How to be a good educational or clinical supervisor (2 May 2024)

SPEAKER_01 0:14

Welcome to the Consultant Conversations Podcast brought to you by the recently appointed Consultants Committee of the Royal College of Physicians of Edinburgh. This podcast has been developed to support early year consultants with difficult or complex non-clinical aspects of their work. I am Kevin Conroy. I'm a respiratory consultant and general medicine consultant. And I'm joined today by Ben Prudon, who is a respiratory consultant and is also the current TPD for IMT Year 3 in the Northern Deanery and a previous college tutor. We're going to be talking today about how to be a good educational and clinical supervisor. And I remember what this was like as a trainee, and I can remember that some of my best placements were the ones where I felt that I had a clinical supervisor and an educational supervisor who really engaged with me and with my trainee. And similarly, I've had experiences that haven't been quite as good as that. As a new consultant a few years ago, I was very keen that I wanted to try and do a good job of this. But I can also remember being slightly paralyzed with fear in the days before my first educational meeting. So I'm joined now by Ben. Hello, Ben. Nice to speak to you, Kev. I've touched on things a little bit there in the intro, but why should we invest time in getting this right as consultants? We've got a lot to do. We're very busy. Why should we bother to try and invest time to not just a passable job, but actually do a good job at this?

SPEAKER_00 1:51

The key point is that particularly when you're a very new consultant, there's a tendency to focus primarily on clinical aspects of your new role and your new job. And starting in education provides a slightly different scope to still having a clinical focus but having a different aspect to it. And it's very, very rewarding. We know through many different surveys going back a number of years that consultants who participate in educational processes have a higher job satisfaction than those who don't. So it's good for you, because it's a different aspect of clinical work, and you are there to try and help with the next generation of doctors, which can be really, really rewarding. Part of the difference between a educational supervisor in clinical supervisor is clearly the educational supervisor is there for a slightly longer period, and it's an opportunity and a really valuable and privileged opportunity to be able to get to know your trainee in much greater detail. That's really good to develop that relationship between you and the trade. And as you will often see a trade slightly nervous at the beginning of their transition into your new department, and as they go through their six, twelve month period with you, or longer if it's a foundation trainee potentially, you really see a great development in them as a clinician and also personally as well, which is fantastic. So there's benefits for you trying to help with the next generation doctors ensuring quality, but it's also a benefit for you having a slightly different aspect in your work responsibilities as well.

SPEAKER_01 3:16

You've alluded to it slightly there, Ben, but there are a lot of names and terms to get used to here. Briefly, what is the difference between an educational supervisor and a clinical supervisor?

SPEAKER_00 3:29

A clinical supervisor is responsible for the trainee within their immediate speciality and placement. Now, for some specialities, particularly when trainees first rotate, typically in August, and they rotate into the new hospital, the ES may be the CS for the first placement. But those roles are slightly different. So CS has got direct responsibility for clinical oversight, helping trainees with potentially more difficult clinical situations, ensuring they've got adequate exposure to their requirements in clinical settings for outpatients or inpatients or theatre time if that's appropriate. Whereas the educational supervisor is there looking at the holistic need of the trainee, looking at their curriculum, looking at their emotional well-being over the 12-month period. And there is a much longer term interaction between the ES and the trainee rather than the CS and the trainee. But at the very beginning, the ES could be the CS.

SPEAKER_01 4:25

There's another term as well, which I'd be grateful if you could just tell us a brief bit about a role you've previously had, and that is college tutor. What's a college tutor?

