Kay-Anne Haykal OD. MD. CCFP Undergraduate Director, DFM

1. How to supervise a resident and a student at the same time?Comment superviser un résident et un étudiantenmême temps? Kay-Anne Haykal OD. MD. CCFP Undergraduate Director, DFM

2. No conflict of interest

3. Objectives • Supervision • Group supervision or supervision of multiple learners • Models of supervision for students and residents • Residents as teachers

4. Supervision • Understanding it • Importance and effectiveness • Availability • Practical problems • Frequency • Style and structure • Interest of supervisors • Who should do it and how

5. Supervision activities : what are they? • Discuss individual patients • Ensure patient safety • Provide informal feedback • Monitor the trainee’s performance • Discuss the management of specific disorders • Ensure that the trainee has an appropriate level and amount of clinical duties • Provide feedback through appraisal • Give advice relevant to personal and professional development • Address successes and problems of trainee performance • Give career development advice • Develop team work skills • Ensure the safety of trainee • Discuss and review the process of supervision • Teach specific techniques and procedures • Plan the trainee’s learning • Develop interpersonal skills • Develops communication skills • Develop presentation skills • Beside teaching • Videotaped consultations

6. Frequency of circumstances of supervision • Appraisal meeting • Regular, specific meetings concerned with trainee’s progress and development • Ward rounds • Informally • Induction meeting • Tutorials • “on the job” assessments • During specific tasks • During clinics

7. Clinical supervision • Essential at all levels of medical education • Complex activity • Occurs in a variety of settings • Has various functions • Has various modes of delivery

8. What authors agree on supervision • 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

9. Barriers to taking students • Increasing 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

10. Collaborative group model • 2 trainees or more (2 students or 1 student and 1 resident) • Take responsibility of their caseload • Learners support each other • Learners learn from each other • They take on more responsibility • Effective teamwork skills • Less dependent on staff • Productivity may increase

11. Challenges 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

12. Multiple mentoring model • A team of 2 or more learners is supervised by a team of 2 or more staff • All staff share responsibility for each trainee’s education • Trainees have individual case load • Trainees share knowledge and problem solve together • Similar benefits and challenges to collaborative group model • Additional advantages • Additional challenges

13. 3 principle themes • Being clear in the chaos • Qualities of the service and people • Is it worth it? Challenges and benefits

14. 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

15. Qualities of the services and people • staff • 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

16. Is it worth it? The challenges and benefits • Time 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

17. Clinical teacher 4 roles • Teacher role • Interested in teaching • Explain, discuss and answer questions • Instructor as a person • Supportive, easy and fun • Helpful and friendly • Physician role • Knowledgeable and clinically competent • Role model • Good rapport with patients • Supervisor role • Gives responsibility for patient care • Reviews patient with resident and student

18. Resident’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

19. Positive comments from students • Residents’ availability • Teaching activity • Operating room teaching • Commitment to teaching • Concern for student learning • Teaching effectiveness • Role as physician and supervision did not change across their training years

20. Residents as teachers • Teachers • Increase resident awareness of the importance of their role as a teacher • Improve teaching behavior • Residents as teachers courses • Resident teaching performance • Supervisors • Enhance residents’ management skills • Leadership skills

21. Positive comments from residents • View themselves as good teachers • Feel they possess adequate teacher characteristics • Attitude toward students • Helps improve their clinical skills • Enjoyment of working with students • communication • Ease of pointing out students’ deficiencies

22. How 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

23. Conclusion • 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.

24. Thank you • Questions?

25. References • Teaching on the run: How to engage learners from different disciplines and levels of training on a busy palliative care service. El-SouradyM., Moore D., Nelson J., Misra S., Karlekar M. Journal of Pain and Symptom Management. Conference: Annual Assembly of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association 2014 San Diego, CA United States. Conference Start: 20140312 Conference End: 20140315. Conference Publication: (var.pagings). 47 (2) (pp 406), 2014. Date of Publication: February 2014. • Supervising diverse student and trainee groups at multiple levels in high volume work environments. Brazil V., Mudge A., Toombes S. Internal Medicine Journal. Conference: RACP Future Directions in Health Congress 2012 Brisbane, QLD Australia. Conference Start: 20120506 Conference End: 20120509. Conference Publication: (var.pagings). 42  (pp 29), 2012. Date of Publication: May 2012. • Priorities during ward attending rounds differ by training level of team members. HaglerB.D., Chandan P., Estrada C., Roy B., Huff N.G., Castiglioni A., CentorR. Journal of General Internal Medicine. Conference: 34th Annual Meeting of the Society of General Internal Medicine Phoenix, AZ United States. Conference Start: 20110504 Conference End: 20110507. Conference Publication: (var.pagings). 26  (pp S284), 2011. Date of Publication: May 2011.

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