1. London Deanery EDUCATIONAL SUPERVISION
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2. Introductions Your name Your role Who you educationally supervise
What you want to get out of the session?
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3. Educational Supervision
Definition of ES?
- roles
- knowledge and skills required
What trainees want in ES?
Difficulties with ES role?
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4. CS vs. ES
CS – day to day line management of trainee in context of providing safe clinical care (here & now) ES – broader role involving discussion of all aspects of training and professional development (retrospective and prospective)
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5. Educational Supervision
“…..process (largely involving regular appraisal interviews) whereby a more senior doctor helps a trainee to maximise the benefit that the trainee gets from a training position in order to fulfil his/her long term career aims….”
BW Lloyd & D Becker 2007
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6. Educational Supervision
Educational supervisors are responsible for overseeing training to ensure that trainees are
making the necessary clinical and educational progress.
Where possible, it is desirable for trainees to have the same educational supervisor for the whole of their training programme or for stages of training (e.g. the early years or more advanced years of training)
Paragraph 4.22 from: A Guide to Postgraduate Specialty Training in the UK (the “Gold Guide”).
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7. Clinical Supervisor
A trainer who is selected and appropriately trained to be responsible for overseeing a specified trainee's clinical work and for providing constructive feedback during a training placement.
Taken from, ‘Operational Guide for the PMETB Quality Framework’ (Version 4.2), February 2009.
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8. Educational Supervision
Roles:
Feedback on performance
Career Advice
Objective Setting
Pastoral Support
Non clinical advice
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9. Educational Supervision
Knowledge & Skills:
Knowledge of syllabus & training programme
Listening skills
Encouragement
Regular protected time to meet
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10. What do trainees want in an ES?
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11. Difficulties with ES role?
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12. ES suggested job description
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14. Types of supervision
Direct – present in same room, observing trainee Immediately available – nearby and immediately available to come to aid of trainee Local – on site and available to come to aid at short notice or help by telephone Distant – on call, available for advice, able to aid in an appropriate time
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15. Conflict?
Supervision should ensure patient/client safety and promote professional development.
Kilminster et al 2007
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16. 3 functions of supervision
Educative
Supportive
Managerial (inc guiding patient management)
Kilminster et al 2007
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17. Kilminster et al study
Respondents asked about educative, supportive and managerial functions of supervision: Significant differences: SpR trainees placed more emphasis on educative functions of supervision…. Whereas ESs prioritised managerial and support functions.
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18. also
21 supervision activities were evaluated by a group of ESs and SpRs On all elements the ESs thought they provided more than did the SpRs Particularly weak were the elements of monitoring performance, feedback, planning learning and supporting the trainee BUT all thought that supervision activities were moderately effective; there just needs to be more
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19. Strengths & weaknesses of ESs
Most helpful
Concerns
Constructive honest feedback
Not straight with feedback
Setting objectives & planning
Form filling exercise
Career planning advice
Sessions difficult to arrange
Pastoral support
Lack of time to talk
Non clinical advice – articles etc
Poor listening skills
Commitment from ES
No real commitment
Protected time
No interest in trainee
Lloyd & Becker 2007
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20. Skills & qualities needed
Supervisory – clinical guidance, joint problem solving, theory-practice, feedback, reassurance, role model
Clinical - good clinician, up to date knowledge and skill
Teaching – providing opportunity to do, directing, feedback, teaching and learning resources, individualised teaching, availability, evaluation skills
Interpersonal – involving trainees in patient care, negotiation, assertiveness, counselling, appraisal, listening skills, self awareness, empathy, own emotions, positive support, enthusiastic
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21. Giving Effective Feedback
Central to develop competence & confidence
Works best when based on observable behaviour
Is the ‘training’element of the WBAs
Informal or formal?
2 way
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22. Giving Effective Feedback
When?
Agreed
Immediate
Where?
Private
Who?
Trust / respect
What?
Observable behaviours
Specific
Positives / alternatives
How?
Here & now
Use ‘I’
Open Qs
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23. Pendleton’s Rules Ask trainee what they thought was good
(elicits insight and critical reflection)
Tell trainee what you thought was good
(introduces /reinforces (unaware) good practice)
Ask trainee what they need to change
(develops critical reflection and service improvement; encourages trainee responsibility)
Tell trainee what they need to change
(teaches improved practice; maintains patient care; is training)
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24. Summary of empirical evidence
Direct supervision helps trainees develop more rapidly
Quality of relationship strongly affects effectiveness of supervision (continuity, control)
Behaviour changes quicker than attitude (continuity)
Self supervision is not effective
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26. Structuring an Educational Supervision session
Initial practicalities:
Frequency?
Time allocation?
Number of trainees to supervise?
Pre meeting preparation?
