London DeaneryEDUCATIONAL SUPERVISION

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Introductions

• Your name• Your role• Who you educationally supervise• What you want to get out of the session?

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Educational Supervision

• Definition of ES?- roles- knowledge and skills required

• What trainees want in ES?• Difficulties with ES role?

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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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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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Educational SupervisionEducational supervisors are responsible for overseeing training to ensure that trainees aremaking 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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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.

http://www.pmetb.org.uk

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Educational Supervision

Roles:• Feedback on performance• Career Advice• Objective Setting• Pastoral Support• Non clinical advice

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Educational Supervision

Knowledge & Skills:• Knowledge of syllabus & training programme• Listening skills• Encouragement• Regular protected time to meet

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What do trainees want in an ES?

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Difficulties with ES role?

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ES suggested job description

http://www.faculty.londondeanery.ac.uk/professional-development-framework-for-supervisors/Prof_Dev_Frame_Jan10.pdf

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Types of supervisionDirect – present in same room, observing

traineeImmediately 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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Conflict?

Supervision should ensure patient/client safety and promote professional

development.

Kilminster et al 2007

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3 functions of supervision

• Educative

• Supportive

• Managerial (inc guiding patient management)

Kilminster et al 2007

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Kilminster et al studyRespondents 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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also21 supervision activities were evaluated by a group of

ESs and SpRsOn all elements the ESs thought they provided more

than did the SpRsParticularly 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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Strengths & weaknesses of ESsMost helpful Concerns

Constructive honest feedback Not straight with feedbackSetting objectives & planning Form filling exerciseCareer planning advice Sessions difficult to arrangePastoral support Lack of time to talkNon clinical advice – articles etc Poor listening skillsCommitment from ES No real commitmentProtected time No interest in trainee

Lloyd & Becker 2007

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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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Giving Effective FeedbackCentral 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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Giving Effective FeedbackWhen?AgreedImmediate

Where?PrivateWho?Trust / respect

What?Observable behavioursSpecificPositives / alternatives

How?Here & nowUse ‘I’Open Qs

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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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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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Structuring an Educational Supervision session

Initial practicalities:• Frequency?• Time allocation?• Number of trainees to supervise?• Pre meeting preparation?

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Structuring an Educational Supervision session

1. Contracting2. Reviewing Progress3. Summarising Discussion & Feedback4. Setting Learning Objectives5. Completing the cycle6. Post meeting

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Structuring an Educational Supervision session - Contracting

Purpose: Agree the aim & format of the sessionRoles: 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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Structuring an Educational Supervision session - Reviewing Progress

Purpose: Trainee to reflect on progress to dateRoles: They lead, you question

• Start with issues trainee raised in contracting phase• Listening is key• Questioning: Open & paired

Avoid closed, judgemental QsConfront difficult issues early

• Ask for Specific examples

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Structuring an Educational Supervision session – Summary & Feedback

Purpose: Overview of progress to dateRoles: 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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Structuring an Educational Supervision session – Setting Learning Objectives

Purpose: Identify areas for focus & developmentRoles: 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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SMARTSpecific – 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 timescaleA7 ES slides

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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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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Supervision - PracticalWHAT? 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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Supervision - PracticalPreparation: 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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Supervision - Practical

Practical 1: 20 minsDiscuss with your partner their role as ES, using:

1.Structure given in previous session (contracting etc)

2.Information they give in Practical Preparation document.

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Supervision - Practical

Feedback: 10 minsPerson 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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Supervision - PracticalWhole 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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Supervision - Practical

Practical 2: 20 minsDiscuss with your partner their role as ES, using:1.Structure given in previous session

(contracting etc) 2.Information they give in Practical Preparation

document.

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Supervision - Practical

Feedback: 10 minsPerson 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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Supervision - PracticalWhole 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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Case Study FPTD

What are the Issues here?

What were the solutions?

Any other thoughts?

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Issues:• Trainee – communication, availability, confidence• CS & ES relationship – indistinct, conflicting adviceSolutions:• 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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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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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) pp238 - 240A7 ES slides

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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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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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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Finally….

What one thing will you do as a result of attending this session, in your ES role?

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