“SEE ONE, DO ONE, TEACH ONE” Bruce Covell GP Clinical Supervision

The underlying philosophy Education of GPs to practice independently is experiential, and necessarily occurs within the context of the delivery of health care requires the supervising doctor to assume personal responsibility for the care of individual patients the essential learning activity is interaction with patients under the guidance and supervision of trainers who give value, context, and meaning to those interactions

The concept is —graded and progressive responsibility

Goals of Supervision assuring the provision of safe and effective care to the individual patient assuring each trainee’s development of the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine establishing a foundation for continued professional growth

Provision of Supervision Who?  GP trainer  Associate trainer  More advanced doctor How and by what means?  Sitting in - Physically present  Immediate availability (in the practice or by means of telephone)  Debrief - Post-hoc review with feedback

Levels of Supervision Direct Indirect  With direct supervision immediately available  With direct supervision available Debrief

“Direct Supervision” The supervising GP is physically present with the trainee and patient. – sitting in Pros Cons

“Indirect Supervision” with direct supervision immediately available  the trainer is physically within the practice or OOH centre, and is immediately available to provide Direct Supervision.

“Indirect Supervision” with direct supervision available – the supervising physician is not physically present within the practice or OOH centre, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision. Pros Cons

“Debrief” Debrief - The supervising doctor is available to provide review of cases with feedback provided after care is delivered Pro Con

Initial Assessment of the Trainee What stage are they in the journey towards independent practice? How do we assess this? What kind of a trainee are they?

SUPERB-SAFETY MODEL Farnan et al. J Grad Med Educ 2010; 2(1): 46-52

For Supervisors… Set expectations Uncertainty is a time to contact Planned communication Easily available Reassure fears Balance supervision and autonomy Farnan et al. J Grad Med Educ 2010; 2(1): 46-52

For Trainees… Seek supervisor input early Active clinical decisions Feeling uncertain about clinical decisions End-of-life care / legal issues – be aware Transitions of care You may need help with referrals/Computers Farnan et al. J Grad Med Educ 2010; 2(1): 46-52

CLEARLY MORE THAN JUST “SEE ONE, DO ONE, TEACH ONE” Supervision

Questions to consider What milestones, competencies, or criteria will we use to evaluate trainees performance and subsequent ability to progress to a more independent mode of practice? To become supervisors themselves? How will we document this for each patient care setting? How will we monitor this?

Disclaimer Most of the text was directly quoted from the ACGME Common Program Requirements