CLINICAL AND EDUCATIONAL SUPERVISION OF
DOCTORS IN TRAINING
Version
4
Name of responsible (ratifying)
committee
Educational Governance Committee
Date ratified
21st August 2013
Document Manager (job title)
Paul Sadler (Director of Education
Date issued
04th November 2013
Review date
September 2016
Electronic location
Clinical Policies
Related Procedural Documents
Trust Policy For The Handling Of Concerns
And Disciplinary Procedures Relating To The
Conduct And Performance Of Doctors And
Dentists
The Wessex Deanery Strategy for dealing with
Doctors in Difficulty
Key Words (to aid with searching)
Doctors in training; Clinical supervision;
Educational supervision; Leadership;
Supervisors; Professional education; Training;
Medical staff; Patient care; Commission for
Healthcare Audit and Inspection; Supervision;
Teaching methods; Clinical teachers;
Supervisors; Health and safety; Occupational
health and safety; Multidisciplinary training;
Clinical guidelines
Clinical and Educational Supervision of Doctors in Training Issue 4 04/11/2013
Review date 01/09/2016
Version Tracking
Version
Date Ratified
Brief Summary of Changes
Author
1
14.03.2008
PG
2
03.09.2008
Review date extended from January 2008 by Chair
of Professional Advisory Committee
New author, new recommendations for training
courses for educational supervisors and new
references added in the appendix. The wording of
the document has also been altered to give the full
titles of relevant professional bodies.
2
09.07.2009
PG
3
30/09/2012
3
08/08/2013
: Policy reviewed by Author- no changes other than
review date extended from October 2009, revised
issue date and issue number
Review date extended due to change in DME and
new GMC guidance to be issued which will
dramatically effect the document
New author, re-write of requirements related to new
national guidance issued by GMC with clear
statement of training and appraisal standards to be
met. Roles and responsibilities updated.
Clinical and Educational Supervision of Doctors in Training Issue 4 04/11/2013
Review date 01/09/2016
PG
PS
PS
CONTENTS
1.
2.
3.
4.
5.
6.
7.
8.
9.
Introduction / background
Status
Purpose
Scope/audience
Definitions
Process
Duties and responsibilities
Training
Associated documentation / references (including related policies and
procedures)
Clinical and Educational Supervision of Doctors in Training Issue 4 04/11/2013
Review date 01/09/2016
1.
INTRODUCTION
1.1 This policy is required for safe patient care, support of doctors in training
and to demonstrate compliance with Local Education Training Board and
General Medical Council Standards.
1.2 All trainee doctors require high quality supervision in the workplace to help
them to, make the most of all training opportunities, progress in the direction
they require to meet the requirements of their curriculum, and develop a
record of their training to evidence this at review.
2.
PURPOSE
2.1 Outline procedures for supervision.
3.
SCOPE
3.1 All medical staff
3.2 Every doctor in training must have a named clinical and educational
supervisor at all times.
3.3 ‘In the event of an infection outbreak, flu pandemic or major incident,
the Trust recognises that it may not be possible to adhere to all aspects of
this document. In such circumstances, staff should take advice from their
manager and all possible action must be taken to maintain ongoing patient
and staff safety’
4.
DEFINITIONS
4.1 A Clinical Supervisor is the named clinician responsible for overseeing
the clinical performance of an individual trainee within a clinical placement.
4.2 The overall aim of clinical supervision is to ensure that the trainee is
safe to carry out the clinical work he/she is expected to do within the
department, and that he/she progresses within this particular training
post/module. This will include direct input to workplace-based assessment.
4.3 The clinical supervisor is responsible for giving informal feedback to
trainees and may discuss objectives and record progress on a more formal
basis. The named clinical supervisor within a trainees placement should be
responsible for flagging any areas of concern to the trainee’s educational
supervisor.
4.4 An Educational Supervisor is a trainer who is selected and appropriately
trained to be responsible for the overall supervision and management of a
specified trainee’s educational progress during a training placement or series
of placements.
