Observational Feedback as a
Supervisor’s Tool
Is it JUST for the struggling registrar ?
Learning Objectives
• 1. Develop an improved understanding of
the role of observational feedback as a routine
Supervision activity
• 2.
Practise delivering feedback to
Registrars with different learning needs
• 3.
Share and workshop experiences of
enabling “one a week” to occur in your
individual clinic setting
What Are We Looking For ?
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Introduction
Doctor : patient relationship
Communication skills
History taking, reasons for attendance
Physical examination
Problem definition, preventive health
Explanation & management
Conclusion, safety netting
Time management
Record keeping
• https://www.youtube.com/watch?v=noMfGD
TIKNU
Learning Objectives
• 1. Develop an improved understanding of
the role of observational feedback as a routine
Supervision activity
• 2.
Practise delivering feedback to
Registrars with different learning needs
• 3.
Share and workshop experiences of
enabling “one a week” to occur in your
individual clinic setting
• Ruth / Rick is a shy GPT2. (S)he is on Remediation
due to borderline results of clinical assessments
in the last Term. You have been briefed by her /
his Training Advisor who has told you to “keep a
close eye”, as (s)he takes forever to get things
done and “really needs to be pushed”. In a recent
clinical encounter you notice (s)he has taken over
an hour to take a history on Mrs Gurramurra, a
patient with asthma and yesterday her / his case
presentation was very long and tedious.
• Kim is aged 35, married with 2 children. She is early in her
GPT1 term in an Indigenous Health Training Post. She
graduated from a Chinese University and soon after
emigrated to Australia. She had a reasonable range of
experience here initially, then took several years off to have
her children. She has been doing mainly Emergency jobs in
the last two years. She is quiet and reserved and she has a
strong accent. The staff report that she is very polite and
willing. Patients seem to like and respect her but often
seem unsure about what they are expected to do. Older
patients especially say they have difficulty understanding
her. In your teaching sessions you have found large gaps in
her medical knowledge and the feedback from NTGPE’s pre
assessment confirms this.
• Jason / Jade is a PRRT1 in a small town hospital. (S)he has been under your
supervision in the emergency department for over 2 weeks. Your
impression of Jason / Jade is that (s)he is knowledgeable and highly
competent in his / her clinical practice. (S)he also appears to be extremely
confident in tackling anything new. Some of the staff think ‘Jase’ / ‘J’ is a
great bloke / gal to have around as (s)he is so capable of doing anything
asked of him / her. (S)he even likes to have a bit of a joke around in the tea
room which lightens up the mood in an otherwise busy and stressful ED.
Other staff have voiced some concerns about his / her bedside manner
saying that (s)he often fails to introduce him/herself to patients, has been
observed speaking abruptly to them and treats some of the nursing staff
in a condescending manner. On one occasion you overhear an interaction
between Jason / Jade and a patient with a mental health problem. Jason /
Jade’s manner is aggressive towards the patient and (s)he appears to be
annoyed at the behaviour the patient is exhibiting. You notice Jason / Jade
walk away and joke with a nursing student about the mental state of the
patient.
• Daniel(le) is repeating his / her PRRT4 due to
unsuccessful completion in the previous Term. He
passed his / her exams and tasks but must now pass all
clinical requirements. (S)he arrives at his / her
community based placement displaying a demeanour
of boredom and disinterest. You ask Daniel(le) for his /
her Learning Plan and (s)he gives you last year’s version
with ‘bits’ missing and you note (s)he has left his / her
stethoscope at home. You ask him / her to assess a
patient for discharge. (S)he declines on the basis that
(s)he has already done this sort of thing before on his /
her last clinical placement. (S)he asks you for
something more interesting to do.
• Chris is a GP Registrar in a Military Medicine ESP Term.
Chris’s philosophy has always been to ‘take the easiest
road’. You are his / her clinical supervisor and on meeting
him / her you notice this laid back attitude such as often
arriving late for clinical tutorials or leaving early. You also
notice that (s)he has a very casual manner with patients.
During feedback Chris comments that (s)he has been told
before that (s)he is too casual, but believes that his / her
style of interaction is important in establishing rapport with
ADF patients. As the clinical teacher, alarm bells start
ringing when you see the following on a patient ward chart
:
• Chris’s findings – afebrile, sinus rhythm, BP 120/80
• Real findings – temp 39, atrial fibrillation, BP 90/60
• Maria is a 44 yo IMG who originally came from the
Philippines where she had been a cardiologist in a large
hospital. She is in the first few weeks of her GPT2 term
doing RACGP pathway under the AGPT. The practice staff
report she is rather aloof and can be quite demanding.
Several patients have complained that she seems more
interested in the computer and in their investigation results
than in them as people. In the few teaching sessions you
have had she seems very knowledgeable about most areas
of clinical practice and has corrected you on a few
occasions! She gets through the work well and her medical
records are excellent. She has firmly resisted your request
to sit in on her consultations.
• Ali is from Iraq. His English is good. He is married to an
Australian. He has had limited hospital experience. He is in
the middle of GPT1 at a mainstream general practice. He
gets on well with practice staff and there have been no
adverse reports from patients. He seems to have a
reasonable grasp of clinical medicine but admits he cannot
understand why so many patients come with minor
complaints. He feels embarrassed when they introduce
personal matters into the consultation and feels that this is
not appropriate to be dealt with by a doctor. He has little
idea about community resources and relies a lot on making
referrals to the local hospital and on phoning hospital
colleagues for advice.
Slow Learner
• Be explicit about time frames.
• Consider providing more time to meet objectives and
provide extra learning sessions.
• Allow more time to practise and offer extra
encouragement
• Concrete examples of time management
• Address knowledge / skills deficits
• Encouragement and exploration of fear of failure
• Provide safe ‘risk taking’ opportunities
• Address language barriers with strategies specific to
those from NESBs
Unmotivated Learner
• Discuss the learner’s professional responsibility to their patients,
supervisor and practice.
• Highlight the learner’s responsibility to meet training objectives.
• Relevant learning opportunities ?
• Bridging theory-to-practice gap ?
• Appropriate determination of learning needs at outset ?
• Explore other issues that may be leading to lack of motivation:
– Long term – is becoming a GP right for them?
– Acute – are there any other issues at play?
– Subject matter – is this an area that is just not of interest to them?
Incompetent Learner
• Initial determination of learning needs
• Offer self-directed learning projects. For example, ask them
to look up a condition and complete a presentation.
• Focused, structured teaching
• Provide a safe environment. Where possible, offer the
learner an opportunity to practise on supervisor or a
practice staff member first; or in a simulation setting.
• Critical incident debrief ( & defuse )
• Internal & external drivers ?
• Counselling ?
• Reporting ?
Poorly Interacting Learner
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Insight ?
Learner aware of your view as supervisor ?
Clear standards of acceptable behaviour ?
Need time set aside to address concerns and
implement a plan
MONITOR
LIAISE
AND PLEASE, PLEASE
DOCUMENT !!