Clinical supervision in Australia – challenges and opportunities

A paper by Martin et al in the MJA highlights the need to build clinical supervision capacity to support the rural medical workforce.

It provides an example using the Queensland Rural Generalist Program and the Central West Single Practice Service Model, which approaches managing the district’s workforce as one large practice rather than multiple small practices. The authors claim that this approach has more than doubled the medical workforce in Longreach.

They recommend for rural communities that:

• A systematic program of support for supervisors of trainees be developed
• Appropriate funding and incentives – such as funded education packages to upskill new fellows, be provided
• A stocktake of training capacity be conducted
• Appropriate, evidence-based, flexible educational courses and qualifications that meet local needs be developed
• Rural directors of clinical training and dedicated clinical supervisors nationally, be established.

Read the full article here:

https://doi.org/10.5694/mja18.00525

Neuroticism and burnout    

Ever wondered if that ever-so-slightly neurotic registrar might be a candidate for burnout? Turns out you’re probably right.

A study by Prins et al in Holland defined burnout as “a prolonged response to chronic emotional and interpersonal stressors on the job defined by three dimensions: emotional exhaustion, depersonalization and a low sense of personal accomplishment”.

Some have proposed that healthcare workers may have personality traits that make them more susceptible to burnout.

This study looked at associations between residents’ personality traits, specialty, and symptoms of burnout.

The results? Neuroticism had a strong association with burnout irrespective of specialty.

Neuroticism was significantly correlated with perception of higher workload, less autonomy, less peer support and less satisfaction with work/life balance.

Sound like anyone you know?

Read about it here:

https://doi.org/10.1080/0142159X.2018.1514459

Responding to microaggression and discrimination by patients

This is a great 12 tips paper that helps you to help your registrar deal with incidents of aggression by patients. It’s a bit hospital focused but a lot of the advice is translatable to the GP setting.

What is “microaggression?” I hear you ask?  “Brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults that potentially have harmful or unpleasant psychological impact on the target person or group” (Sue et al. 2007).

In brief, the tips are:

1. Establish a culture of openness and respect up front
2. Be prepared to recognize microaggressions and discrimination
3. Determine whether to respond at the bedside
4. Attempt unconditional positive regard
5. Repeat the patient’s statement and allow time for reflection
6. Share your own response to communication impact
7. Open a dialog to learn more about the patient’s perspective
8. Use objective statements, when possible
9. Know when to walk away
10. Debrief with learners outside the room
11. Practice saying the words
12. See out training opportunities that allow for discussion about race and discrimination.

The tips are illustrated with some great scenarios and examples.

Read about it here:

https://doi.org/10.1080/0142159X.2018.1506097

Endemic unprofessional behavior in health care

A paper by Westbrook et al in the MJA outlines the recent history of surveys and reports of bullying, harassment and unprofessional behavior that have riven the sector in recent years. It also points to the limited evidence base when it comes to knowing what works in terms of effective interventions.

It also describes organizational professional accountability programs such as when staff can report negative or positive behavior anonymously online with the purpose being for designated peer review messengers to convey to the subject of the complaint the impact that their behavior is having on others with the intention being to encourage reflection and behavior change. This approach originated in the US but is apparently being used in some Australian hospitals, including the Royal Melbourne.

Another example described is the rollout of a program called “Ethos” in the St Vincent’s group, with the aim of redefining normal and tackling unprofessional behavior across all staffing groups and will be evaluated over a 4-year period.

The paper calls for a greater investment in research on behavior, teamwork and culture and unprofessional behaviour change in order to deal with the problem.

Read about it here:

https://doi.org/10.5694/mja17.01261

GP supervisory relationship measures

GPSA’s contribution to this space is the development, in partnership with General Practice Training Tasmania (GPTT), GPEx and Monash University, a set of tools to measure the supervisory relationship. These tools – one for supervisors (GP-SRMS) and one for registrars (GP-SRMR) can be used by individuals for reflection. They have been validated for use in the AGPT program*. And they may also have wider uses yet to be identified and tried.

For now though, if you want to reflect on your supervisory relationship with your registrar, you can download the tool as a writeable PDF and keep the results entirely to yourself, purely for your own information and reflection. We’re working on delivering these tools to you as an app which will also shorten the number of questions.

You can find the GP-SRMS here:

GP SRMS

https://doi.org/10.6084/m9.figshare.7034750

And the registrar version here, should your registrar wish to do likewise.

GP SRMR

https://doi.org/10.6084/m9.figshare.7132100

We’d love to hear any feedback from you on how you find these tools.

You can email joan.burns@gpsupervisorsaustralia.org.au or give me a call on 0472 520 611

*The GP-SRMS and GP-SRMR were developed as part of a research project supported by the Royal Australian College of General Practitioners with funding from the Australian Government under the Australian General Practice Training Program.

Research-assist

GPSA exists to support supervisors. We have had a request this month from a supervisor member for assistance in disseminating a survey as part of his PhD. Should you wish to support your fellow supervisor, you can find out more about the study here:

Atrial fibrillation (GPSAFER) study

We have also had a request to assist with an evaluation of dementia GP support services. You can participate here:

Help improve dementia support services for GPs – survey

The Rosemary Bryant AO Research Centre at the University of South Australia is conducting an evaluation of the:

• Dementia Behaviour Management Advisory Service  – delivered by Dementia Support Australia
• Dementia Training Program – delivered by Dementia Training Australia

Doctors, nurses and allied health professionals who work with people living with dementia are invited to complete the anonymous survey at: https://www.surveymonkey.com/r/RRW6PBD

The survey closes on 30 November 2018.