'When the talking starts': a framework for analysing tutorials

The drive towards learner-centred learning which will equip doctors for the next century has encouraged the exploration of alternative ways of learning. A fundamental assumption is that a new learning strategy will either fit into existing patterns or trigger changes in the way that teachers and learners talk together. Despite the use of videotaped tutorials within re-accreditation visits in parts of the UK, the literature reveals no currently existing frameworks to analyse these teaching/learning interactions in the general practice setting. In this qualitative study of tutorials in general practice vocational training, a new grounded theory was developed. This study was innovative in its use of audiotaped tutorials as opposed to espoused theories of interaction. The new theoretical framework of Trainer/GP Registrar interactions consists of five categories: 'gaps to be filled', 'listening in', 'quick fix', 'problem solving' and 'talk on'. Each category illustrates whose agenda was met, who triggers the learning issue, time factors, the educational philosophy and the degree of reflection encouraged. The key principle underpinning this framework is that for learning to be effective a range of educational transactions may need to occur. If educational transactions occur exclusively around one point on the framework, the quality of training and opportunities for critical reflection may suffer. This framework may have implications for the analysis by Trainers of their teaching dialogues in the same way that consultation analysis has informed the development of consultation styles in general practice.