How to supervise a
resident and a student
at the same time?
Comment superviser un
résident et un étudiant
en même temps?
Kay-Anne Haykal OD. MD. CCFP
Undergraduate Director, DFM
No conflict of interest
Objectives
Supervision
Group supervision or supervision of multiple
learners
Models of supervision for students and residents
Residents as teachers
Supervision
Understanding it
Importance and effectiveness
Availability
Practical problems
Frequency
Style and structure
Interest of supervisors
Who should do it and how
Supervision activities :
what are they?
Discuss individual patients
Ensure patient safety
Provide informal feedback
Monitor the trainee’s performance
Discuss the management of specific disorders
Ensure that the trainee has an appropriate level and
amount of clinical duties
Provide feedback through appraisal
Give advice relevant to personal and professional
development
Address successes and problems of trainee performance
Give career development advice
Develop team work skills
Ensure the safety of trainee
Discuss and review the process of supervision
Teach specific techniques and procedures
Plan the trainee’s learning
Develop interpersonal skills
Develops communication skills
Develop presentation skills
Beside teaching
Videotaped consultations
Frequency of circumstances
of supervision
Appraisal meeting
Regular, specific meetings concerned with trainee’s
progress and development
Ward rounds
Informally
Induction meeting
Tutorials
“on the job” assessments
During specific tasks
During clinics
Clinical supervision
Essential at all levels of medical education
Complex activity
Occurs in a variety of settings
Has various functions
Has various modes of delivery
What authors agree on
supervision
Should be regular
Should be structured
Related to learning objectives
Has positive patient outcome
Content should include
Clinical management
Interpersonal skills
Personal development and reflection
Barriers to taking students
Increasing number of students
Overloaded health care
Critical placement shortages
Resource constraints/space
Workload pressures
Quality and interest of supervisor
Providing quality medical care
Maintaining efficacy
Time constraints
Collaborative group model
2 trainees or more (2 students or 1 student and 1
resident)
Take responsibility of their caseload
Learners support each other
Learners learn from each other
They take on more responsibility
Effective teamwork skills
Less dependent on staff
Productivity may increase
Challenges of collaborative model
Sharing resources
Ensure enough individualised feedback
Ensuring sufficient opportunities to observe
trainees are competitive
appropriate working relationships
Staff perceives it as more time consuming
but no substantial increase
Multiple mentoring model
A team of 2 or more learners is supervised by a
team of 2 or more staff
All staff share responsibility for each trainee’s
education
Trainees have individual case load
Trainees share knowledge and problem solve
together
Similar benefits and challenges to collaborative
group model
Additional advantages
Additional challenges
3 principle themes
Being clear in the chaos
Qualities of the service and people
Is it worth it? Challenges and benefits
Being clear in the chaos?
Supervision can be hectic and intense
Need to implement it in a carefully planned way
Structure : timetables, caseloads, space and
resources
Communication more direct
Student skills develop quickly
Qualities of the services and people
staff
Appreciation of other’s clinical practices
Work collaboratively
Discuss clinical reasoning
Students
Develop greater awareness of their own learning skill
Ability to adapt to diversity
Is it worth it? The challenges and benefits
Time demands and stress for both staff and students
Services benefits
Less experienced staff can supervise
Student supervision can occur in a high turnover
Increased time spent with patients
students learning more
More stress in the organisation of the placement and
monitoring of students and patients
Inconsistency among educations stressful to students
Clinical teacher 4 roles
Teacher role
Interested in teaching
Explain, discuss and answer questions
Instructor as a person
Supportive, easy and fun
Helpful and friendly
Physician role
Knowledgeable and clinically competent
Role model
Good rapport with patients
Supervisor role
Gives responsibility for patient care
Reviews patient with resident and student
Resident’s teaching
Demonstrate expertise and up-to-date
knowledge
Allows and encourages student participation
in patient procedure
Maintains a learning climate of respect and
support
Substantial if not more important component
of medical student education
Positive comments from students
Residents’ availability
Teaching activity
Operating room teaching
Commitment to teaching
Concern for student learning
Teaching effectiveness
Role as physician and supervision did not
change across their training years
Residents as teachers
Teachers
Increase resident awareness of the importance of
their role as a teacher
Improve teaching behavior
Residents as teachers courses
Resident teaching performance
Supervisors
Enhance residents’ management skills
Leadership skills
Positive comments from residents
View themselves as good teachers
Feel they possess adequate teacher
characteristics
Attitude toward students
Helps improve their clinical skills
Enjoyment of working with students
communication
Ease of pointing out students’ deficiencies
How to improve resident’s teaching
Communication about their teaching
responsibilities
Increase participation is student programs :
orientation, formal classes, clinical
Provide mid-rotation feedback to students
Monitor resident and student progress
Encourage and support resident
Conclusion
Multiple learners’ teaching is beneficial for
student and resident learning
Benefits outweighs the challenges
Need to be structured and planned
Residents teaching is effective for both
resident and student
Residents require training and guidance to
teach more effectively.
