Content for Educational / Clinical Supervisor Face to Face/Virtual session; a guide for DMEs

Summary

Marina Flynn’s presentation is a guide to effective educational supervision of medical trainees. It covers supervisors’ responsibilities, teaching and feedback, inclusion, employment and training arrangements, support for trainees in difficulty, and the processes used to assess and maintain progression.

1. The purpose and role of supervision

• Supervision combines educational, supportive and managerial functions.
• Trainees may focus on learning practical tasks—such as performing a procedure or running a clinic—while supervisors also need to help them understand how to work safely within the healthcare system and service.
• The central aims are safe, effective patient care and professional development.
• Good supervisors show commitment, provide support and guidance, listen, encourage self-awareness and emotional management, and model positive professional behaviour. Protected time for supervision matters.
• Trainees can be hardworking and caring clinicians but still fall behind if they do not engage with their curriculum or portfolio. Supervisors should explain the consequences and help them get back on track.
• Concerns about unsafe practice, poor teamwork or disruptive behaviour should be addressed early. If concerns are significant, involve the appropriate training or medical education leads rather than letting problems persist.

2. Teaching, assessment and learning opportunities

The presentation describes learning as involving three connected areas of professionalism:

• Knowledge: Address gaps through reading, e-learning or case-based discussion.
• Skills: Teach and practise the task using supervision, simulation, models, skills labs or other learning resources. Deliberate practice can help develop procedural skills.
• Attitudes and non-technical skills: Address communication, teamwork and other behaviours relevant to safe care. Explore concerns sensitively and promptly, drawing on observation and multi-source feedback where appropriate.

Assessment should move beyond testing factual recall. Trainees need opportunities to explain how they would apply knowledge, demonstrate skills and put learning into practice in real clinical settings, including the relevant human factors.

Workplace-based assessments should be chosen to fit the learning situation. Examples mentioned include case-based discussions, mini-CEX, direct observation of procedural skills, simulation and OSCE-style assessment.

3. Structuring a teaching session

A practical approach for a clinical learning encounter is to:

1. Agree learning objectives.
2. Decide which assessment or observation tool suits the task.
3. Observe the trainee and give feedback.
4. Agree what the trainee will work on before the next meeting.
5. Complete the assessment promptly, while the event is still fresh.
6. Debrief and discuss any barriers to learning or ways the clinical environment could improve.

The trainee should submit the agreed assessment, and both parties should understand their responsibilities. Routine clinical work can still provide useful learning when its educational purpose is made explicit.

4. Giving effective feedback

Feedback should help trainees improve competence and confidence. The presentation recommends that it be:

• Timely: Given immediately or within a few days of the learning event.
• Private: Avoid putting an individual on the spot in front of a group.
• Specific and based on observable behaviour: Describe what was seen rather than using vague judgments such as “you weren’t very good.”
• Balanced and practical: Identify what went well and offer alternative strategies for what could be improved.
• Two-way: Use open questions to prompt the trainee’s reflection and discuss what feedback style works for both people.
• Given by someone credible for the task: This need not always be a consultant; other trained team members, such as nurses, pharmacists or physiotherapists, may be well placed to give feedback.

Supervisors should remember that a task that feels routine to an expert may be new to a trainee.

5. Objectives, meetings and reflection

• Set objectives using a SMART approach: specific, measurable, achievable and realistic for the placement and workload. Include a review point so the trainee knows when progress will be revisited.
• At the start of a placement, clarify what the trainee needs to achieve in the training year and incorporate relevant prior ARCP targets into the work schedule where possible.
• Record the discussion, agreed objectives, and the date and time of the next meeting in the portfolio. Meetings can take place in person or remotely.
• At follow-up meetings, review progress against the original objectives and record what has changed.

For reflective practice, the presentation recommends the “What? So what? Now what?” framework:

• What? Describe what happened, what the trainee was trying to achieve and how they felt.
• So what? Explore why the event mattered, what was learned, and its consequences for the patient, family or team.
• Now what? Consider what should happen next, what might be done differently, and whether policies or practice need to change.

Reflection can be about positive events as well as difficult ones. More experienced trainees are expected to show deeper consideration of the wider consequences of events, including communication and departmental practice.

For distressing or high-profile incidents, supervisors should discuss the event privately, offer support and allow time for reflection. Reflections should be neutral and should not identify patients or staff, assign blame, or simply reproduce a formal incident statement. Supervisors should review what the trainee writes and use relevant college or portfolio guidance.

6. Inclusion and differential attainment

The presentation highlights that trainees may enter the NHS with different cultural, educational and communication backgrounds. Supervisors should avoid assuming that unfamiliarity with local ways of working means a lack of ability. They should explain expectations clearly, be mindful of language and colloquialisms, and help trainees feel welcome.

