This section of the curriculum describes how RCEM trainees will be supervised, and how they will receive feedback on performance. Detailed guidance can be found by referring to the AoMRC guidance on improving feedback and reflection to improve learning.
Access to high quality, supportive and constructive feedback is essential for the professional development of the trainee. Trainee reflection is an important part of the feedback process and exploration of that reflection with the trainer should ideally be a two-way dialogue. Effective feedback is known to enhance learning and combining self-reflection to feedback promotes deeper learning.
Trainers should be supported to deliver valuable and high quality feedback. This can be by providing face to face training to trainers
Supervision
All elements of work in training posts must be supervised with the level of supervision varying depending on the experience of the trainee and the clinical exposure and case mix undertaken. As training progresses the trainee should have the opportunity for increasing autonomy, consistent with safe and effective care for the patient.
Organisations must make sure that each doctor in training has access to a named clinical supervisor and a named educational supervisor. The role and responsibilities of supervisors have been defined by the GMC in their standards for medical education and training.
Educational supervisor
The educational supervisor is responsible for the overall supervision and management of a doctor’s educational progress during a placement or a series of placements. They regularly meet with the doctor in training to help plan their training, review progress and achieve agreed learning outcomes. They are also responsible for the educational agreement, and for bringing together all relevant evidence to contribute to a summative judgement about progression at the end of the placement or a series of placements.
Clinical supervisor
The clinical supervisor oversees the doctor’s clinical work throughout a placement and should be a member of the trainee’s clinical specialty team. The clinical supervisor leads on reviewing the doctor’s clinical or medical practice throughout a placement, and contributes to the educational supervisor’s report on whether the doctor should progress to the next stage of their training.
The clinical and educational supervisors, when meeting with the trainee, should discuss issues of clinical governance, risk management and any report of untoward clinical incidents involving the trainee. If the clinical directorate (clinical director) has any concerns about the performance of the trainee, or there were issues of doctor or patient safety, these would be discussed with the trainee’s clinical and educational supervisors. These processes, which are integral to trainee development, must not detract from the statutory duty of the trust to deliver effective clinical governance through its management systems. Educational and clinical supervisors need to be formally recognised by the GMC to carry out their roles.
It is essential that training in assessment is provided for trainers and trainees in order to ensure that there is complete understanding of the assessment system, assessment methods, their purposes and use. Training will ensure a shared understanding and a consistency in the use of the WPBAs and the application of standards. Opportunities for feedback to trainees about their performance will arise through the use of the work place based assessments, regular appraisal meetings with supervisors, other meetings and discussions with supervisors and colleagues, and feedback from ARCP.
Trainees
Trainees should make the safety of patients their first priority. Furthermore, trainees should not be practising in clinical scenarios which are beyond their experiences and competences without supervision. Trainees should actively devise individual learning goals in discussion with their trainers and should subsequently identify the appropriate opportunities to achieve said learning goals. Trainees would need to plan their WPBAs accordingly to enable their WPBAs to collectively provide a picture of their development during a training period. Trainees should actively seek guidance from their trainers in order to identify the appropriate learning opportunities and plan the appropriate frequencies and types of WPBAs according to their individual learning needs.
It is the responsibility of trainees to seek feedback following learning opportunities and WPBAs. Trainees should self-reflect and self-evaluate regularly with the aid of feedback. Furthermore, trainees should formulate action plans with further learning goals in discussion with their trainers.
Appraisal
A formal process of appraisals and reviews underpins training. This process ensures adequate supervision during training, provides continuity between posts and different supervisors and is one of the main ways of providing feedback to trainees. All appraisals should be recorded in the e-Portfolio
Induction appraisal
The trainee and educational supervisor should have an appraisal meeting at the beginning of each post to review the trainee’s progress so far, agree learning objectives for the post ahead and identify the learning opportunities presented by the post. Reviewing progress through the curriculum will help trainees to compile an effective Personal Development Plan (PDP) of objectives for the upcoming post. This PDP should be agreed during the Induction Appraisal. The trainee and supervisor should also both sign the educational agreement in the e-Portfolio at this time, recording their commitment to the training process.
Mid-point review
At this meeting trainees should review their PDP with their supervisor using evidence from the e-portfolio. Work place -based assessments and progress through the curriculum can be reviewed to ensure trainees are progressing satisfactorily, and attendance at educational events should also be reviewed.
End of attachment appraisal
Trainees should review the PDP and curriculum progress with their educational supervisor using evidence from the e-portfolio. Specific concerns may be highlighted from this appraisal. The end of attachment appraisal form should record the areas where further work is required to overcome any shortcomings. Further evidence of competence in certain areas may be needed, such as planned work place -based assessments, and this should be recorded. If there are significant concerns following the end of attachment appraisal, then the programme director should be informed. Information gathered from this meeting should be incorporated into the Educational Supervisor Report (ESR).