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      Watching the watchmen: an evaluation of educational supervision in a busy district general hospital

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          Abstract

          Introduction

          Educational supervisors (ESs) play a critical role in the training of Foundation doctors. Many hospital trusts do not currently offer formal mechanisms to ensure the quality of supervision is at a high standard. Our Trust wanted to empower trainees to offer objective feedback on the quality of the supervisors.

          Methods

          We introduced a feedback form sent to all Foundation doctors at our Trust. The questionnaire was designed to identify whether ESs were meeting their responsibilities as defined by the Health Education England South West’s Severn Deanery. We collected data throughout the academic year 2017–2018 (Year 1) as a pilot, before rolling out the definitive questionnaire with minor modifications from 2018 to 2019 (Year 2).

          Results

          All respondents met with their supervisor within the first month of the placement and 90.7% of the trainees found it easy to meet with their supervisor. The Trust received generally very good feedback for all of its supervisors. Low numbers (4/120 trainees) reported supervisors not engaging with the exception reporting process.

          Conclusion

          Our Trust provides ESs of a high standard. The authors believe collecting feedback for ESs will achieve three things: 1) Drive up standards through increasing accountability of ESs receiving objective feedback. This will be of critical importance in the context of the severe acute respiratory syndrome coronavirus 2 pandemic and the changes to our work it has necessitated. 2) Empower trainees to make informed decisions about where they wish to train and under which supervisors. 3) Facilitate revalidation and appraisal for supervisors by collecting data from trainees on the quality of their supervision.

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          Most cited references6

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          AMEE Guide No. 27: Effective educational and clinical supervision.

          This guide reviews what is known about educational and clinical supervision practice through a literature review and a questionnaire survey. It identifies the need for a definition and for explicit guidelines on supervision. There is strong evidence that, whilst supervision is considered to be both important and effective, practice is highly variable. In some cases, there is inadequate coverage and frequency of supervision activities. There is particular concern about lack of supervision for emergency and 'out of hours work', failure to formally address under-performance, lack of commitment to supervision and finding sufficient time for supervision. There is a need for an effective system to address both poor performance and inadequate supervision. Supervision is defined, in this guide as: 'The provision of guidance and feedback on matters of personal, professional and educational development in the context of a trainee's experience of providing safe and appropriate patient care.' A framework for effective supervision is provided: (1) Effective supervision should be offered in context; supervisors must be aware of local postgraduate training bodies' and institutions' requirements; (2) Direct supervision with trainee and supervisor working together and observing each other positively affects patient outcome and trainee development; (3) Constructive feedback is essential and should be frequent; (4) Supervision should be structured and there should be regular timetabled meetings. The content of supervision meetings should be agreed and learning objectives determined at the beginning of the supervisory relationship. Supervision contracts can be useful tools and should include detail regarding frequency, duration and content of supervision; appraisal and assessment; learning objectives and any specific requirements; (5) Supervision should include clinical management; teaching and research; management and administration; pastoral care; interpersonal skills; personal development; reflection; (6) The quality of the supervisory relationship strongly affects the effectiveness of supervision. Specific aspects include continuity over time in the supervisory relationship, that the supervisees control the product of supervision (there is some suggestion that supervision is only effective when this is the case) and that there is some reflection by both participants. The relationship is partly influenced by the supervisor's commitment to teaching as well as both the attitudes and commitment of supervisor and trainee; (7) Training for supervisors needs to include some of the following: understanding teaching; assessment; counselling skills; appraisal; feedback; careers advice; interpersonal skills. Supervisors (and trainees) need to understand that: (1) helpful supervisory behaviours include giving direct guidance on clinical work, linking theory and practice, engaging in joint problem-solving and offering feedback, reassurance and providing role models; (2) ineffective supervisory behaviours include rigidity; low empathy; failure to offer support; failure to follow supervisees' concerns; not teaching; being indirect and intolerant and emphasizing evaluation and negative aspects; (3) in addition to supervisory skills, effective supervisors need to have good interpersonal skills, good teaching skills and be clinically competent and knowledgeable.
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            Feedback in clinical education: untying the Gordian knot.

