A Medical Supervisor's Perspective

I was working as a GP in a small rural town, became a GP supervisor and ignited a desire to become more involved in medical education and a lifelong respect for the importance of clinical supervision.

Sadly as time has gone on and with a deepening involvement in medical education, my involvement in clinical practice has reduced and my direct involvement in supervising trainees has also diminished. What has not changed is my belief that clinical supervision is integral in developing the skills and expertise of our junior colleagues. Clinician supervisors commit their time and expertise into mentoring, teaching, coaching and assessing their junior colleagues while keeping patients safe, supported and in receipt of high quality care. We need to ensure that our supervisors are trained, supported and acknowledged for the role they play in developing and maintaining a skilled clinical workforce.

I have considered myself privileged to have had the opportunity to be involved in the supervision of junior doctors. It has taught me to be a better doctor. In turn I have focused on maintaining the integrity of clinical supervision in my work in medical education.

I have also had the privilege of working alongside colleagues who are now lifelong friends. Our friendships were forged as part of the supervisor-trainee relationship and I have watched these trainees go on to become exemplary clinicians, and GP supervisors themselves.

The most important element of supervision is the quality of the relationship between supervisor and trainee. Like any relationship, it requires effective communication, trust and mutual respect. It requires an understanding and acceptance of what each other brings to the relationship, including prior experiences and expectations of the supervision process. Like any relationship, there may, at times, be misunderstandings, differences of opinion and in the worst instance, communication breakdown. However provided there is trust, honesty and respect for the importance of the supervisory relationship, the integrity of supervision will remain intact.

There are multiple elements of supervision. Skills such as teaching, assessing, mentoring, coaching, evaluating and providing feedback are all integral to effective supervision. This requires supervisor training and ongoing maintenance of clinical as well as supervising skills.

Supervision is not the responsibility of only one person within the supervision relationship. The trainee is also accountable for ensuring effective supervision is taking place. Patients themselves often play an important role in the provision of feedback about the care that is being provided and in turn the quality of the supervision. Depending on the clinical setting, context and type of clinical training there are often multiple members of the team contributing to the supervision. Clinical supervision is multifaceted in nature and the roles and responsibilities of all parties involved in the supervision need to be acknowledged.

Why is clinical supervision so important? Because it ensures that patients can receive safe and quality care while the new clinician is learning their craft, and the novice clinician can receive safe and quality training while delivering patient care.

There will always be increased demands on clinicians to see more patients, deliver more clinical services and at the same time teach more students and supervise increasing numbers of trainees. At times the delivery of teaching services will seem to be a competing priority with the delivery of clinical services but in fact the two should be seen as synergistic. Supervising trainees is directly related to being a clinician and should always remain fixed in the heart of the clinical setting. There will always be the need for someone experienced and trained to be available to the trainee to provide clinical assistance, to debrief over clinical cases, to mentor and teach the learner. Exposure to experienced clinicians is essential for trainees to learn how to become experienced clinicians themselves. A positive supervision experience will encourage these trainees to become supervisors themselves for the next generation of clinicians.