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Study of professional growth is useful for reflective purposes at any time during a career. The concept of known knowns and unknowns with a training twist can be used to summarise the overall stages of any trainee. At the start of vocational training the trainee does not know what they do not know, they have not yet recognised how much they have to learn. This happens in the second stage (that could be equated to survival) when they begin to understand the vast array of skills they must develop to make it look easy. With time and practice they will reach the point where they know what they have to do--not always getting it right but then who does? Finally, and it is particularly important that trainers recognise this, an individual will reach the point where everything is so automatic they are no longer aware of the intricacies of the skills they have acquired. This is where most trainers, both for teachers and GPs, find themselves and this can be frustrating for both trainee and trainer as they find they are unable to communicate effectively. A good trainer will spend time dissecting and 'unlearning' their skills so they are able to teach their trainees successfully. Trainees, meanwhile, must realise that, one day, they will have their own unknown knowns, but they cannot expect it to happen overnight or without substantial effort. In moving forward from our training it is how we deal with repeated survival stages that determines if we can keep doing the job, it is how we deal with the plateau that determines if we will be any good at it--effective on-the-job training leads to lifelong on-the-job learning.

Professional growth of trainees: applying teacher training models to the training of GPs