Clinical and education supervision model guidelines

Definitions and guidelines on the role and responsibilities of clinical and education supervisors.

Whilst in many cases the doctor on the scheme will be placed in a practice under the supervision of an Educational Supervisor (ES), in some cases doctors on the scheme may spend a significant proportion of their practice placement with a Clinical supervisor (CS) supported by an Educational Supervisor (ES) in a different practice or location.

The following page sets out a framework and offers general principles and guidelines to support such a supervisory model, with the two supervisors, CS and ES, working together to make a make formal recommendations about progress and attainment of the appropriate skills and standards for satisfactory completion of the programme.

The CS and ES require training on how to work closely together and on how to support the doctor safely and appropriately through their placement.

Both the CS and the placement site will require formal approval of their learning and the environment.

The model also supports the development of CS competency, provides modelling for how supervisory capacity can be built in training hubs through triangulation but also addresses previously difficulties encountered with ESs reluctance to sign statements of competency where they have had limited direct observation of performance.

Gold Guide definitions of educational and clinical supervisors

The Gold Guide is the Reference Guide for Postgraduate Specialty Training in the UK and is applicable to all trainees (StRs) taking up appointments in specialty training, including GPs. Although doctors on this scheme are not trainees, they are still “learners” on a recognised educational programme and the definitions of Educational and Clinical Supervisors set out in the Gold Guide are helpful in explaining the role of supervisors in this scheme. For the full guide, visit the Conference of Postgraduate Medical Deans of the United Kingdom (COPMeD) website.

The following definitions are directly taken from the Gold Guide.

Educational supervisors

2.49 An educational supervisor is a named 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. The educational supervisor is jointly responsible with the trainee for the trainee's educational agreement.

2.50 The educational supervisor is responsible for collating evidence of the performance of a trainee in a training placement, providing feedback to the trainee and agreeing action plans to ameliorate any concerns or issues identified (see paragraph 4.32)

Clinical supervisors

2.51 Each trainee should have a clinical supervisor for each placement to ensure that educational governance requirements are met. This arrangement is distinct from the requirement for supervisory arrangements to meet local clinical governance requirements. A named clinical supervisor is a trainer who is selected and appropriately trained to be responsible for overseeing a specified trainee's clinical work and providing constructive feedback during a training placement. Some training schemes appoint an educational supervisor for each placement. In integrated academic training, a trainee will also have a named academic supervisor.

2.52 All trainees must have a named clinical and educational supervisor for each placement in their specialty programme. It is normal practice for these roles to be undertaken by different people but (in some elements of a rotation) the same individual may provide both clinical and educational supervision. In such a circumstance, the respective roles and responsibilities should be clearly defined.

Explanation of roles

With the Gold Guide definitions presented, we have also taken the time to include a more accessible, easier to read definition of the roles below.

The roles and responsibilities in relation to the clinical and educational supervision of doctors are as follows.

Clinical supervisor role

A clinical supervisor:

• is responsible for ensuring that appropriate supervision of the doctor's day-to-day clinical performance
• is responsible for overseeing the clinical work of the doctor and for providing constructive feedback on that work
• provides regular assessment and written feedback to both doctor and the ES
• agrees to support a schedule of contact for the doctor with the ES, which should be no less than once a month
• meet with the doctor at least once daily and less frequently as agreed with the ES as the placement progresses, subject to satisfactory and safe progression (daily supervision may be provided by a partner or suitable approved clinician)
• document meetings with written feedback recorded in the WPBA report (weekly)
• undertaking and support appropriate assessments of performance including a MSF, PSQ, observations of practice and cased based discussions
• will meet with the doctor and the ES for a joint planning meeting which could be before or at the start of the placement and agree a written educational plan

In addition, the CS provides the programme, as part of the agreed induction plan, for the doctor based on their previous experience and identified needs to include:

• introduction to the NHS (regulations, structure etc.)
• GMC “Good Clinical Practice”
• professional boundaries in the NHS
• induction to the practice and staff roles
• patient safety
• clinical prescribing
• protocols (NICE guidelines etc.)
• management and referral of patients
• NHS Computer systems and Clinical record keeping

Educational supervisor role

The GMC definition of an educational supervisor is 'A trainer who is selected and appropriately trained to be responsible for the overall supervision and management of a specified doctor’s educational progress during a placement or series of placements.'

Given this, the ES:

• is responsible for the doctor’s Educational Agreement.
• is responsible for the overall supervision and management of the trajectory of learning of the doctor and their educational progress
• guides the doctor and helps them plan their training and achieve agreed learning outcomes
• is responsible for the educational agreement and for bringing together all relevant evidence to form a summative judgement at the end of the placement
• and CS will include a summary of progress in the final review – with both supervisors contributing to the decision-making process
• will sign off the whole programme
• will facillitate a minimum of one session per month in their practice with the doctor, which can be combined where required with the monthly review
• review meeting should include opportunities for direct patient consulting, observation of practice through indirect means (recordings of consultations) and case based discussion

In the situation where the doctor is placed in a different practice to the ES (“hub and spoke” model) the ES should meet with the CS and doctor as agreed monthly or more frequently if required, including:

• before the start of the practice placement and then at two weeks
• thereafter (subject to satisfactory progress) these will be monthly
• a formal final review meeting with the doctor, the CS and the ES to allow the sign off of the programme to be competed.

Outcome recommendations

The ES needs to be in a position to assure HEE and the NHS England Team that the doctor has been inducted or returned to a sufficient standard in order to undertake independent practice at the final review.

Recommendation by ES of candidate for full NPL can conclude in one of three ways:

• strongly without reservation
• could recommend as competent
• have some reservations, so could not recommend

Other notes

The ES will be an approved and a current GP trainer. The approval process is managed by HEE. They will, therefore be known to the GMC and listed as an ES by the GMC.

All scheme placements should be agreed by the local HEE team (Educational Lead) in agreement with the relevant NHS England Medical Director (MD) or Regional Officer (RO) or deputy.

The CS should have appropriate MDO indemnity for their scheme role.

Placements with a CS should be restricted to Band 4 MCQ outcome recommendations and will always be for a minimum of 3 months.

Any changes to the recommended placement period will only be made following a review by the ES and the scheme lead and in agreement with the NHS England MD.

HEE requirements

In accordance with HEE standards, the organisation should:

• provide CS with appropriate training and undertake formal approval of the practice or training site
• maintain a register and support CS with follow up support and refresher training
• inform the relevant NHS England team and the NRO of the named CS
• establish a formal network of CSs linked to one or more approved ES