Transcript Building a Community of Practice for learners and teachers

Clinical Supervision on a
Shoestring
MasterClass 2014
Fiona Lake
Outcomes
•
Explore ideal supervision – what does it
look like?
•
Effective strategies to use when resources
are limited
•
Advanced concepts
• Reflective practitioner
• Content of feedback
• Safe community of learners
Clinical Supervision scenario
• Dr 4 years out
• Reviews patient with pleuritic chest pain
• Discussion – clinical, tests - advise on Mx
• Do I trust what I hear?
– Poor construction, missing information
– Inconsistencies
– Pet hates
– Do I know them?
Supervision?
Allied Health
The purpose of clinical supervision is to ensure:
1. delivery of high quality patient care and treatment
through accountable decision making and clinical
practice
2. facilitation of learning and professional
development
3. promotion of staff wellbeing by provision of
support.
The SuperGuide AH, 2014
Nurses and Midwives
“…….the term supervision applies to a range of
processes undertaken by nurses and midwives,
as they provide or participate in supervision of
professional practice. Reflection is a central
component of all types of supervision, and is
essential for improvements to patient safety and
care.”
The SuperGuide NM, 2013
Medical
Clinical supervision has three key elements:
1. Clinical oversight to lead, guide and support the
trainee at the point of care to ensure patient
safety.
2. Clinical teaching to enable trainees to develop
the competence and knowledge required for
responsible practice.
3. Trainee management to ensure that trainees
are safe and well in their work.
The SuperGuide Med, 2010
Supervision Framework for Nurses & Midwives
Clinical Supervision
Occurring during
• delivery of high quality patient care
• facilitates learning (teaching)
• Staff/learner support.
Shoestring?
Money
or
Time?
What strategies do you use as a clinical
supervisor
(looking after patients safely, teaching
and supporting the learners)
that you think
are efficient and effective?
Strategies
• Clinical
– Share roles and reflect
– High quality observation and feedback
– Patient/client role
• Unformal
– Involve multiple supervisors
– Culture of teaching and feedback
• Self Directed
– Clear tasks and standard
– Peers
Pre-requisites….
• Set clear expectations
• Ensure learners have the skills
– Reflective
– Seek quality feedback
– Work with patients/clients
– Work with peers
• Seek patient/client support and give
them permission/guidance for feedback
Clinical Supervision
• delivery of high quality patient care
• facilitation of learning (teaching)
• Staff/learner support.
• Independent
– Observe (competence)
– Reflect (knowledge and insight)
– Feedback and teaching (learn)
– Monitor change
Know your trainees competence level
Expert Performance (Ericcson)
Reflective Competence
Awareness
Unconsciously
Incompetent
Consciously
Incompetent
Learning
Unconsciously
Competent
Consciously
Competent
Practice
Reflective
Competence
Deliberate Practice
• Well defined and important tasks
• Opportunity to practice and improve
• Good supervision and feedback
• Motivation and endurance (hanging in there)
• Reflection
• Planning to ensure optimal use of time
Ref: Ericsson KA. Academic Medicine. 2004; 79(10):S70-81.
Feedback
• Balanced (done well, improve)
• Reflective (what did you think you did
well, what could you improve?)
• Constructive (how you could improve)
• and timely, frequent, fair………..
Levels of Feedback
Self
Task
Process
Processes underlying
task or extension of
task
Self-regulation
Personal
Performance of task
“Great job.
Come and
work with
us”
“What were the key “I liked the way you
points you wanted made it concise by
to emphasise?”
using professional
terms. Can you think
of other ways
presenters have
achieved this?”
“How did you organise
your thinking around
the case?”
“No good.
You should
be much
better at this
stage”
“I do not know what
problems you
thought they had.
Can you tell me?”
“In terms of developing
how you think about
your case, what are you
going to stop or start or
continue next time?”
“Your case
presentation ran over
time. Have you seen a
concise presentation?
How did the presenter
achieve it?”
Directs learning or
facilitate self-monitoring
Reflection and self assessment
• Key part of the definition of a good health professional
• BUT, research shows we are poor judges of our own
performance.
• BUT our self assessment can improve through
– practice
– by learners comparing their self-assessment with an
“experts” assessment (feedback from the supervisor)
– by learners comparing performance with the gold
standard available at the time the task is finished
(guidelines, frameworks or videos)
– Observing a role model and deconstructing performance
Organisational Culture
•
•
•
•
Role Model – reflect on own practice,
seek feedback, articulate thinking
All activities – meetings, rounds, end of
the day – reflect
Ask – “anything you are unsure about?”
Confidential – regular review of
performance
Outcomes
•
Ideal supervision – integrated with
patient care.
•
Strategies to use when resources are
limited
•
•
•
•
Encourage reflective competence
Consider the level of feedback
Improve self assessment
Build a community
What will you change
in your practice?
References
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Ericsson KA, Charness N. Deliberate practice and the acquisition and maintenance of expert
performance in medicine and related domains. Acad Med 2004; 79(10 Suppl):S70-81.
Ericsson KA. Deliberate Practice and the acquisition and maintenance of expert performance in
medicine and related domains. Acad Med. 2004;79:s70-s81.
Schuwirth L, van der Vleuten CPM. Challenges for educationalists. BMJ 2006; 333:544-6.
Hattie, J. and Timperley, H. (2007). The Power of Feedback. Review of Educational Research, 77
(1), pp. 81-112.
Koole S, Dornan T, Aper L. et al. Factors confounding the assessment of reflection:
a critical review. BMC Medical Education 2011, 11:104.
Sargeant J. How external performance standards inform self-assessment. Med Teach 2012; 34:
267–268.
Hattie, J. and Timperley, H. (2007). The Power of Feedback. Review of Educational Research, 77
(1), pp. 81-112.
Koole S, Dornan T, Aper L. et al. Factors confounding the assessment of reflection:
a critical review. BMC Medical Education 2011, 11:104.
Sargeant J. How external performance standards inform self-assessment. Med Teach 2012; 34:
267–268.
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