How to supervise a How to supervise a resident and a student resident and a student

at the same time?at the same time?

Comment superviser un Comment superviser un résident et un étudiant résident et un étudiant

en même temps?en même temps?

Kay-Anne Haykal OD. MD. CCFPKay-Anne Haykal OD. MD. CCFP

Undergraduate Director, DFMUndergraduate Director, DFM

No conflict of interestNo conflict of interest

ObjectivesObjectives

Supervision

Group supervision or supervision of multiple learners

Models of supervision for students and residents

Residents as teachers

SupervisionSupervision

Understanding itImportance and effectivenessAvailabilityPractical problemsFrequencyStyle and structureInterest of supervisorsWho should do it and how

Supervision activities : Supervision activities : what are they?what are they?

Discuss individual patientsEnsure patient safetyProvide informal feedbackMonitor the trainee’s performanceDiscuss the management of specific disordersEnsure that the trainee has an appropriate level and amount of clinical dutiesProvide feedback through appraisalGive advice relevant to personal and professional developmentAddress successes and problems of trainee performanceGive career development adviceDevelop team work skillsEnsure the safety of traineeDiscuss and review the process of supervisionTeach specific techniques and proceduresPlan the trainee’s learningDevelop interpersonal skillsDevelops communication skillsDevelop presentation skillsBeside teachingVideotaped consultations

Frequency of circumstances Frequency of circumstances of supervisionof supervision

Appraisal meetingRegular, specific meetings concerned with trainee’s progress and developmentWard roundsInformallyInduction meetingTutorials“on the job” assessmentsDuring specific tasksDuring clinics

Clinical supervisionClinical supervision

Essential at all levels of medical education

Complex activity

Occurs in a variety of settings

Has various functions

Has various modes of delivery

What authors agree on What authors agree on supervisionsupervision

Should be regular

Should be structured

Related to learning objectives

Has positive patient outcome

Content should include Clinical management

Interpersonal skills

Personal development and reflection

Barriers to taking studentsBarriers to taking studentsIncreasing number of students

Overloaded health care

Critical placement shortages

Resource constraints/space

Workload pressures

Quality and interest of supervisor

Providing quality medical care

Maintaining efficacy

Time constraints

Collaborative group modelCollaborative group model

2 trainees or more (2 students or 1 student and 1 resident)Take responsibility of their caseloadLearners support each otherLearners learn from each otherThey take on more responsibilityEffective teamwork skillsLess dependent on staffProductivity may increase

Challenges of collaborative modelChallenges of collaborative model

Sharing resources

Ensure enough individualised feedback

Ensuring sufficient opportunities to observe

trainees are competitive

appropriate working relationships

Staff perceives it as more time consuming but no substantial increase

Multiple mentoring modelMultiple mentoring modelA team of 2 or more learners is supervised by a team of 2 or more staffAll staff share responsibility for each trainee’s educationTrainees have individual case loadTrainees share knowledge and problem solve togetherSimilar benefits and challenges to collaborative group modelAdditional advantages Additional challenges

Being clear in the chaos

Qualities of the service and people

Is it worth it? Challenges and benefits

3 principle themes3 principle themes

Being clear in the chaos?Supervision can be hectic and intense

Need to implement it in a carefully planned way

Structure : timetables, caseloads, space and resources

Communication more direct

Student skills develop quickly

Qualities of the services and peoplestaff

Appreciation of other’s clinical practices

Work collaboratively

Discuss clinical reasoning

Students Develop greater awareness of their own learning skill

Ability to adapt to diversity

Is it worth it? The challenges and benefitsTime demands and stress for both staff and students

Services benefits Less experienced staff can supervise

Student supervision can occur in a high turnover

Increased time spent with patients

students learning more

More stress in the organisation of the placement and monitoring of students and patients

Inconsistency among educations stressful to students

Clinical teacher 4 rolesClinical teacher 4 rolesTeacher role

Interested in teachingExplain, discuss and answer questions

Instructor as a personSupportive, easy and funHelpful and friendly

Physician roleKnowledgeable and clinically competentRole modelGood rapport with patients

Supervisor roleGives responsibility for patient careReviews patient with resident and student

Resident’s teachingResident’s teaching

Demonstrate expertise and up-to-date knowledge

Allows and encourages student participation in patient procedure

Maintains a learning climate of respect and support

Substantial if not more important component of medical student education

Positive comments from studentsPositive comments from studentsResidents’ availabilityTeaching activityOperating room teachingCommitment to teachingConcern for student learningTeaching effectivenessRole as physician and supervision did not change across their training years

Residents as teachersResidents as teachers

TeachersIncrease resident awareness of the importance of their role as a teacherImprove teaching behaviorResidents as teachers coursesResident teaching performance

SupervisorsEnhance residents’ management skillsLeadership skills

Positive comments from residentsPositive comments from residentsView themselves as good teachersFeel they possess adequate teacher characteristicsAttitude toward studentsHelps improve their clinical skillsEnjoyment of working with studentscommunicationEase of pointing out students’ deficiencies

How to improve resident’s teachingHow to improve resident’s teaching

Communication about their teaching responsibilities

Increase participation is student programs : orientation, formal classes, clinical

Provide mid-rotation feedback to students

Monitor resident and student progress

Encourage and support resident

ConclusionConclusion

Multiple learners’ teaching is beneficial for student and resident learning

Benefits outweighs the challenges

Need to be structured and planned

Residents teaching is effective for both resident and student

Residents require training and guidance to teach more effectively.

Thank youThank you

Questions?

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