Assessments in the context of remote supervision
Registrar assessments are completed as per their training program requirements. This section discusses considerations of assessments in the context of remote supervision.
Assessments of a registrar’s progress and feedback about gaps and improvements are an integral part of training. For Australian GP registrars, the Fellowship exams can be used as reference points, but low stakes assessments, such as directly observed consulting, RCA, case-based discussions, workshops and other group educational activities, are essential as part of the RACGP progressive assessment framework and to ascertain whether a registrar is a safe and effective practitioner.17
In order for any assessment to be valid, the doctor doing the assessment must understand the context of the registrar’s workplace. This is particularly true for remote assessments when the assessor cannot directly see the environment in which the registrar is working.
The initial face-to-face orientation period will assist the supervisor in ascertaining the supervision the registrar is likely to need in the future, to build up a relationship with the registrar and to discuss how feedback will be given when the supervisor is remote. Further face-to-face periods of time throughout the term will also strengthen this.
If a supervisor is worried about a registrar’s progress in a face-to-face situation, they will usually choose to spend more time with the registrar. There will be an escalation process in place for registrars who are flagged or need remediation, but ascertaining the need for further input will be done after more information is gleaned.23
The use of IT to ‘Zoom in’ to the registrar’s consulting room can overcome some of the barriers to assessments, coaching and giving feedback. Some supervisors actually find this more useful than face to face because they can see what the registrar is writing in the notes, for example if they have a remote desktop access to the patient’s file in addition to the videoconference into the consultation.
The experience of one registrar exemplifies how this can be successful:
Sometimes they will be [a long way away] and they would web zoom into my consult room and I had a little camera on top of my computer and they could see me and the patient.
So they would just sit there muted and with my camera on in the background and watch me with the consult, which is actually really fantastic because usually you’ll have people that come in and watch you observe your practice and they’ll be sitting in your room and kind of make you feel uncomfortable.
This is great, because no one else was in the room, and it worked really well and it was a mix of getting direct feedback from consultations that I had, RCAs … and then if I wanted to learn more, it was what I wanted to do. Or whether the supervisor thought that I had a gap in my knowledge to focus on those kind of areas, so it was a mix of things.
Another advantage of videoconference-based assessments is the cost saving on travel for the supervisor or medical educator. Despite many assessments being undertaken remotely, all should still fulfil the requirements of the RACGP progressive assessment framework.
How assessments can be done remotely by the supervisor or medical educator
- Remote supervisor observation of consultations using the registrar’s computer or another online camera in the room
- Remote observation of registrar consultations with the ability to simultaneously watch them make notes in the patient file
- Focused observation of consultations, which may be a Mini-Clinical Evaluation Exercise (MiniCEX), where the supervisor and registrar agree that the supervisor will focus on giving feedback on a particular issue (eg body language, open-ended questions, safety-netting, communication skills)
- RCA where both the registrar and supervisor have access to the clinical software
- Case-based discussions where the registrar presents a case of their choosing
- Review of investigation ordering, referrals and prescribing where both the registrar and supervisor have access to the clinical software
- Discussions with the onsite supervision team about the registrar’s competence
- Role-playing, particularly for mental health issues, domestic violence, drug and alcohol, motivational interviewing for chronic disease management or ethical dilemmas
- Review of ‘call for help’ list or EPAs25
External clinical teaching visits
External clinical teaching (ECT) visitors will need to have a thorough understanding of the guidelines, especially because they will be assessing the risk management plan and the utility of the onsite supervision team.
The following questions should be asked during an ECT visit at a remote supervision site:
- Do you think you have adequate access to your supervisor?
- Has the onsite supervision team been useful?
- Has the risk management matrix identified and mitigated any risks you have encountered?
- Has the contextualised remote supervision plan helped you identify gaps and issues?