Following my invitation to speak at the NACT UK Winter meeting last week on the Extended Role of the Educational Supervisor it forced me to sit down and consider how the role has developed over the last 10 years. It appears to have drifted from the historic important role of the mentor and advocate for the trainee into the person that is overseeing the training portfolio, policing the contract and managing performance issues.
Time to reconsider and refocus.
The title of the meeting was “The Role of Education in improving trainees’ working lives”. We heard from many perspectives about the importance of educating about managing fatigue & nights shifts, supporting trainees following incidents and signposting to opportunities that provide a broader leadership view of aspects of health care eg chief resident, chief registrar and OOPE. All of these are really important and are now part of the expanding role of the ES.
So lets break down the role of the Educational Supervisor in 2019….
EDUCATION v. TRAINING ??
Historically the role has been to support the trainee – and this involved providing pastoral support, career advice, and supervising their learning needs. Since 2005 the role has been more clearly defined in the Gold Guide and has led to the focus being on overseeing the progress of the trainee in the training programme – and on the documentation in the ePortfolio.
So has the role become a “Training Supervisor”. Training as defined in the various dictionaries can be stated as Box 1 – and so requires a syllabus, an assessment framework a place to document the required elements and a judgment at the end to state that training has been achieved and the individual can progress into the next year of training or be granted a certificate of completion of training. It contains all the tick boxes – training requires the boxes to be ticked. Education does not….
Acquisition of knowledge, skills and competencies as a result of the teaching of vocational or practical skills and knowledge that relate to specific competencies.
Knowledge, skills, values, beliefs and habits of a group of people are transferred from one generation to the next through story telling, discussion, teaching, observation and research
Education however has no defined curriculum, no start, no end and is how professionals learn from their seniors through observation and discussion – Box 2.
It includes everything about the profession, the professional and the organization & system in which they are working. It is the content of the consultant interview as the “training” curriculum has already been judged at the time of granting the CCT. The suggestions of topics that come under this “educational” umbrella are long and limitless – see Box 3
– Being a leader, developing your style
– Negotiation, Delegation, Managing others
– Having difficult conversations
– Quality Improvement Projects
– Business Cases / Reports
– NHS / social care Funding
– Private Medicine
– Role of the GMC / Revalidation
– Role of the STP / CQC / CSQM
– Legal issues, medical reports
– Awareness of key partners – Kings Fund, Doctor Foster etc etc
The role of the Educational Supervisor is to encourage the trainee to be the best that they can be.
To expect excellence – if the supervisor has high expectations the trainee will strive to achieve. The role is not about ensuring the boxes are ticked in the eportfolio – it is about supervising, talking, supporting and discussing in a safe and supportive environment anything and everything related to being a doctor within the current and future NHS.
Training – what is expected of the Educational Supervisor
The Gold Guide defines the role of the Educational Supervisor as
- Identify educational needs, agree educational agreement with SMART objectives
- Review progress and document meetings in the portfolio.
- Implement & monitor any remedial requirements
- Collate a structured report summarizing the required evidence for the ARCP
- Identify learning opportunities and facilitate a trainee’s access to them
- Provide mechanism for receiving feedback on quality of training provided
- Ensure appropriate opportunities for workplace based assessments are provided
This focuses on the curriculum requirements, and the provision of the relevant learning opportunities in the placement and ensuring that the evidence of learning and required assessments are all documented in the ePortfolio.
In many programmes this requires the educational supervisor to “tick off” a long list of required competences and see the “evidence” that these competencies have been met. And the list is very long and takes a very long time. This rather paternalistic approach if “checking up” and “proof” is rather against the instinct that many trainers have that we are developing a professional who is working to Good Medical Practice and is being honest about his experience and capabilities.
I have had this discussion with many at the RCP as it goes against what I have been training all over the UK for the last ten years – that……
The importance of the Educational Supervisor – Trainee relationship is about mutual respect & trust and maintaining an adult-adult conversation.
The role of the educational supervisor is about supporting the trainee through the requirements of the training programme, stressing that these requirements are a low bar and that to be a great specialist in the future requires education about many other important things which are brought into the supervision conversation by both the trainee and the supervisor.
The reason we have a curriculum is for patient and public safety – so that all specialists have completed the full syllabus and been judged as having the required knowledge and skills to exit the training programme – FOR PATIENT SAFETY.
If the role of the educational supervisor is to encourage the trainee to be the best that they can be then we meet the training requirements as the bare minimum and encourage much much more.