Clinical and Educational Supervision of Doctors in Training Issue 4 04/11/2013
Review date 01/09/2016
4.5 The main aim of educational supervision is to ensure the overall clinical
and educational progress of the trainee through training covering a number of
placements and includes responsibility for regular appraisals, the collation of
workplace-based assessment outcomes, and the provision of career advice
and support as required. The educational supervisor is specifically
responsible for the learning agreement.
4.6 Clinical supervision and educational supervision are often provided by the
same person. The Wessex Local Education and Training Board (LETB) is
however actively promoting a separation of the two roles, which means they
need to be properly managed, and relevant information about progress and
performance needs to be exchanged on a regular basis.
5.
DUTIES AND RESPONSIBILITIES
5.1 Requirement under Health and Safety at Work act to provide information
on appropriate supervision in the workplace.
All clinical supervisors to note.
All trainees to be aware.
All educational supervisors to note.
Director of Postgraduate Medical and Dental Education.
5.2 The trainee also has responsibilities and these are outlined in the
educational agreement. In essence the trainee agrees to take an active part in
the appraisal process, setting objectives and developing a personal
development plan. They are expected to identify their learning needs and also
to recognise their own level of competence. This is formally recorded on their
initial learning agreement and development plan and should form the basis of
discussion with their educational supervisor. All trainees should include this
information in their portfolio. These responsibilities are emphasised at junior
doctor induction.
6.
PROCESS
6.1 Every doctor in training must have a named clinical and educational
supervisor at all times.
6.2 All Clinical Supervisors:
a. Should meet with the trainee as early as possible in the job (ideally within
the first fortnight) and ensure they have received an appropriate local
induction for the department or area they are to work in.
b. Must offer a level of supervision of clinical activity appropriate to the
competence and experience of the individual trainee.
c. No trainee should be required to perform or assume responsibility for a
clinical, operative or other technique in which they have insufficient
experience and expertise.
d. Trainees should only perform tasks without direct supervision when the
supervisor is satisfied regarding their competence to do so.
e. Both trainee and supervisor should at all times be aware of their direct
responsibilities for the safety of patients in their care.
f. Must inform the educational supervisor of any concern related to trainee
performance.
Clinical and Educational Supervision of Doctors in Training Issue 4 04/11/2013
Review date 01/09/2016
g. May provide supervision at four levels:
h. Direct supervision in the operating theatre, the ward or the consulting room.
i. Close but not direct supervision e.g. in the theatre suite, in the next door
room, reviewing cases and process during and/or after a session.
j. Availability on site within minutes, and regular review of cases.
k. Off site, but accessible promptly by telephone, and reasonably rapidly in
person along with regular review of cases.
l. May delegate, thoughtfully and responsibly, periods of supervision to a
sessional or workplace supervisor. This role can be fulfilled by, a fellow
consultants/general practitioner, a senior trainee or specialist, or an
appropriately trained and experienced practitioner, but only in appropriate
circumstances. The clinical supervisor remains responsible and accountable
overall for the actions of doctors in training. For every patient it needs to be
clear where responsibility for supervision lies.
6.3 Safe and effective clinical care at night requires that hospitals (and
integrated healthcare systems) establish multidisciplinary and multiprofessional teams that include doctors in training. With appropriate induction
(cross-specialty when cross-cover is required), managed hand-over and a
clear team understanding of individual competencies, safe clinical care will be
maintained. Strong leadership is a requirement, with overall responsibility
residing with a named consultant working in partnership with a senior nurse.
The move to full shift working, especially in systems (hospitals) with small
numbers of doctors in the rota, could profoundly restrict a doctor’s access to
clinical supervision. Dedicated senior supervision of emergency work is
mandatory for all healthcare systems and in future professional demarcation
will be replaced by defined competence to offer safe supervision. The clinical
supervisor should ensure this is occurring.
6.4 All Educational Supervisors:
Must be approachable and enthusiastic, offering a level of supervision and
review appropriate to the grade and specialty of the individual trainee; no
trainee should be expected to occupy a training position without a regular
review by their educational supervisor.
a.