SPEAKER_00 4:36

Different trusts use a college tutor slightly differently. So a college tutor is a link between a department and typically with the deaneries and the school of medicine. So these typically, again, we're clearly talking about ES, which is covering a number of different curriculum. We're obviously physician-based, but we've got many different foundation trainees, but we also have trainees on internal medicine programme as well as higher specialty training as well. So the college tutor primarily is there to help individuals outside of the foundation program and is a link between the trust and colleges to try and support opportunities, but at the same time, also the stepping stone between a train program director and the trust as well. So college tutors use differently in different places. Again, the college doesn't actually pay for a college tutor. That funding is provided via the trust who's employing the college tutor. But we normally see it as a stepping stone between TPDs who are employed by the deanery and then the trust organisation. But they are there to provide support not only for trainees but also for educational supervisors as well. So particularly with internal medicine, we have lots of involvement with college tutors trying to support new educational supervisors, trying to provide insight and understanding of trainees' curriculum and trying to lead quality of their training within their trust. Thanks for that.

SPEAKER_01 6:04

So picture the scene. I'm invited to have my first educational supervision meeting with a trainee. Bearing in mind that quite often we have trainees on different curriculum. So you might have a foundation doctor that you're supervising and an IMT doctor. Where do we start? What's the first thing I should be doing?

SPEAKER_00 6:23

I think first thing to do is to understand who you are going to be the educational supervisor for. There are different elements to that. Firstly, as you mentioned, you potentially could be looking after a foundation trainee, or you could be looking after an internal medicine trainee or a higher specialty trainee, or a combination of, or some of us will also potentially be looking after other healthcare professionals such as physician associates. So firstly, you need to just remember who this trainee is, which curriculum they are following, what the placements are going to be over the next 12 or 24 months if it's a foundation programme. And you need to have an insight into what their needs are from a training perspective to make sure that you can provide the best opportunities for them. You also are effectively, for the majority of cases, unless it's a new foundation year one trainee, you are going to be inheriting them part through their training. So what's really important is to try and look at their last ARCP to try and see if there are any insights into potentially some challenges or some positives that the trainee had during that. And the educational supervisors report from the last year is a really good place to start. So you've got the ARCP from the last year, you've got the educational supervisors report, and that's a really good place to start to know who the trainee is that you are actually coming in. That's a good starting point. Now, to know the curriculum, clearly all the curriculum are available via the websites and via the JRCTB. You can also effectively take part in ARCP panels as well. And that's a really good way to understand a curriculum for the trainees that you are looking after. And there are many panels, and all were very, very happy to take on volunteers to try and help with those panels. So thinking about those opportunities, not just simply reading the curriculum, looking at the internet resources, thinking about opportunities from the ARCPs as well.

SPEAKER_01 8:12

We've mentioned that you would need to look at the curriculum. A good way of doing that is being on an ARCP panel. Look at where the trainee was last year from a portfolio perspective. I've had other colleagues who've made a clear point of saying park the computer. Tell us a bit more about what they might be getting at.

SPEAKER_00 8:31

Well, I think they're trying to reiterate the fact that you are trying to start to build a relationship between you and the trainee. If you concentrate simply on looking at the Horace portfolio, the ePortfolio, or looking on the screen, you're not really getting the subtle clues from the trainee's body language, which is really important. So I think it's important about making sure you are in an environment which is appropriate for starting to have some educational supervision meetings. So that may not be in a communal office. It may not even be your office, it may be somewhere else. So sometimes libraries have quiet rooms that you can take individuals to, or sometimes educational departments have rooms set aside for college tutors, but you potentially could use those as well. So a nice quiet environment which does have access to a computer, but it needs to be appropriate so you can have an open and honest discussion with your trainee.

SPEAKER_01 9:17

Interestingly enough, so I've had trainees talk to me about all kinds of issues that I haven't really expected during supervision meeting. And I've kind of found myself having to offer emotional support and give some guidance on where to go for other issues. Is that a common issue during educational supervision sessions?

