Best Practice Supervision

Facilitate learning and provide teaching

• → Assisting registrars to identify their learning needs and help them plan learning

• → Providing registrars with formal in-practice teaching

• → Providing registrars with assistance with clinical queries and opportunistic informal teaching

• Identify and discuss learning needs before the registrar starts seeing patients and ongoing throughout the term
• Use a range of tools and methods to help the registrar identify their learning needs
• Focus on ‘unknown’ learning needs
• Consider non-clinical learning needs eg. consultation skills, professionalism
• Consider the process of planning learning as integral to teaching and assessment

• Focus on skill development rather than knowledge acquisition, especially encouraging your registrar how to ‘think like a GP’
• The consultation is the centrepiece of general practice education – ensure a focus on consultation skills development
• Involve a wide range of staff members in formal teaching e.g. practice nurse, practice manager
• When teaching, adopt an ‘ask before tell’ approach i.e., always probe the registrar for their understanding first before offering your advice
• Use a wide variety of teaching methods – keep it fresh!
• Use ‘topic tutorials’ to help plug gaps in clinical exposure

• Explicitly discuss how and when the registrar should ‘seek help’ i.e., how to contact the supervisor etc.
• Use the ‘Call for Help’ list to help identify when the registrar should call for help
• Schedule sufficient time in the day for provision of ad hoc supervision e.g., book fewer patients, especially in the first weeks
• Reassure the registrar that questions, interruptions, and ad hoc teaching is both expected and essential for patient safety and learning

Assess performance and provide feedback

Feedback is at the heart of effective teaching and clinical supervision. Feedback can be formal, as part of structured performance reviews, or informal (‘on the run’).

GPSA have developed a specific guide to Giving effective feedback.

Undertake assessments

In comparison to ‘summative’ assessment (assessment of learning, for example in the fellowship exams), so-called ‘formative’ assessment is assessment for learning. Formative assessment is the in-practice assessment of performance that supervisors undertake with registrars throughout the placement. Formative assessment can be both formal, for example direct observation and random case analysis, or informal.

Provide effective feedback

Feedback is at the heart of effective teaching and clinical supervision. It is an essential element of the supervision process to help develop a registrar’s knowledge and skills. Feedback is ideally not one-way, but should be more of a two-way dialogue. Feedback can be formal, as part of structured performance reviews, or informal (‘on the run’).

To be effective, feedback needs to be:

• → Based on observation
• → Specific and relevant
• → Given in a timely manner
• → Given in a non-threatening environment
• → Descriptive rather than judgemental.

• The fundamental teaching methods to best assess performance are direct observation, problem case discussion, and random case analysis – use them often
• Sit in with your registrar on the first day, and have them sit in with you
• Competence is broad and includes non-clinical aspects of practice – ensure assessment of professionalism and other skills
• Don’t regard ‘assessment’ as a separate undertaking to that of identifying learning needs, teaching or feedback – they are all part of a cohesive approach to supervision
• Seek assistance early when needing to identify and manage issues for the registrar in difficulty
• Establish the process for formal and informal feedback at the commencement of term

Monitor and support patient safety

• → Call for help list
• → Assessment of past experience and training
• → Self-assessed competence and confidence
• → Reports from previous GP placements
• → Results of knowledge quizzes
• → Assessment of approach to high-risk clinical situations
• → Direct observation
• → Random case analysis

• • Explicitly discuss patient safety with the registrar as the most fundamental element of supervision
  • Be available, accessible, and approachable
  • Ensure that the registrar knows that you ‘have their back’
  • Conduct regular supervision team meetings

Ensure registrar wellbeing and safety

• • Be available, accessible, and approachable
  • Conduct an initial safety assessment and match the level of supervision to this
  • Consider the registrar’s personal wellbeing and development as the third aspect of your supervision role, in addition to the clinical and educational aspects
  • Ensure that the registrar knows that you ‘have their back’
  • Conduct regular supervision team meetings.

It is essential that the supervisor implement a model of clinical oversight that reflects the registrar’s competence and ensures safe patient care. This requires early and ongoing assessment of competence, and a clear understanding of the nature and volume of patient encounters. 

• → Call for help list
• → Assessment of past experience and training
• → Self-assessed competence and confidence
• → Reports from previous GP placements
• → Results of knowledge quizzes
• → Assessment of approach to high-risk clinical situations
• → Direct observation
• → Random case analysis

• Attend professional development activities from a range of providers, including GPSA