Narrative GP Supervision – a novel approach for the high performing registrar
Published on August 31, 2025
We’re delighted to feature this piece by Hilton Koppe, a writer, workshop facilitator, podcaster and GP based on Bundjalung land on the east coast of Australia. With many years of experience in GP education and training, Hilton brings a unique perspective that blends his clinical expertise with his passion for reflective writing. In this article, he shares how narrative approaches can be used to support high-performing registrars in their growth as future GPs.
I was very fortunate during my years as a GP supervisor to have a number of exceptional registrars who excelled in most aspects of clinical care. I struggled to think of ways to best support them. To help them grow into their roles as a GP.
In addition to my roles as supervisor and regional medical educator, I had developed reflecting writing workshops for doctors and other health practitioners with the goal of deepening their compassion and helping to reduce their risk of burnout. I wondered if perhaps I might be able to adapt some of these writing exercises to suit the high performing
registrars in our practice.
This is what I came up with:
Step 1: Making the offer.
I might say something to the registrar like, “Overall you are doing extremely well for your level of training and experience. I was wondering if you might like to try something a little different for our teaching sessions. Something which involves you writing about one of your patients.”
Step 2: Explaining the process
If the registrar agrees to try something difference, I might explain the process as follows, “I’d like you to think about a patient-doctor relationship that has intrigued you or disturbed you. One where you might find yourself wondering why you have responded to the patient in a particular way, maybe like worrying about them away from work. Your task is to write a short piece about this patient-doctor relationship, and to include yourself in the story. Write it in the first person, from your point of view. In other words, include the word ‘I’ in the story in the bits about your actions and responses. This is different to usual case presentation which is told in the third person, about the patient, with the doctor invisible in the story.”
Step 3: The writing and the feedback
The registrar writes a piece as per instructions and then emails it to me. I read the piece from start to finish. I then re-read and make notes/comments within the body of the piece. Most of these are in the form of questions designed to help the registrar think a little more deeply about this patient-doctor relationship, and their role as a GP in general. I then email this feedback to the registrar. (see below for examples of feedback)
Step 4: The reading and discussion
At our next in-practice teaching session, with the registrar’s permission, we make time to read the piece out loud and discuss any issues arising from the piece and the feedback. This can be done during a one-on-one supervision session, or again with registrar’s consent, at a group teaching session. The registrar can choose to read the piece themselves, or I offer to read it. (Experience has taught me that publicly reading my own writing which may have
emotional content can be awkward. When I am telling a story, I can skirt around emotionally difficult spots if I feel myself tearing up, but when I read, there is nowhere to hide if I am to be true to the words on the page.)
Outcomes
Registrars who have accepted the offer of this process (not all do) told me how much benefit they gained – mostly what they learnt about themselves, and their unconscious responses to the people they care for.
For me as an aging supervisor, it was an absolute delight to try something new and to see the benefit derived from what essentially was an experiment, albeit with clear controls and safety margins.
One of my guiding principles when I am planning a teaching session is: “The learners do the
work while the teacher gets paid.” What a privilege it was for me to be able offer this approach in my role as a GP supervisor. I hope you enjoy it too. Please do contact me with questions or stories about how it went.
Examples of feedback (registrar writing in normal font, my feedback in red italics):
She would force herself to have a small breakfast and lunch during the day because ‘I know I
have to eat something’, [How does including a statement in the patient’s words change the
narrative for you?] but dinner she just couldn’t stomach.
She surprised me [What was the surprise? Why were you surprised by this? What is it like
for you when you are surprised during a consultation?] by explaining that she was worried
because last time this happened she was depressed.
She was getting up at 6am to drive her 23 year old son to work every morning after falling
into bed at 4.30am. [What did you think this meant – for her to be driving her 23 year old son to
work.]
She had some protective factors. [What were the protective factors? It is great that you
mentioned protective factors at all. It tells me that you are thinking very well about your role
with D. It is interesting to me that in medicine, there is a great focus on listing problems, but
protective factors are not often mentioned. What does this tell you about our medical
culture?]
I ordered some bloods to rule out an organic cause for her melancholy. I gave her some
numbers for 24hr help if she needed. We made a plan of some simple things for her to do
between then and next week. We left the chronic back pain and the menorrhagia for
another time. [In this paragraph, I am interested that some of the sentences started with “I”
and some started with “we”. What does this mean to you?]
Examples of feedback (registrar writing in normal font, my feedback in red italics):
She would force herself to have a small breakfast and lunch during the day because ‘I know I
have to eat something’, [How does including a statement in the patient’s words change the
narrative for you?] but dinner she just couldn’t stomach.
She surprised me [What was the surprise? Why were you surprised by this? What is it like
for you when you are surprised during a consultation?] by explaining that she was worried
because last time this happened she was depressed.
She was getting up at 6am to drive her 23 year old son to work every morning after falling
into bed at 4.30am. [What did you think this meant – for her to be driving her 23 year old son to
work.]
She had some protective factors. [What were the protective factors? It is great that you
mentioned protective factors at all. It tells me that you are thinking very well about your role
with D. It is interesting to me that in medicine, there is a great focus on listing problems, but
protective factors are not often mentioned. What does this tell you about our medical
culture?]
I ordered some bloods to rule out an organic cause for her melancholy. I gave her some
numbers for 24hr help if she needed. We made a plan of some simple things for her to do
between then and next week. We left the chronic back pain and the menorrhagia for
another time. [In this paragraph, I am interested that some of the sentences started with “I”
and some started with “we”. What does this mean to you?]
D came the next week. Her bloods were all normal, I expected as such. She had slept better!
[What is the exclamation mark saying? What has not been said here? What did you think
when she told you that she had been sleeping better? Why do you think you reacted in this
way?]
There was no way I could convince her [Sounds like you were working pretty hard here] to
see a counsellor. It was going to be me and her. [I am reminded here by something I learnt
early on in my medical career, that sometimes is can be very hard work trying to talk
someone out of a fixed belief. It is much easier to listen them out of the belief]
I feel like I don’t really know what I’m doing. [Join the club!]