            Feedback is essential to clinical education, especially in the era of competencies, milestones, and entrustable professional activities. It is, however, an area where medical educators often fall short. Although educational leaders and faculty supervisors provide feedback in a variety of clinical settings, surveys show important gaps in medical student and resident satisfaction with the feedback received, suggesting lost opportunities to identify performance problems as well as to help each learner reach his or her greatest potential.In this issue of Academic Medicine, Telio and colleagues extend the empirically validated concept of a "therapeutic alliance" to propose the "educational alliance" as a framework for enhancing feedback in medical education. They highlight the importance of source credibility, which depends on the teacher-learner relationship and alignment of values, the teacher's understanding of the learner's role and goals, the teacher's direct observation of the learner, and the learner's perception of the teacher's good intentions. The author of this Commentary suggests that the educational alliance framework should prompt medical educators to reconsider feedback and explore opportunities for optimizing it. Most medical schools and graduate medical education programs are not designed in a way that supports the education alliance model, but the Commentary author offers suggestions for cultivating educational alliances, including rethinking supervisor selection criteria. Such interventions should be combined with ongoing faculty development and efforts to improve coaching and mentoring for students, residents, and fellows. Untying the Gordian knot of effective feedback will require innovative approaches, exchange of successful strategies, and continued research.
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              What is effective supervision and how does it happen? A critical incident study.

              To identify the key features of supervision from the perspectives of educational supervisors and specialist registrars. Critical incident study. Telephone interviews were conducted with selected informants representing a range of specialties. The sample comprised educational supervisors with an identified interest in supervision, specialist registrars and GP trainees in the Yorkshire region. Educational supervisors and specialist registrars were generally agreed on what constitutes effective supervision: direct supervision was seen as very important. Educational supervisors and specialist registrars had very different concerns in relation to ineffective supervision: specialist registrars were concerned with inadequate supervision whilst educational supervisors were concerned with failures in direct supervision and poorly performing trainees. Supervision practices varied between specialties; in this study there seemed to be particular problems in anaesthesia, medicine and paediatrics. Direct supervision and the quality of the supervisory relationship are key to effective supervision. There is a need for clear guidance on supervision and the establishment of appropriate procedures and mechanisms to resolve difficulties relating to inadequate supervision for trainees and performing trainees. Insufficient numbers of supervisors have received training in supervision.
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                Author and article information

                Contributors
                Journal
                Postgrad Med J
                Postgrad Med J
                pmj
                Postgraduate Medical Journal
                Oxford University Press
                0032-5473
                1469-0756
                December 2020
                20 August 2020
                20 August 2020
                : 96
                : 1142
                : 777-779
                Affiliations
                Postgraduate Medical Education, Gloucestershire Hospitals NHS Foundation Trust , Cheltenham, UK
                Postgraduate Medical Education, Gloucestershire Hospitals NHS Foundation Trust , Cheltenham, UK
                Paediatrics, Gloucestershire Hospitals NHS Foundation Trust , Gloucester, UK
                Postgraduate Medical Education, Gloucestershire Hospitals NHS Foundation Trust , Cheltenham, UK
                Author notes
                Correspondence to Christopher James Heining, Gloucestershire Hospitals NHS Foundation Trust, 82 Laynes Road, Gloucester GL3 3PZ, UK; chrisheining@ 123456hotmail.co.uk
                Author information
                https://orcid.org/0000-0002-6685-2578
                Article
                postgradmedj-2020-138473
                10.1136/postgradmedj-2020-138473
                10016928
                32820086
                285ee241-bad0-4046-9fc9-afafccea6f0c
                © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                : 11 June 2020
                : 15 July 2020
                Page count
                Pages: 3
                Categories
                Quality Improvement Report
                AcademicSubjects/MED00160
                AcademicSubjects/MED00790
                AcademicSubjects/MED00530

                Medicine
                medical education & training
                Medicine
                medical education & training

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