SPEAKER_00 9:37

Yeah, I think we're all relatively used to the fact that most trainees do okay and most trainees perform as expected, and most trainees don't need additional support. And so sometimes you then encounter a trainee that is now needing some additional support, and actually it may be quite some time ago that you have had to get involved in this type of situation. There is always more support available, and as we mentioned, the role of the college tutor, so particularly within physician specialities, we would see them as being the first point of contact if you have a trainee and you are exploring additional support for them. If we're doing that, we'd also expect that we get the TPDs involved as well. You've got local support from your trust, you also then get the support from the deanery infrastructure as well. And most deaneries work that we have learner support services, and as part of that is a dedicated occupational health service often by the lead employer trust, and they have access to potentially offering both occupational health assessments, thinking about physical, emotional, and then often they have a stream thinking about counselling services as well. Just like an onion, lots of different layers of support, but it may not be something that's top of your mind, and then linking with your college shooter or the TPD if there are any concerns, and I can definitely point you in the right direction. And if you're aware that you've got a trainee who's coming to you and you're already aware there may be some challenges, having a chat to one of these individuals beforehand is a really good way of just making sure you're aware of the options available to you.

SPEAKER_01 11:06

We've talked about the curriculum, we've talked a bit about getting to know your trainee on a personal level, making sure that you know where they've come from, academically and clinically. What about now? What about agreeing where we go for the next 12 months or however long you're supervising that trainee for?

SPEAKER_00 11:27

So we are there to make sure that we provide an excellent training opportunity for the trainee, and at the same time we're looking after their emotional well-being as well. So that's kind of what we're trying to achieve being an educational supervisor. What we are also aware is that these individuals are adult learners, and that's really important. So they are coming to this with their own educational agreements that they're going to be participating as expected, working towards the ARCP and being proactive with PTP reflective practice. What we'd also want to try and achieve at the meeting is that we're agreeing actions going forward, so that may be taking into account the last ARCP recommendations, and it could be a trainee who has some outstanding requirements that's still needing work on. And it could be that there are a trainee because of that who's got an ARCP six months following a last ARCP rather than at the end of the academic year, as most trainees will do. So you potentially are going to be agreeing your priorities for learning over the next few months and a timeline for that, and hopefully that's on your trainee's PDP. What you also need to agree on is really when and how are you going to be seeing that the trainee. So with internal medicine, we are very much encouraging ES to see their trainees on a monthly basis. And so what I often find really good is that when you have had that educational supervision meeting with a trainee, it's coming to a close, you've made your educational agreements for the next period, then look at your diaries together and decide when you're both going to have the next appointment. Because often we know that everybody's busy and sending out another email cascade a few months later is not great. So trying to pre-book your next appointment with your trainee at the end of your current meeting is a really good stepping stone.

SPEAKER_01 13:08

Thanks, Ben. We've talked about being an educational supervisor. There is, of course, another role, which is being a clinical supervisor. We know that this rule is slightly different, and that involves the day-to-day supervision of a particular trainee and helping them develop on the ward as a doctor. We also know that the rule is slightly different in so much as we might only be a supervisor for a trainee for a briefer period, such as four months, rather than being throughout the whole year. Additionally, we know that the trainees are required to collect workplace-based assessments that they can use as evidence of their clinical development on their portfolio. A large part of our role as clinical supervisors is helping them with their development and in part helping them to capture some of this evidence for their portfolio. How do we maximize our potential as new clinical supervisors? But also how do we help trainees get the most out of us?

SPEAKER_00 14:05

For those of us who are interested in education and interested in the well-being of our trainees and good patient care, which we all are, I think what we recognize is that every day is a training day. Now, there may not be particularly classroom sessions, but it's really important that we continue to talk through cases when we're on the wards, try and ensure that there is an educational element to the practice and make sure that we are leading by example. So it's part of that, that is making sure that when we are encouraging trainees to complete work-based assessments, and we're trying to complete those on a prompt basis, because we all know that unfortunately we do get lots of emails, and sometimes it's quite difficult to quickly catch up with all the work-based assessments we may get. But it's about trying to lead by example, encourage trainees to look at the educational opportunities during the workplace, and also complete work-based assessments in a timely manner. But at the same time, as we've talked about, these trainees are adult learners and with their own responsibilities. And we would expect that if we are having a work-based assessment, we'd anticipate that the trainee should be sending the ePortfolio slip or Horace slip within the next 24 hours a week and complete it in a timely manner. That's their responsibility.

