Managing Educational Supervision

Author: Nikki Abela / Editor: Charlotte Davies / Codes: SLO9 / Published: 27/11/2018

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Educational supervision has come under scrutiny the last few years. People are no longer automatically deemed to be good supervisors when they hit consultant level. The GMC now mandates that new supervisors need to be trained in supervision, and in one blog post, St. Emlyn’s Simon Carley even questioned whether Supervisors should have their own ACRP.

Whether you think that’s over the top or not, the truth is that educational supervision has a massive impact on trainees and their performance. And people feel quite strongly about it. When Hannah McKee asked the twittersphere what they thought mandated good supervisory practise, there was quite a response.

Such strong reactions and opinions are good, because it means people care and want things to change for the better. But what does that mean for me?

Well, as a trainee, it means I can’t just “graduate” from training and become a supervisor anymore. I actually have to reflect and prove I am worthy. And that “worthiness” is going to be under more and more scrutiny. For those of us coming though the system, it means we can start to expect our supervisors to be good at their jobs and it is more likely that they will be.

With this in mind, I’ve been doing some reflecting on supervision, about some things I found useful as a trainee and what I think will be useful in future practise (the caveat here is that I am not a supervisor as yet, but I do have a fair bit of experience from the other side).

One of my favourite supervisors had directed me to the bestseller book The One Minute Manager by Blanchard and Johnson, as part of my reflective learning on management experience. However, as I read the book I realised that it is in fact a lot about motivating and driving people, even trainees and much of it can be applied to educational supervision.

Now, I hear what you’re saying, supervisors are not managers. But educational supervisors are, in a way. In fact, the Reference Guide for Postgraduate Specialty Training in the UK (a.k.a. The Gold Guide) states that:

When I read this this year, it further reinforced initial thoughts about the book I had read in 2014/2015, so I went back to the book and found that there was a new version The New One Minute Manager, which had a more collaborative approach as, “today, people look for more fulfilment in their work and their lives. They want to feel engaged and make a meaningful contribution. They’re less willing to trade time on the job to satisfy needs outside work”.

This sentiment could not be more true of what was happening to people working in medicine at the moment. With so many of us, especially in the ED, questioning how we are going to make an impact, but look after our wellbeing at the same time, I felt there wasn’t a better time for me to read this revised version.

The book is essentially about the manager’s Three Secrets, which he delivers in an efficient way:

1. One minute goals
2. One minute praisings
3. One minute re-directs

Now, of course, we have to allow the authors some poetic licence, in that although ED practitioners tend to be ultra-efficient, doing any of these three things is a bit unlikely, but the key here is to stick to doing them well, to avoid repetition.

One Minute Goals

Make it clear from the beginning what their targets for the placement are. Get trainees to write them down in a SMART way and make each goal clear and concise for them to review regularly to see “if their behaviour matches their goals”. All trainees are adults, and can review their own performance. They may need a little more direction at the start, but you can teach them early to review what they are doing to see if it matches up to their original plan, if it does – great – if not, then encourage them to find ways to change this.

Use their end-of-year checklist found on their e-portfolio and their curriculum map to ensure they are covering what they need to cover for that year. It’s pretty disheartening for a trainee to have done lots on one area, and not get a good ARCP outcome because they have spent all their energy on one thing, and neglected something else.

Be clear about what you want from them. For example, if efficiency is something you wish your trainee to learn, give them direction on how to achieve this, and what you would expect from them at the end of the placement. If this isn’t clear from the start, and trainees do not see it as part of their objectives, they may feel offended by trainers telling them they aren’t going fast enough, because that wasn’t one of their goals to start off with.

Also, lead by example. As Simon Carley rightly commented on the twitter conversation mentioned earlier: credibility is key. If you don’t practise what you preach, then you can not expect trainees to follow suit.

With all trainees, find out what makes them tick, and find opportunities for them to get involved in this. If they are doing well in a certain aspect and enjoy it, signpost them to ways of discovering this further, so that they may progress from novice to expert.

One Minute Praisings

A good manager, or supervisor, makes it clear to a trainee, in no uncertain terms, what specifically they have done right and that succeeding in their placement is important to them.

