Transcript EDUCATIONAL SUPERVISORS TOOL KIT ONE

Faculty Development
EDUCATIONAL
SUPERVISORS
TOOL KIT ONE
www.londondeanery.ac.uk
INTRODUCTIONS
• Your name
• Your role
• Who you educationally supervise
• What you want to get out of the session?
EDUCATIONAL SUPERVISION
• Definition of ES?
- roles
- knowledge and skills required
• What trainees want in ES?
• Difficulties with ES role?
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)
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
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”).
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
EDUCATIONAL SUPERVISION
Roles:
• Feedback on performance
• Career Advice
• Objective Setting
• Pastoral Support
• Non clinical advice
EDUCATIONAL SUPERVISION
Knowledge & Skills:
• Knowledge of syllabus & training programme
• Listening skills
• Encouragement
• Regular protected time to meet
WHAT DO TRAINEES WANT IN AN ES?
DIFFICULTIES WITH ES ROLE?
ES SUGGESTED JOB DESCRIPTION
http://www.faculty.londondeanery.ac.uk/professional-development-framework-forsupervisors/prof_dev_frame_jan10.pdf
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
CONFLICT?
Supervision should ensure patient/client safety and promote
professional development.
Kilminster et al 2007
3 FUNCTIONS OF SUPERVISION
• Educative
• Supportive
• Managerial (inc guiding patient management)
Kilminster et al 2007
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.
Where as ESs prioritised managerial and support functions.
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
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
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
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
GIVING EFFECTIVE FEEDBACK
When?
Where?
Agreed
Private
Immediate
Who?
Trust / respect
What?
How?
Observable behaviours
Here & now
Specific
Use ‘I’
Positives / alternatives
Open Qs
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)
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
STRUCTURING AN EDUCATIONAL
SUPERVISION SESSION
Initial practicalities:
• Frequency?
• Time allocation?
• Number of trainees to supervise?
• Pre meeting preparation?
STRUCTURING AN EDUCATIONAL
SUPERVISION SESSION
1. Contracting
2. Reviewing Progress
3. Summarising Discussion & Feedback
4. Setting Learning Objectives
5. Completing the cycle
6. Post meeting
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
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
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
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
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
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
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
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
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.
SUPERVISION - Practical
Practical 1: 20 mins
Discuss with your partner their role as ES, using:
1. Structure given in previous session (contracting etc)
2. Information they give in Practical Preparation document.
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?
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?
SUPERVISION - Practical
Practical 2: 20 mins
Discuss with your partner their role as ES, using:
1. Structure given in previous session (contracting etc)
2. Information they give in Practical Preparation document.
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?
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?
Case Study FPTD
What are the Issues here?
What were the solutions?
Any other thoughts?
Case Study FPTD
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
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?
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 - 240
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
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
REMEMBER
• Most trainees are not in difficulty
• All trainees can benefit from good supervision
• With struggling trainees good supervision can benefit hugely.
FINALLY
What one thing will you do as a result of attending this session,
in your ES role?