how to supervise a resident and a student at the same time? comment superviser un résident et un...
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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
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No conflict of interestNo conflict of interest
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ObjectivesObjectives
Supervision
Group supervision or supervision of multiple learners
Models of supervision for students and residents
Residents as teachers
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SupervisionSupervision
Understanding itImportance and effectivenessAvailabilityPractical problemsFrequencyStyle and structureInterest of supervisorsWho should do it and how
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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
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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
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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
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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
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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
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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
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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
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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
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Being clear in the chaos
Qualities of the service and people
Is it worth it? Challenges and benefits
3 principle themes3 principle themes
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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Thank youThank you
Questions?
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ReferencesReferencesClinical supervision of SpRs: where does it happen, when does it happen and is it effective? Specialist registrars. Grant J. Kilminster S. Jolly B. Cottrell D. Medical Education. 37(2):140-8, 2003 Feb. What is effective supervision and how does it happen? A critical incident study. Cottrell D. Kilminster S. Jolly B. Grant J. Medical Education. 36(11):1042-9, 2002 Nov. Practice educator perspectives of multiple mentoring in diverse clinical settings. [References]. Copley, Jodie; Nelson, Alison. The British Journal of Occupational Therapy. Vol.75(10), Oct 2012, pp. 456-462. AN: Peer Reviewed Journal: 2012-30914-003. Providing cross-discipline group supervision to new supervisors: Challenging some common apprehensions and myths. [References]. Cassedy, Paul; Epling, Mike; Williamson, Liz; Harvey, Gale. Cutcliffe, John R [Ed]; Hyrkas, Kristiina [Ed]; Fowler, John [Ed]. (2011). Routledge handbook of clinical supervision: Fundamental international themes. (pp. 208-217). xxvii, 404 pp. New York, NY, US: Routledge/Taylor & Francis Group; US. AN: Book: 2011-00188-019.
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ReferencesReferencesDevelopment and preliminary validation of a measure for assessing staff perspectives on the quality of clinical group supervision. Horton S., Drachler M.D.L., Fuller A., Leite J.C.D.C. International Journal of Language and Communication Disorders. 43 (2) (pp 126-134), 2008. Date of Publication: March 2008. Group supervision in facilitating learning and teaching in mental health clinical placements: A case example of one student group. Saarikoski M., Warne T., Aunio R., Leino-Kilpi H. Issues in Mental Health Nursing. 27 (3) (pp 273-285), 2006. Date of Publication: April 2006.Teaching to the level of the learner: The effects of a brief faculty development intervention. Zgurzynski P., Zinzuwadia S.N., Tubbs R., Woolley W., Smith J. Academic Emergency Medicine. Conference: 2011 Annual Meeting of the Society for Academic Emergency Medicine, SAEM Boston, MA United States. Conference Start: 20110601 Conference End: 20110605. Conference Publication: (var.pagings). 18 (5 SUPPL. 1) (pp S252), 2011. Date of Publication: May 2011.