Thank you
Questions?
References
Teaching on the run: How to engage learners from different disciplines and
levels of training on a busy palliative care service. El-Sourady M., Moore D.,
Nelson J., Misra S., Karlekar M. Journal of Pain and Symptom Management.
Conference: Annual Assembly of the American Academy of Hospice and Palliative
Medicine and the Hospice and Palliative Nurses Association 2014 San Diego, CA
United States. Conference Start: 20140312 Conference End: 20140315. Conference
Publication: (var.pagings). 47 (2) (pp 406), 2014. Date of Publication: February
2014.
Supervising diverse student and trainee groups at multiple levels in high
volume work environments. Brazil V., Mudge A., Toombes S. Internal Medicine
Journal. Conference: RACP Future Directions in Health Congress 2012 Brisbane,
QLD Australia. Conference Start: 20120506 Conference End: 20120509.
Conference Publication: (var.pagings). 42 (pp 29), 2012. Date of Publication: May
2012.
Priorities during ward attending rounds differ by training level of team
members. Hagler B.D., Chandan P., Estrada C., Roy B., Huff N.G., Castiglioni A.,
Centor R. Journal of General Internal Medicine. Conference: 34th Annual Meeting
of the Society of General Internal Medicine Phoenix, AZ United States. Conference
Start: 20110504 Conference End: 20110507. Conference Publication:
(var.pagings). 26 (pp S284), 2011. Date of Publication: May 2011.
References
Clinical supervision of SpRs: where does it happen, when does it
happen and is it effective? Specialist registrars. Grant J. Kilminster
S. Jolly B. Cottrell D. Medical Education. 37(2):140-8, 2003 Feb.
What is effective supervision and how does it happen? A critical
incident study. Cottrell D. Kilminster S. Jolly B. Grant J. Medical
Education. 36(11):1042-9, 2002 Nov.
Practice educator perspectives of multiple mentoring in diverse
clinical settings. [References]. Copley, Jodie; Nelson, Alison. The
British Journal of Occupational Therapy. Vol.75(10), Oct 2012, pp. 456462. AN: Peer Reviewed Journal: 2012-30914-003.
Providing cross-discipline group supervision to new supervisors:
Challenging some common apprehensions and myths. [References].
Cassedy, Paul; Epling, Mike; Williamson, Liz; Harvey, Gale. Cutcliffe,
John R [Ed]; Hyrkas, Kristiina [Ed]; Fowler, John [Ed]. (2011). Routledge
handbook of clinical supervision: Fundamental international themes. (pp.
208-217). xxvii, 404 pp. New York, NY, US: Routledge/Taylor & Francis
Group; US. AN: Book: 2011-00188-019.
References
Effectively teaching diverse student groups : a reflection on teaching
and learning strategies. Trees, Kathryn. Australian Journal of Adult
Learning Volume 53 Issue 2 (July 2013)
A Tiered Mentorship Program Improves Number of Students With an
Identified Mentor. Kman N.E., Bernard A.W., Khandelwal S., Nagel
R.W., Martin D.R. Teaching and Learning in Medicine. 25 (4) (pp 319325), 2013. Date of Publication: October 2013.
Expectations and experiences of group supervision: Swedish and
Norwegian preceptors' perspectives. Andersson C.S., Danielsson A.,
Hov R., Athlin E. Journal of Nursing Management. 21 (2) (pp 263-272),
2013. Date of Publication: March 2013.
Nursing leadership from the perspective of clinical group supervision:
a paradoxical practice. Bondas T. Embase Classic+Embase Journal of
Nursing Management. 18 (4) (pp 477-486), 2010. Date of Publication: May
2010.
Group mentoring: a transition-to-work strategy. Scott E.S., Smith S.D.
Journal for nurses in staff development : JNSD : official journal of the
National Nursing Staff Development Organization. 24 (5) (pp 232-238),
2008. Date of Publication: 2008 Sep-Oct.
References
Development and preliminary validation of a measure for
assessing staff perspectives on the quality of clinical group
supervision. Horton S., Drachler M.D.L., Fuller A., Leite J.C.D.C.
International Journal of Language and Communication Disorders.
43 (2) (pp 126-134), 2008. Date of Publication: March 2008.
Group supervision in facilitating learning and teaching in
mental health clinical placements: A case example of one
student group. Saarikoski M., Warne T., Aunio R., Leino-Kilpi H.
Issues in Mental Health Nursing. 27 (3) (pp 273-285), 2006. Date
of Publication: April 2006.
Teaching to the level of the learner: The effects of a brief
faculty development intervention. Zgurzynski P., Zinzuwadia
S.N., Tubbs R., Woolley W., Smith J. Academic Emergency
Medicine. Conference: 2011 Annual Meeting of the Society for
Academic Emergency Medicine, SAEM Boston, MA United States.
Conference Start: 20110601 Conference End: 20110605.
Conference Publication: (var.pagings). 18 (5 SUPPL. 1) (pp S252),
2011. Date of Publication: May 2011.