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27. Structuring an Educational Supervision session
Contracting
Reviewing Progress
Summarising Discussion & Feedback
Setting Learning Objectives
Completing the cycle
Post meeting
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28. Structuring an Educational Supervision session - Contracting
Purpose: Agree the aim & format of the session
Roles: You lead, they contribute
Purpose of session
Time available
Confidentiality
Areas to be covered
LOs from previous session/placement
Note taking
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29. Structuring an Educational Supervision session - Reviewing Progress
Purpose: Trainee to reflect on progress to date
Roles: They lead, you question
Start with issues trainee raised in contracting phase
Listening is key
Questioning: Open & paired
Avoid closed, judgemental Qs
Confront difficult issues early
Ask for Specific examples
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30. Structuring an Educational Supervision session – Summary & Feedback
Purpose: Overview of progress to date
Roles: You lead, they contribute and confirm
Involve the trainee in this summary – use Pendleton
Describe behaviours, patterns not personalities
Refer to specific examples
Be sensitive – watch for emotional overload
Perhaps prioritise most important issues first
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31. Structuring an Educational Supervision session – Setting Learning Objectives
Purpose: Identify areas for focus & development
Roles: You lead, they contribute and confirm
Involve trainee by asking first what to focus on
Use system for LO definition (SMART)
Plan: how to meet LO, evidence required, timescale
Documentation of LOs
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32. SMART
Specific – what exactly? Measurable – how will it be demonstrated? Observation, evaluation, feedback, WBAs? Achievable – syllabus/stage related Relevant – to the placement and the workload Time framed – with specified timescale
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33. Structuring an Educational Supervision session – Completing the cycle
Purpose: Review the contracting phase and record meeting
Roles: You question, they evaluate
Ask trainee to review the contracting phase and raise outstanding issues or questions
Agree a method of recording the conversation
Share notes if you have taken any
Arrange next session
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34. Structuring an Educational Supervision session – Post meeting
Document the meeting if necessary
Spend a few minutes reflecting on what went well and what could have been better
Perhaps document your thoughts
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36. Supervision - Practical
WHAT? 20 minutes practical supervision session with partner CONTENT? Their role as an educational supervisor – what is going well? What are they struggling with? AIM? Identify 1-2 appropriate LOs re ES role
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37. Supervision - Practical
Preparation: 20 mins Review your supervision practice in light of the role as discussed this morning (use ES Practical Preparation document) Swap documents with your partner and read through theirs, thinking of Qs you might ask when supervising them.
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38. Supervision - Practical
Practical 1: 20 mins
Discuss with your partner their role as ES, using:
Structure given in previous session (contracting etc)
Information they give in Practical Preparation document.
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39. Supervision - Practical
Feedback: 10 mins
Person who has been supervised should give feedback to the supervisor:
What did they find useful?
What did they take away from the session?
What was less useful?
How did the supervisor conduct the session?
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40. Supervision - Practical
Whole group plenary:
Supervisees?
Supervisors?
What are you finding helpful?
How easy is it to use the structure?
What kinds of questions are being used?
How do you involve the supervisee in reflecting on their practice?
How far does your supervisor follow the structure for supervision?
What do you think you did well?
What could they improve upon?
What do you think you need to work on?
What else would you like to do in your session?
What else do you think is needed?
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41. Supervision - Practical
Practical 2: 20 mins
Discuss with your partner their role as ES, using:
Structure given in previous session (contracting etc)
Information they give in Practical Preparation document.
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42. Supervision - Practical
Feedback: 10 mins
Person who has been supervised should give feedback to the supervisor:
What did they find useful?
What did they take away from the session?
What was less useful?
How did the supervisor conduct the session?
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43. Supervision - Practical
Whole group plenary:
What can you transfer to your ES role with trainees?
What may not work so well with trainees?
What might you do differently when having such sessions with trainees?
Have you identified skills you need to develop?
Did you identify any objectives for your PDP? Example?
What stopped you from identifying objectives?
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45. Case Study FPTD
What are the Issues here? What were the solutions? Any other thoughts?
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46. Trainee – communication, availability, confidence
Issues:
Trainee – communication, availability, confidence
CS & ES relationship – indistinct, conflicting advice
Solutions:
Change ES (not always possible)
Communication support offered
Monthly meetings with CS reports
Preparation for next placement
Special placement in GP
A&E visit
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48. Struggling Trainee – early warning signs?
Think about a trainee (or trainees) you have known who have struggled with their training. What were some of the early warning signs (even if you did not recognise them at the time) that they were in difficulty?
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49. Struggling Trainee – early warning signs?
Disappearing act (late, sick, unavailable)
Rigid thinking
Very slow
Inappropriate emotional outbursts
Failure to gain trust
Colleagues don’t want to be on call with them
Lack of insight
Probity
Paice & Orton (2004) Hospital Medicine, 65 (4) pp
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50. Potential sources of support
Mednet (self referral, confidential, LD website)
The Mentoring Service (LD web)
The Careers unit (LD web)
Local Occupational Health
FPTD
Specialty TPD
Governance in Trust
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51. Remember….. Use the Educational Governance structure
Use the Trust Governance structure
Take early action
Document everything and have signed by you and trainee
If trainee does not agree to the actions, document what was discussed, issues, suggested courses of action and trainee signs to say they felt these actions were not necessary
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52. Remember! Most trainees are not in difficulty
All trainees can benefit from good supervision
With struggling trainees good supervision can benefit hugely.
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53. Finally….
What one thing will you do as a result of attending this session, in your ES role?
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