Although this may sound patronizing, actually receiving positive feedback and knowing that your supervisor has your best interests at heart allows trainees to gain confidence to continue to progress.

A good trainee will, in time, learn to recognise their own good performance, and will learn to “self-review” without needing as much praise as they did initially, the one minute manager professes.

What I had found useful when receiving praise, is to break down what it was specifically that I had done right. Like this, I had moved from being unconsciously competent to consciously competent. This is extremely useful when learning and teaching a skill – as you can’t really teach something without knowing how exactly you are performing it.

And yes, moving from unconscious competence is a step back from the hierarchy of competence, but as people who are expected to teach at the bedside, we can not expect trainees to pick up what we are doing without knowing why we are doing it, which is why, as a trainee, I get so frustrated by the term “gestalt” (because you can’t learn this until you have it).

One Minute Re-Directs

Making mistakes is an important part of learning, as long as a supervisor is ready to re-direct the supervisee onto the right track.

Building a supervisor-supervisee relationship is important for effective re-directs, as without this, negative feedback may feel personal or targeted. Prior praisings are important to give negative feedback without these repercussions and building a relationship of trust is pertinent to a safe learning environment.

When a trainee has done something wrong, fact find as much as you can, and ask a trainee for their own views on what has happened. Speak to them as early as you can about it. A good trainee will feel as let down by their performance as their supervisor, and if the relationship is a good one, they will feel even more let down by the fact that they let you down (we go back to the importance of credibility here).

When dealing with struggling trainees, be aware of the drama triangle so that you can recognise this mind game when it is being played out before you.

The drama triangle is a form of transactional analysis used in psychology to analyse relationships in counselling and supervision, and essentially is an effective way to look at roles in difficult conversations and relationships. In the drama triangle, the roles are essentially ineffective, and an unsuspecting supervisor may try to take on the role of rescuer for a trainee, and may, because of this, end up in a relationship where they feel they are at a loss from what is going on, eventually becoming the victim, of something which may have gone wrong. (Think about a trainee who is struggling at work, a supervisor who is trying to help by “rescuing”, becomes portrayed as a persecutor by a trainee when they approach them to talk about it, and is then labelled as a bully for doing so, becoming the victim of the whole saga.)

The trick here is to flip the drama triangle to the winner’s triangle, where each player has roles of responsibility and the conversation allows place for assertiveness, caring and vulnerability. Before a difficult conversation, it’s important to reflect on ways to project yourself, so that both you and your trainee  emerge as winners at the end of it.

Many of these ramblings are part of my reflections for some work I am doing as a PGCE at Edge Hill University. As a trainee, I would love to hear what supervisors and other trainees think in the comments section or on twitter.

Much thanks goes to Andy Ashton for directing me to the book.

Editor’s Notes: As a new supervisor, much of what Nikki has said is really useful. I have not had any doctors in difficulty yet, but what seems to have been key is, as Nikki says, setting expectations at the beginning of the placement. I wrote myself a little checklist for the first meeting and it included:
– Ask what they perceive your role to be. Stress that this is a partnership. What I will and won’t do.
– I expect them to have a proactive role in their learning, seeking frequent feedback and integrating.
– Confidential discussions. We discuss everyone at faculty meetings. No news is good news – but this might change.
Whether this is good or bad, it means you know you’ve started off well!

All doctors in our trust are pointed towards the London Deanery Education modules, which have now moved to eLfH – thankfully, they’re still open to anyone and everyone. ACP supervision is a bit different as their curriculum is so specific – luckily, RCEM has some free training days arranged. 

If wondering what your trainees think, check out our other blog on educational supervision – a trainee’s perspective. 

Other RCEMLearning Links:

Educational supervision – a trainee’s perspective

An education in social practice

ED Education in theory

Look in the Mirror, What Do You See

References:

1. A Reference Guide for Postgraduate Specialty Training in the UK
2. The New One Minute Manager
3. Drama and Winner’s Triangle
4. MCKIMM, J. and FORREST, K., 2010. Using transactional analysis to improve clinical and educational supervision: the Drama and
Winner’s triangles. Postgrad Med J 86: pp. 261-265