SPEAKER_01 15:15

That's an interesting point. I often try and make a concerted effort to offer a workplace-based assessment on every consultant wardround that the trainees with me for. But as you say, getting the actual ticket back in a timely fashion is often the loose link in the chain there. And unfortunately, sometimes because we are so busy, if you get that ticket a month later, you can't really fill it in, in all honesty.

SPEAKER_00 15:44

Exactly. The role of that educational summary is now negligible because again, you can't remember, the trainee can't remember, and that's why realistically it needs to be done as soon as possible once you've had that educational opportunity.

SPEAKER_01 15:57

Another thing I've noticed when I was a trainee is the quality of the feedback that you get is really important. If you get simply continue to see more patients or see above, it doesn't really add an awful lot of depth. Have you got any advice for a new clinical supervisor on how to construct some good feedback?

SPEAKER_00 16:19

So it depends which curriculum you're submitting work-based assessments for. So with internal medicine, the absolute number of work-based assessments trainees need is now much smaller compared to the old core medical training programme. Within that, often, particularly if we think about a multiple consultant report, these are really important. So there are relatively few of them, and each one is really important. And it does take a little bit of time to go through and actually provide the feedback that is required. But all of that is really important. The reason it's important is because you as the educational supervisor are going to be completed at the end of your supervisor's report, and you are going to be partly basing it on the feedback you've got from the consultant colleagues from the workbase assessments. If you are completing the assessments by yourself, you need to also just be reminding yourself that actually I'm trying to provide some useful feedback. There's minimal advantage in simply just saying trainee did well, no particular concerns. What you're trying to do is remember actually these are trainees who are in training, who are looking for feedback, and you need to try and record one or two good nuggets of how they would improve their practice.

SPEAKER_01 17:26

That's a really good point. And certainly for the IMT curriculum, as you say, the multiple consultant reports really form the backbone of the ARCP. Segueing neatly into the ARCP process as a new supervisor, so towards the end of your year of supervision, have you any top tips for new supervisors doing their first end-of-year supervisors report?

SPEAKER_00 17:52

Again, it comes down to knowing the curriculum. Now, different programs and different areas run things a little bit differently. Within our area, we provide update training for educational supervisors before the summer ALCP season because sometimes there are small changes to the curriculum each year, and it's worth just being switched on to that. So there may be opportunities to having formal training pre-ARCP to help you complete the educational supervisors report. That may be a really good stepping stone. Try to keep up to date with emails from your program coordinator or your TPDs because they'll often be sending out emails about updates and important aspects. And also speaking potentially to some of the other consultants in your department who've been ESs for a little while. They may provide some useful information about things as well to how you structure the report.

SPEAKER_01 18:43

Really useful points that you've raised, Ben. I wonder if you could just give us a summary of your top points for a new supervisor.

SPEAKER_00 18:51

Well I'd definitely say is being a new educational supervisor feels a little bit foreign because again, you were the trainee, now you are the educational supervisor. You will have seen some positives and negatives about how you've been treated as trainee and moving into being a ES yourself. What you want to do is make sure that this is something that actually you are prepared for, and that maybe thinking about could you do some courses locally or via your deanery? Could you have a chat to more senior individuals such as your college tutor or your TPD, making sure you're fully prepared to understand the curriculum and the needs for that trainee, and actually really enjoying the privilege of getting to know trainee well over the next 12 months. And I think it's something that we really all enjoy. We know we're all pressurized for time, but this is something that actually you get a lot of enjoyment out.

SPEAKER_01 19:38

Thank you very much, Ben Prudon. Really nice chatting to you, and good luck to all the new educational and clinical supervisors out there. I hope this podcast has been helpful.