HETV GP School document to offer guidance on the supervision of clinical activity of trainees by doctors other than trainers and experienced principals (including locums).
It is the explicit duty of the trainer to ensure the supervision arrangements for trainees are safe and robust. Although it is anticipated that the majority, if not all, supervision of a trainee within a practice will be done by the trainer or other experienced doctors within the practice who are either partners or salaried principals, it is recognized that there will be circumstances when less experienced doctors or locums may be asked to perform this role for one or more surgeries. The purpose of the document is to clarify issues which might arise from this.
What Qualifications does a supervisor need?
The supervisor must be a qualified doctor, but beyond this no formal qualification is needed. The ability to teach is viewed as a core competence by the GMC for any qualified doctor. It is important that any supervisor has insight into the role that he or she is being asked to undertake and specifically an appreciation that the trainee is in a training post and not yet licensed for independent practice. Hence the supervising doctor carries a responsibility to ensure, within reasonable limits, that any decision made by a trainee is safe and acceptable (even if the supervising doctor may have done something different).
What other competencies should a supervisor have?
In addition to being a competent general practitioner from a clinical perspective, it is also important that the supervisor is competent in using the computer system and is appropriately familiar with the local health system so that appropriate advice can be offered about, for example, referral pathways
Who decides if the clinical supervisor is acceptable?
Ultimately it is the responsibility of the trainer along with the training practice clinical governance structure to ensure that supervision arrangements are satisfactory. It is clearly important that the doctor who is asked to act as a supervisor is fully informed and agrees with the arrangement. It is also strongly recommended that the trainee agrees to any arrangement, especially if the supervisor is from outside the practice and very possibly unknown to the trainee.
Supervision arrangements are also reviewed when the practice is visited by a Deanery inspection team, and the report is duly considered by the GP Dean and GP training practice appointments committee. The GP Dean also reserves the right to review the supervision arrangements at any stage within a practice should evidence emerge that this is appropriate.
Should, for example, a locum be paid extra for acting as a clinical supervisor?
Possibly, but not necessarily. The fee paid to a locum, along with associated terms and conditions, is entirely negotiable between the practice and the locum, but consideration should be given to the extra role and responsibility involved in this negotiation. Most important is that sufficient time and space in workload is given to the supervising doctor to allow this role to be discharged effectively and safely.
How should the supervisor approach a session from a practical perspective?
It is important that the supervisor talks to the trainee and a shared understanding is reached on how the supervising arrangement will operate.
The supervisor and trainee should be roomed in close proximity.
The clinical supervisor should be aware of the stage of training and experience of the trainee.
He or she should ascertain how the trainee wishes to ask questions or receive feedback, which could include as and when issues crop up during a clinic, or else at the end of the surgery (bearing in mind that urgent issues should always be addressed immediately). Does the trainee expect a formal debrief on every patient seen at the end of surgery, or, if an experienced trainee, simply an opportunity to discuss any problem cases?
If the supervisor supervises any practical procedure then it is important that the supervisor is also competent in this procedure (examples might include the insertion of a coil, a joint injection or a minor operation).
If visits are involved in the arrangement, the clinical supervisor should ascertain whether the trainee is able to undertake these alone, and ensure that he or she is easily contactable to offer advice as appropriate. If there is a late call and a visit is needed by the trainee, it is important that the supervisor remains available to give advice or, if not, then an alternative arrangement is securely and appropriately put into place.
What feedback should be given to the trainer?
Ideally this should be decided prior to the session – as part of the contracting process (for a locum). Although it may be that no verbal or formal written documentation is requested or felt necessary, if the performance of the trainee raises concerns it is imperative that this is fed back to the trainer in a specific and objective fashion, ideally in writing (and definitely in writing if serious concerns).
What about if the trainee is one whose performance is already causing significant concern?
This trainee should not be supervised by, for example, a locum. The exception to this might be if the locum is an experienced educator and is fully briefed about the circumstances. Indeed, such an arrangement could potentially add triangulation of evidence from an informal assessment perspective.
Author – David Grimshaw
Reviewed and approved by Training Practice Appointments Committee October 2014.