trainees meet newly introduced Capabilities in Practice (CiP) requirements. Through reflexive thematic analysis, I generated five themes from the interviews, focusing on support within the clinic, and three from the reflexive sessions, focusing on wider systems supporting trainees. VRE highlights the value consultants place on trainees within clinics. Although many of the skills required to conduct clinics are not always apparent, the introduction of CiPs has highlighted areas where trainees should be supported and appear to act as a driver for learning. VRE allowed participants to recognise areas of excellence within their team while recognising barriers such as time and technology. The culture within the observed outpatient clinic was positive, driven by supportive senior discussions and trainees being allowed to develop an increasing autonomy in patient care, making the observed clinic a thriving community of practice.