“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