Clinical Supervision
Each trainee should have a named clinical supervisor for each placement who is responsible for ensuring that appropriate clinical supervision of the trainee’s day-to-day clinical performance occurs at all times, with regular feedback. This will usually be a consultant within seconday care placements and a GP Trainer within Primary care placements.
Clinical supervision has been used in mental health services for many years, and describes the framework for regular, structured encounters reflecting on casework in the context of the post or specialty in which the health professionals are working and aims to identify areas of best practice and developmental needs. Clinical supervision has an important clinical governance role setting and improving professional standards of care.
As from December 2009, there will be a new clinical supervisors' report, information is given below:
Educational supervision
Educational supervisors are responsible for overseeing training to ensure that trainees are making the necessary clinical and educational progress. In the Severn Deanery it has been decided that the educational supervisor will be the GP Trainer who will be supervising the final year of training (ST3). During the ST3 year, this trainer will also usually have the role of clinical supervisor.
The role of an educational supervisor (ESR) in training is similar to that of an appraiser in continuing professional development. The ES has a responsibility to ensure that trainees get the best out of their training programme, realising educational opportunities, and appropriately tailoring their programme to their learning and developmental needs. Like an appraisal, ES reviews encourage critical reflection, constructive criticism and give the opportunity for feedback and guidance in developing trainees professional development plan (PDP).
Educational supervision is not a new concept in postgraduate medical training, but since the review of postgraduate medical education and the implementation of Modernising Medical Careers (MMC), the role and purpose of educational supervision has become more clearly defined. The Gold Guide details the function of educational supervision in specialty training programmes. It fails to recognise the different relationship for primary care and the unique master and apprenticeship role that GP training provides with the potential conflict of formative and summative roles for a GP trainer with an educational supervision role.
Both clinical and educational supervisor may have conflicting roles. One is developmental, allowing reflection and development, the other to provide performance assessment. The summative nature of the end point of postgraduate training and the contribution clinical and educational supervisors’ report make to that final summative decision, means there is no easy way to resolve this conflict and it must be recognised and carefully managed.
What are the qualities and attributes of an educational supervisor?
- The ES should be a senior person with knowledge and understanding of the educational programme, assessments and employment issues in the context of the trainees’ professional development journey.
- A good listener, with counselling skills and analytical, critical thinking.
- Understand feedback principles and be able to ask discriminating questions, giving constructive feedback, supportive challenge, allowing formative development.
- Non-judgmental, the relationship relies on mutual trust and respect and therefore the ES should provide non judgmental reflection of observed behaviours and be able to set the necessary boundaries when assessment of performance in practice is required.
- Self awareness and insight into own weaknesses and potential pitfalls. The ES should be able to recognise the problems created by transference and dependence the ES/trainee relationship can create and have strategies for preventing stress and burnout.
- Professionalism, the ES must treat this relationship with professionalism, respecting confidentiality, making the process transparent.
- Motivation, the ES should want to be involved in this privileged relationship however, educational organisation should value its important role in professional development and it should be appropriately rewarded.
The key roles for an Educational Supervisor can be summarised.
- An ES provides a guiding and supportive role; it cannot be divorced from performance appraisal and the potential conflict should be recognised and managed in such a way that does not discourage openness from the learner.
- Guide learners through their programme, identifying learning and development opportunities.
- Contact and conduit function, the ES can provide regular contact outside of the programme and act as a conduit for resources and liaison with programme staff.
- Information and network resource, signposting the learner, “opening doors” and providing introductions appropriately.
- Counsellor, it is the role of the ES to listen, provide constructive and challenging reflection and facilitate problem solving.
- To nurture, identifying strengths and weaknesses, empowering and facilitating the learner on the journey from novice to expert.
- Provide an appropriate role model.
- Coaching, there is a role to coach learners through key stages, grooming for interview etc.
- Finally there is a guardian role, the ES can pick up potential problems and provide an understanding of the support and referral framework allowing both ES and trainee to fulfil their professional obligations in Good Medical Practice (e.g. encouraging a sick doctor to seek help).
The Severn Deanery has produced some practical guidance sheets to help with the process and practicalities of supervision for GP speciality training.