Best Practice Principles for Supervision

Facilitate learning and provide teaching

The role of teacher is the probably the most apparent of all the GP supervisor roles. The task of facilitating learning and providing teaching includes:

• 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

GPSA has a wealth of educational resources available to support teaching and learning. These include teaching plans, webinars and flash cards. As well, there are specific guides to planning learning and practice based 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

Monitoring and maintaining patient safety is the most fundamental aspect of the GP supervisor’s role. It is essential therefore 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. 

Another important element of safety is cultural safety, in particular for Aboriginal and/or Torres Strait Islander staff and patients. Safety and wellbeing requires robust practice policies, including for bullying & harassment, and discrimination.

It is critical that all supervisors undertake a safety assessment of their registrar at the start of a placement. This may be informed by a range of methods and tools, including:

• 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

The GP supervisor has a key role as pastoral carer in both prevention and early intervention of stress-related issues in the registrar. Registrar well-being should be explicitly addressed in the first week of the placement and monitored throughout.

Conduct monthly performance and pastoral care discussions with your registrar.

The supervisor also has an important role to ensure the wellbeing and function of the broader supervision team. Effective self-care for all is critical to ensure effective teaching and learning, and patient 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. 

Another important element of safety is cultural safety, in particular for Aboriginal and/or Torres Strait Islander staff and patients. Safety and wellbeing requires robust practice policies, including for bullying & harassment, and discrimination.

It is critical that all supervisors undertake a safety assessment of their registrar at the start of a placement. This may be informed by a range of methods and tools, including:

• 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

Ongoing professional development is an important commitment for the GP supervisor. Both colleges highlight the importance of ongoing professional development in their standards.

Professional development should include supervision topics, as well as topics in clinical and non-clinical aspects of practice.

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