Differential attainment refers to differences in outcomes between groups of trainees. The presentation links this to factors such as inclusion, access to support, learning styles, language barriers and unconscious bias. It calls on supervisors and departments to:

• Examine how recruitment, induction, teaching and support affect different groups.
• Recognise that trainees may have different social networks and familiarity with the NHS.
• Provide appropriate induction and tailored support, including for international medical graduates.
• Make unconscious bias visible and challenge it rather than allowing it to influence assessment.
• Consider how departments can promote inclusion and use reverse mentoring, in which learners help supervisors understand their experience of the working environment.

Examples of bias discussed include affinity, conformity, contrast, benevolence, stereotyping, and “horns and halo” effects. Assessment should be based on evidence and observed performance, not whether someone resembles the assessor or fits the team’s expectations.

The presentation also uses a support-and-challenge framework: low support and low challenge can lead to inertia; high support with little challenge can create complacency; and high challenge with little support can create stress and burnout. The desired environment provides both high support and high challenge.

7. Training arrangements, contracts and working patterns

• The presentation explains that funding is provided to trusts for trainee posts and includes an allocation for educational supervision. In return, trainees should receive training opportunities and appropriate supervision while also contributing to service work.
• Trainees should receive their generic work schedule and rota before starting a post, then meet their educational supervisor to discuss specific goals and agree the schedule.
• If a trainee and trainer cannot agree, the guardian of safe working may mediate.
• Trainees should submit exception reports when working hours are breached, training is not being provided, or patient safety is a concern. These should be raised promptly; patient-safety concerns need to be addressed within 24 hours. The educational supervisor should review reports with the trainee and agree appropriate action. Repeated problems may require a work-schedule review.
• Less-than-full-time (LTFT) training is increasingly common. Supervisors should consider how training and service duties are shared fairly, and how the rota can accommodate trainees. LTFT trainees still undergo an annual ARCP review, and the supervisor’s report should assess progress proportionately to their training.
• Supervisors should discuss concerns if a trainee’s working pattern, health or extensive locum work may be affecting wellbeing or training.

8. Supporting trainees in difficulty

A change in performance may be related to health, workload, training problems, sleep loss, caring responsibilities or other pressures. Supervisors are not expected to diagnose the underlying cause, but should recognise that something may be wrong and try to help.

The recommended response is to:

1. Clarify what has been noticed.
2. Verify the facts and gather relevant evidence.
3. Explore the trainee’s perspective and possible contributing factors.
4. Document the concern and actions taken.

Encourage the trainee to seek support through their GP and relevant organisational or training services. Involve the appropriate college tutor, training programme director, clinical lead, director of medical education or other senior contacts, depending on whether the issue concerns conduct, employment or education. Significant concerns should be escalated early.

9. ARCP, revalidation and returning to training

• Supervisors should understand the Annual Review of Competency Progression (ARCP) process, know the trainee’s curriculum and portfolio, and base their report on evidence. Reports should include mitigating factors where relevant.
• Taking part in ARCP helps supervisors develop their practice and supports trainees’ progression.
• Revalidation is related to, but separate from, ARCP. Trainees must complete the relevant forms and report matters such as complaints, serious incidents and complications, as well as the full scope of their practice.
• The presentation describes a support process for doctors returning to training. For planned absence, it recommends a pre-absence meeting and an individual return-to-work plan.
• Trainees returning after an absence of more than three months may receive a period of supernumerary time. “Keeping in touch” days can be used for activities such as simulation, supervised clinical work or courses, if planned in advance.

10. Supervisor development, resources and resilience

• Supervisors should record their educational work for appraisal, using evidence such as ARCP participation and workplace-based assessments.
• They should access available GMC, academy, deanery and other education resources, and pursue relevant development opportunities.
• Supervisors need suitable time and resources to do the job; the presentation refers to allocated job-plan time for educational supervision.
• Supervisors should attend to their own resilience as well as helping trainees develop theirs, to support a sustainable workforce and safe patient care.

Workshop activities

The presentation proposes group discussions and exercises on:

• What supervisors find rewarding or difficult, and what they want to learn in the workshop.
• Making routine clinical encounters into learning opportunities.
• How non-technical skills affect patient care and how to assess them.
• Which workplace-based assessment suits different situations.
• Appropriate and inappropriate feedback.
• Producing contrasting examples of poor and good reflective practice.
• Improving inclusion within departments and learning from trainees through reverse mentoring.

Speakers and sources featured

• Speaker: Marina Flynn, identified in the presentation as a former deputy DME at Hull Trust.
• Named people, cases, frameworks or sources referenced: Steve Jobs (as an example of the value of mentorship); Kilminster (supervision and feedback research); the GMC’s Reflective Practitioner guidance; Maslow’s hierarchy of needs; and the Dr Bawa-Garba case.
• Organisations and resources mentioned: The GMC, HEE/Health Education England, the deanery, NACT (the subtitle transcription is uncertain), medical schools and postgraduate training bodies. No other speaker is identified in the subtitles.