Are responsible for ensuring that relevant information about progress and
performance is made available from clinical supervisors on a regular and
routine basis to inform assessment procedures (e.g. RITA, ARCP).
b.
Be responsible for ensuring systems that provide fair and nondiscriminatory feedback from clinical supervisors and the collation of such
evidence.
d.
Are responsible for maintaining an appropriate record of performance for
each trainee and for contacting Deanery representatives should the
performance of any individual trainee give rise for concern.
e.
Should ensure that evidence is gathered from the multi-professional team
in situations where they may be more able to reflect the performance of a
trainee than the assigned medical clinical supervisor. The supervisor
should report on this as required for any specific training programme.
f.
Are responsible for providing feedback on performance at least twice in
every 6 month post to each trainee.
Clinical and Educational Supervision of Doctors in Training Issue 4 04/11/2013
Review date 01/09/2016
g.
Must ensure any Serious Untoward Incidents and complaints involving
the trainee are, discussed, and a reflective note written in the portfolio.
This should be mentioned in the Educational Supervisors Report for
ARCP and revalidation.
h.
Must ensure that the time requirement is discussed and identified in their
job plan as per the Trust’s job planning process.
i.
Compliance with the policy will be monitored via Departmental and Trust
Postgraduate Medical Education systems. Feedback will be given to the
deanery.
j.
Compliance will also be demonstrated in reports annually to Heath
Education Wessex and by Deanery / General Medical Council (GMC)
visits.
k.
Compliance is triangulated using the annual trainees and trainers GMC
questionnaire results.
7.
TRAINING REQUIREMENTS
All named clinical supervisors must be fully trained in this role in the area of
clinical care and understand their responsibilities for patient safety. They
should be actively involved in teaching and training in the workplace.
If an individual is named as a clinical supervisor in a trainees portfolio, the
requirements for appointment, training, and appraisal are now all laid down in
“Recognition and Approving Trainers: the implementation plan” GMC August
2012. Completion of this will be monitored at a Trust level and reported on to
the GMC via HE Wessex.
All educational supervisors must have prepared themselves adequately for
the role and have an understanding of educational theory and practical
educational techniques.
They should have: 1. Attended a designated training course meeting the requirements
of the Academy of Medical Educators (2010) and the GMC August
2012
2. Have then been appointed to the role
3. Taken part in annual appraisal covering their educational role.
8.
REFERENCES AND ASSOCIATED DOCUMENTATION
1. A Guide to Management and Quality Assurance of Postgraduate Medical
and Dental Education. Academy of Medical Royal Colleges and COPMeD
UK ( August 2000).
2. Hospital at Night Implementation Resource Pack. NHS Modernisation
Agency (2004).
3. Hospital at Night at PHT: A guide for staff. Portsmouth Hospitals Intranet
(November 2011) Version 4.
4. Foundation E-Portfolio Trainee Guide
5. Foundation Reference Guide 2012
Clinical and Educational Supervision of Doctors in Training Issue 4 04/11/2013
Review date 01/09/2016
6. Educational Supervisor Time and SPA. Wessex Deanery Policy
Statement March 2010
7. Recognising and approving trainers: the implementation plan. General
Medical Council August 2012
8. A Framework for the Professional Development of Postgraduate Medical
Supervisors. Academy of Medical Educators (2010)
9. Trust Policy For The Handling Of Concerns And Disciplinary Procedures
Relating To The Conduct And Performance Of Doctors And Dentists
10. The Wessex Deanery Strategy for dealing with Doctors in Difficulty
9.
EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is
reasonably practicable, the way we provide services to the public and the way
we treat our staff reflects their individual needs and does not discriminate
against individuals or groups on any grounds.
This policy has been assessed accordingly
All policies must include this standard equality impact statement. However,
when sending for ratification and publication, this must be accompanied by
the full equality screening assessment tool. The assessment tool can be
found on the Trust Intranet -> Policies -> Policy Documentation
Clinical and Educational Supervision of Doctors in Training Issue 4 04/11/2013
Review date 01/09/2016