Strategies for supporting senior medical students with difficulties: a qualitative study of tutors at the Department of general practice in Clermont-Ferrand

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Background : General practice students encounter different kinds of difficulties and are particularly exposed to psychosocial risks. The tutors are the student’s closest pedagogical chaperons and have a pedagogical role in supporting them. The objective of this study was to analyse tutors strategies when dealing with senior medical students with difficulties.Summary of Work : We conducted a qualitative study with tutors from the Department of general practice in Clermont-Ferrand. After full transcription, the verbatims were analysed using a method derived from grounded theory: open analysis, axial coding, and integration. The triangulation of the researchers was respected and the results were validated by the participants.Summary of Results : Seven semi-directed interviews and two focus groups made it possible to model a three-step support strategy. The first stage was the identification of difficulties based on practice exchange groups, tutoring interviews, written learning records and placement evaluations. Warning signs enabled the tutors to identify interns  having difficulties.The second stage was an exploration through exchanges between tutor and student on the one hand, and with training supervisors or other tutors on the other.The third stage was the search for solutions by gradually calling on the personal resources of the student and the tutor, then on external resources (peers from the student, other tutors, DMG, university, carers).Discussion and conclusion : Our results show the importance of a tutor’s structured strategy to support students in difficulties. Personal support by the same tutor during all the internships was a central element. Tutors had to deal with two principal ambiguities in their role. They feel an ambiguity between their mentorship and evaluator roles. The problem may be in the distinction between normative and formative evaluation. Supporting and orienting rather than offering plain psychological aid represented another challenge for the tutors.This study led to an integrative diagram modeling the tutors' strategies for supporting a student in difficulties. This diagram can help us to make a tool to help tutors.Take home messages :Dealing with students with difficulties involves a tutor’s structured strategy.Tutors have a three step strategy : identification, exploration and searching for a solution.The main resources used by tutors are exchanges with students, and multiple external aids