Provide ‘as needed’ supervision
Providing ad hoc or ‘as needed’ supervision during daily consulting can be challenging for a supervisor. While simple questions can often be answered over the phone, others will require you to leave your consultation and visit the registrar’s room to interact with them and their patient. It’s important that you have enough time available for this in your appointment schedule, so your own consulting is not significantly impacted and you’re available when called. If your registrar perceives that you’re not available or that their calling you is a burden, they may not call when they should. This can jeopardise patient safety.
In considering how you should alter your schedule, it’s worth noting that the frequency of calls is highest early in the term and decreases as your registrar gains confidence and competence. As a guide, by the middle of the term, on average, a registrar calls their supervisor for help twice per consulting session.
When called into the room your task is to ensure safe patient care while not undermining the relationship between your registrar and their patient. The patient should be left feeling confident to return to the registrar for future care. While this usually means it isn’t the time to quiz your registrar about their knowledge, much can still be learnt and taught if you each share your reasoning by ‘thinking aloud’. It’s worthwhile explaining the ‘thinking aloud’ approach to your registrar when the patient is present, as it may be significantly different from their supervisory interactions in hospitals.
How the interactions in the room are managed will vary according to the registrar’s knowledge of the clinical problem and how to manage it. If you’re called into a consultation where your registrar has little knowledge or experience about the patient’s problem, you will most likely need to take over the consultation. In this case you will be teaching by demonstrating. If, on the other hand, your registrar is confident of their decisions and management and is only seeking to ‘double-check’ their approach, you may just need to listen to their plan and confirm it.
The provision of ad hoc supervision is a topic frequently covered in supervisor professional development.