1. Clinical Supervision: Safe trainee practice Safe patient care
Gavin Anderson
Deputy Foundation School Director NYEC

2. What are the attributes of a good clinical supervisor
Educational Environment

3. What makes a good CS? Knowledge Skills Behaviours Motivation
Opportunity
If they don’t have it can we train them???
Why, what do we need to imbue?, who ? How ? When/how often ?

4. Academy of Medical Educators Framework
NB. The Framework for the Professional Development of Postgraduate Supervisors should not be confused with the Academy’s ‘Professional Standards’ which appeared in 2009 and have recently been revised.

5. Named clinical supervisor
‘A trainer who is responsible for overseeing a specified trainee’s clinical work for a placement in a clinical environment and is appropriately trained to do so.
He or she will provide constructive feedback during that placement, and inform the decision about whether the trainee should progress to the next stage of their training at the end of that placement and/or series of placements.’
This definition of named clinical supervisors says they will oversee the clinical work of specified trainees throughout a placement in a clinical environment, provide feedback and inform the decision on the trainee’s subsequent progress.
It does not include other senior doctors who have a clinical supervisory role with trainees (eg during a period on call).
In some cases the roles of clinical supervisor and educational supervisor may be merged – not every trainee will have a clinical supervisor apart from their educational supervisor.
We would particularly welcome comments on how well the definition sets a clear boundary between those who should be covered and those who are more loosely involved in supervising trainees.

6. Clinical Supervision Not just workplace assessment training
Not just teaching
Clinical supervision includes
ensuring the safety of the trainee and patient in the course of clinical care
as well as giving feedback on performance, both informally and through appraisal

7. Clinical Supervision Service Issues
Nature of clinical supervision will vary between speciality
In some areas trainees may be working with minimal supervision
Trainees performing only at appropriate level
Induction
Time for effective supervision
Handover
International Medical graduates
Benefits for clinical managers
Quality; reduced errors
More effective and efficient resource use
Faster proficiency of skills and independence
Managing poor performance
Time & Training
Money well spent

8. Clinical Supervision the characteristics….
Helpful supervisory behaviours
giving direct guidance on clinical work, linking theory and practice, engaging in joint problem-solving and offering feedback, reassurance and providing role models.
Ineffective supervisory behaviours
Rigidity, low empathy; failure to offer support; failure to follow supervisees’ concerns; not teaching, being indirect and intolerant and emphasizing evaluation and negative aspects.
Good interpersonal skills
involving trainees in patient care, negotiation and assertiveness skills, counselling skills; appraisal skills; self-awareness, warmth, empathy, respect for others, listening skills, expressing one’s own emotions appropriately, offering support; being positive; having enthusiasm.
Clinical competence
being seen as a good clinician and having up-to-date theoretical and clinical Knowledge
Teaching skills
offering opportunities to carry out procedures; giving direction, giving feedback, having knowledge of teaching resources, knowledge of certification requirements; individualizing the teaching approach; being available and having evaluation skills.
*AMEE Guide No. 27: Effective educational and clinical supervision. Sue Kilminster ; David Cottrell ; Janet Grant ; Brian Jolly (2007).
Not the same as Educational Supervision
Day to day even more important?
Not really available in a course locally.
Some exists in some specialities and some generic course….needs pulling together and extending to juniors, particularly ST3+

9. Clinical Supervision training for all
Consultants who have any contact with trainees, e.g. “sessional supervisors” etc.
Other trainees. Already the largest direct support. Peer Support.
Selected other healthcare workers….most are fairly generic skills
A challenge, but crucial to success!

10. Clinical supervision is at the sharp end of post graduate education
Program Director
Educational Supervision
Clinical Supervision
Managing multiple trainees, workplaces to promote high quality training in LEP. QC.
Educational Supervision, planning and monitoring training and workplace, career guidance.
Patient safety, quality care, workplace support and assessment and feedback.

11. HEE YH Educational Supervisors Online Course

12. BUT! Remember the other qualities we need in clinical supervisors…..
Minimum extras…
Check understanding of e-learning
Localisation/speciality specification
Calibration/standard setting for assessments
Effective feedback (and practicing under supervision) QM
Clinical Supervision

13. When? Training Grades Non-training grade At entry to programme
Part of educational induction
Major change in seniority
FY2/CT1
Entry to ST3
Non-training grade
New consultant/Trust
Recognition of problems
Revalidation of workplaces
Before SPAs can be given over to training
Repeated how often???

14. Environment

15. Educational Environment
“it is difficult to define the training environment – is it a single training programme within a region, an institution, a team or a combination of all of these?”
Themes from the Quality Assurance Review Workshops June 2012 GMC
Rota, rest breaks, unsocial hours
Ability to access training opportunities, informal & structured, local vs regional
Trust and HEE admin support
Workplace, team working, ethos and morale of extended team, service pressures, physical environment
Its complex so it takes a lot of effort to make it run effectively, and often very little negative experience to really let down

20. Requirements
R1.7
Organisations must make sure there are enough staff members who are suitably qualified, so that learners have appropriate clinical supervision, working patterns and workload, for patients to receive care that is safe and of a good standard, while creating the required learning opportunities.

21. Requirements
R1.8
Organisations must make sure that learners have an appropriate level of clinical supervision at all times by an experienced and competent supervisor, who can advise or attend as needed. The level of supervision must fit the individual learner’s competence, confidence and experience. The support and clinical supervision must be clearly outlined to the learner and the supervisor.

22. Requirements
Foundation doctors must at all times have on-site access to a senior colleague who is suitably qualified to deal with problems that may arise during the session.
Medical students on placement must be supervised, with closer supervision when they are at lower levels of competence.

23. Further Highlights
Organisations must make sure that work undertaken by doctors in training provides learning opportunities and feedback on performance, and gives an appropriate breadth of clinical experience.
Organisations must make sure learners have an induction in preparation for each placement
Doctors in training must have uninterrupted protected time for learning

24. Requirements
Organisations must have the capacity, resources and facilities to deliver safe and relevant learning opportunities, clinical supervision and practical experiences for learners required by their curriculum or training programme and to provide the required educational supervision and support.

25. QM of the Educational Environment
Source of Intel
GMC survey
Deanery QM visits
Deanery EOP form
Untoward clinical incidents and their investigation
Local DME/FTPD/ES knowledge
Comment by trainees at specific feedback sessions
School meetings (including trainee reps)

26. Questions?