One of the biggest concerns for many new GP supervisors is feeling like they need to ‘know it all’. With a registrar in the practice, suddenly they may feel like their hitherto hidden knowledge gaps will be exposed, their rudimentary teaching skills critiqued, and their discomfort giving feedback raised to a new level. New supervisors may even worry they will feel like an imposter in the role, especially those only recently graduated who are just getting comfortable with clinical practice.
But just like a new registrar starting out in clinical practice, embarking on this new role does not require freshly minted supervisors to know it all. Far from it, in fact. For example, it is far preferable to model lifelong learning by demonstrating information seeking rather than making up an answer to an unknown clinical query. Supervision knowledge and skills will develop with time, and confidence will grow with each successive registrar placement.
Many existing clinical skills are directly transferable to the supervision role. As GPs providing clinical care to patients on a daily basis, supervisors already have the foundational attributes – communication skills, advocacy, patient/learner-centeredness, curiosity, commitment, a passion for life-long learning, professionalism, organisational skills, and more – on which to build successful supervision.
Shared supervision is where more than one doctor provides supervision for the registrar. Shared supervision can expose the learner to different perspectives and styles, as well as different ways of learning. If using shared supervision, it is essential to appoint a lead GP supervisor to coordinate the supervision and ensure tasks and requirements are completed.
Increasingly, general practice supervision is delivered by teams. Supervision teams may include other GPs in the practice, as well as practice nurses, the practice manager, allied health practitioners, Aboriginal Health Workers, cultural mentors, receptionists, and other administrative staff within the practice. It may be even broader, and include a community pharmacist or visiting physician, for example. Supervisors should build and support an effective supervision team, in order to give the registrar the broadest experience possible as well as make the supervision role more sustainable.
Apart from the generic skills, each supervisor will bring their own background and experiences to the role. It is useful to identify such knowledge and skills, and discuss them with the registrar. Take a few minutes to reflect on your supervision experiences – from both being supervised as a student or junior doctor or GP registrar, as well as supervising your own learners.
How would you describe your past supervision experiences? What were the highlights? Were there parts that you did not enjoy? Was there one great mentor who you remember over others? What was it about them that made them so effective?
What do you like about the supervision role? What aspects do you find challenging? What are your strengths as a GP supervisor? What areas do you need to work on?
Registrars must learn a massive amount to be safe and effective practitioners, as well as to pass their exams. This can potentially be projected onto the GP supervisor, making them feel like they need to teach a correspondingly overwhelming amount to their registrar. The new supervisor may wonder therefore where to invest their energy. The following are suggestions to help focus this task.
GP registrars are required to learn not just knowledge, but also skills and attitudes. While registrars are often driven by knowledge acquisition e.g. ‘What are the clinical features of gout?’, and seek guidance about this from their supervisor, this aspect of learning may occur just as effectively from independent study. Skill development, however, requires deliberate practice and guidance, and could rightly be regarded as the primary aim of GP supervisor teaching. These skills include clinical reasoning, managing uncertainty, consultation skills, cultural safety, communication skills, and more.
The supervisor has an important role to put the registrar’s learning into context, so called ‘practice wisdom’. Operating in a workplace-based learning environment, supervisors must be nimble and opportunistic by enhancing the learning that ‘walks in the door’. While the registrar may read about the presentation or diagnosis from a textbook or online resource, the supervisor has a key role to ‘contextualise’ the information into the real world of general practice, adding their accumulated wisdom to the theoretical knowledge. This also relates to framing learning through the prism of primary care and community-based medicine, in contrast to the hospital system from which the registrar came.
The Johari window illustrates how gaps in knowledge, skills and attitudes can be hidden from the registrar, the supervisor, or both. It is useful for the new supervisor to think about uncovering ‘unknowns’ in their registrar, especially ‘unknown unknowns’. This is explored in detail in the companion GPSA guide, ‘Helping your registrar plan their learning’.
GP registrars invariably focus on the clinical aspects of practice – diagnosis, investigation and management of illness. This is not all surprising and is even more of a focus as exams loom. However, as the curricula of both colleges describe, general practice is much broader than the clinical aspects of practice, and includes a breadth of nonclinical aspects of quality practice. In a similar way to focussing on skill development over knowledge acquisition, as above, we encourage GP supervisors to focus on the non-clinical aspects of practice in their supervision role – this includes communication and consultation skill development, population health, professional and ethical practice, organisational skills, risk management and medicolegal practice.
As previously stated, the foundation stone of effective supervision and registrar learning (and patient safety) is a respectful, trusting relationship between the supervisor and registrar. This can certainly begin before the registrar starts in the practice. GPSA recommends that once the placement has been confirmed, the supervisor should meet the new registrar well in advance of the commencement date, over a coffee is ideal. This may include a discussion of professional background and experience, as well as personal background and family (potentially for both the supervisor and registrar). The latter is particularly important if the registrar is relocating to join the practice. The conversation may cover cultural aspects, especially if the registrar trained in a country other than Australia. Roles and potential conflicts e.g. teacher versus assessor, might be raised. The conversation should certainly cover the registrar’s expectations, aspirations, and concerns for the term ahead.