‘The aim of all supervision and feedback is to make learners reflect on their practice’.
Clinical practice is far from straightforward. GPs practice complex competencies in a clinical world rich with uncertainty and where the textbook knowledge only provides some of the answers. Clinical decision-making therefore requires GPs to combine experience-based knowledge with evidence-based knowledge, but also to constructively process both formal and informal feedback.
The ability to reflect is necessary for efficient use of feedback and essential when performing complex competencies in practice. It has been argued that the ability to reflect on one’s own role and performance is the key factor in expertise development – indeed, that the aim of all supervision and feedback should be to facilitate the learner’s reflection on their own practice.
‘Clarifying supervision’ is based on direct instruction and confirmation of a decision, whereas ‘expanding’ or ‘broadening supervision seeks to generate reflection through questions that create ‘productive struggle’, link knowledge with practice, or broaden the case. The nature of the registrar and situation may determine which type of supervision is most appropriate, but expanding supervision allows for significantly greater reflection and professional development.
Reflective questions can be used at all times of case discussion, even in the brief corridor consultaiton.
It is important to not ‘examine’ the registrar and make them feel uncomfortable.
Thus, it is essential to encourage registrars to prepare for their teaching.
Some competencies require discussions broader than a series of patient cases. It is important to assess reflection because of its link to good clinical practice. A new tool has been developed called the Global Assessment of Reflection Ability (GAR) (Lillevang et al. BMC Medical Education (2020) 20:352).
The GAR is a tool for formative and summative assessment of the ability to reflect. It works in two parts.
This begins with the trainee presenting his/her mind map/written presentation which then is the basis for a structured discussion between trainer and trainee that includes references to the concrete experience that the trainee has had.
The trainee produces a mind map or similar written presentation in a concept formation process addressing a concrete, complex competency. The trainee is given 1-2 weeks for the preparation and uses the description of the competency in the curriculum.
The focus of the discussion is on formative aspects leading to a plan for further learning, but it also includes a summative assessment of whether the competency is successfully achieved.
Date reviewed: 01 August 2024