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“SEE ONE, DO ONE, TEACH ONE”
Bruce Covell GP
Clinical Supervision
The underlying philosophy
Education of GPs to practice independently is experiential, and necessarily occurs within the context of the delivery of health care
requires the supervising doctor to assume personal responsibility for the care of individual patients
the essential learning activity is interaction with patients under the guidance and supervision of trainers who give value, context, and meaning to those interactions
The concept is —graded and progressive responsibility
Goals of Supervision
assuring the provision of safe and effective care to the individual patient
assuring each trainee’s development of the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine
establishing a foundation for continued professional growth
Provision of Supervision
Who? GP trainer Associate trainer More advanced doctor
How and by what means? Sitting in - Physically present Immediate availability (in the practice or by means of
telephone) Debrief - Post-hoc review with feedback
Levels of Supervision
Direct
Indirect With direct supervision immediately available With direct supervision available
Debrief
“Direct Supervision”
The supervising GP is physically present with the trainee and patient. – sitting in
Pros
Cons
“Indirect Supervision”
with direct supervision immediately available
the trainer is physically within the practice or OOH centre, and is immediately available to provide Direct Supervision.
“Indirect Supervision”
with direct supervision available
– the supervising physician is not physically present within the practice or OOH centre, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision.
Pros
Cons
“Debrief”
Debrief - The supervising doctor is available to provide review of cases with feedback provided after care is delivered
Pro
Con
Initial Assessment of the Trainee
What stage are they in the journey towards independent practice?
How do we assess this?What kind of a trainee are they?
MEETING NEEDS OF SERVICE
PRACTICE DEVELOPMENT
PLAN - PRACTICE NEEDS FEEDBACK:
& WANTS STAFF
AGREED SYLLABUS COLLEAGUES
PCT / NHS AGENDA - HIMP/NSF PATIENT QUESTIONNAIRES
VIDEO ASSESSMENT
SIMULATED SURGERY /
OSCEs (Objective Structured
clinical examinations)
CONFIDENCE RATING
SCALES BY COLLEAGUES
DEVELOPMENTAL APPRAISAL SIGNIFICANT EVENT ANALYSIS
AUDIT
SCALES BY SELF MCQ / PEP (Phased Evaluation
PERCEIVED NEEDS / WANTS Programme)
PUNs (Patients' unmet needs)
PENs (Practitioners' unmet needs)
* EACH OF THESE NEEDS ASSESSMENT METHODS MAY APPLY TO THE OTHER WINDOWS
CONFIDENCE RATING
Known to self Unknown to self
Unknown to others
Hidden Unknown
3 4
The Johari Window & Learning Needs Assessment
1
Open Blind
2
Known to others
SUPERB-SAFETY MODEL
Farnan et al. J Grad Med Educ 2010; 2(1): 46-52
For Supervisors…
Set expectationsUncertainty is a time to contactPlanned communicationEasily availableReassure fearsBalance supervision and autonomy
Farnan et al. J Grad Med Educ 2010; 2(1): 46-52
For Trainees…
Seek supervisor input earlyActive clinical decisionsFeeling uncertain about clinical decisionsEnd-of-life care / legal issues – be awareTransitions of careYou may need help with referrals/Computers
Farnan et al. J Grad Med Educ 2010; 2(1): 46-52
CLEARLY MORE THAN JUST“SEE ONE, DO ONE, TEACH ONE”
Supervision
Questions to consider
What milestones, competencies, or criteria will we use to evaluate trainees performance and subsequent ability to progress to a more independent mode of practice? To become supervisors themselves?
How will we document this for each patient care setting?
How will we monitor this?
Disclaimer
Most of the text was directly quoted from the ACGME Common Program Requirements