Remote supervision orientation requires the registrar and remote supervisor to spend the initial one to two weeks of the placement together in a mostly supernumerary capacity, preferably at the training site. The aims of this orientation period will require clear communication with the training site staff prior to the orientation time, because local expectations may be centred on opportunities for increased clinical work opportunities.
There is some flexibility in how the orientation is structured, and it should be tailored to suit the needs of the training site, registrar and remote supervisor. The remote supervisor and registrar should spend at least one week together, and the remaining orientation could be conducted by other members of the onsite team as deemed appropriate.
There is also flexibility to reduce the period of orientation if the registrar and remote supervisor already have a strong working relationship, or if the registrar has extensive remote supervision experience. If face-to-face orientation is reduced, it is expected that the registrar and remote supervisor speak daily to build their relationship and discuss patients for at least the first two weeks.
A good orientation takes time and organisation. Some activities can be done by the practice manager and other members of the onsite supervision team; however, the supervisor should take a primary role and must be involved with teaching how to use the clinical software and in the rehearsal of emergency procedures, as well as in discussions about teaching and supervision.
The remote supervision orientation guidance document and checklist has been developed to support practices and remote supervisors plan and provide a comprehensive orientation. This document is designed to be downloaded, edited and contextualised to the training site.
Outcomes of the face-to-face orientation period
- Clearly defined expectations, roles and responsibilities
- Clear instructions for the multidisciplinary onsite supervision team
- A Remote supervision risk management plan with mitigation strategies documented
- A tailored clinical supervision plan and call for help list
- Scheduled supervision times in advance as appropriate
- Escalation and emergency planning and pathways
- Confirmation that the workplace, contracts and facilities are appropriate and suitable for the registrar
- Mutual understanding of the complexities and the breadth and depth of support that is needed in that particular context
- Established communication processes and mutual willingness and ability to communicate effectively online
- Encouragement for the registrar to join an online community of practice with other registrars in similar contexts
- In rare situations, it may become clear that the registrar is not appropriate to continue at this training site at this time
Remote supervisor responsibilities during orientation
- Observe the registrar consulting to assess performance, any unconscious lack of awareness of gaps and the questions they ask and do not ask, so as to assess the appropriateness of their help seeking
- Discussion of complex local case scenarios, referral pathways, procedural skills, cultural issues, point-of-care investigations, communication style, follow-up processes, liaison with the team on the ground, escalation and emergency protocols
- Discussion and support not just about clinical education, but also about non-clinical issues, such as management, administrative issues, billing, internal political issues, patient advocacy, public health concerns and personal, social and emotional aspects of life in a small community
- Development of the local supervision team to clarify expectations and roles, to establish methods of giving and receiving feedback and to reinforce the value of this team to the success of the training term
- Assisting connection between the registrar and the community, with support from the local cultural advisor if appropriate
If the registrar does not feel supported by the remote supervisor, they are unlikely to be comfortable in calling for help or in acknowledging their clinical, educational and personal areas of need.
As a previously remotely supervised registrar who was interviewed for this project said:
[I want to speak to] someone I know and trust … you know that they’re responsible and reliable and care about what you’re doing … and they know a bit about me and my limits.
Orientation to the community
Community engagement is fundamental to a successful remote supervision placement. The community needs to be engaged with the registrar and they need to be integrated into the community to understand the contextual, cultural and nuanced needs of that community.
It is important to have the community engagement led by a community ambassador and supported by a cultural advisor, if the training site is within an Aboriginal or Torres Strait Islander community or a site with predominance of other cultural groups.
Orientation to the community should include:
- the local supervision team and other health professionals in the area
- clinic operations and procedures
- other healthcare facilities (eg hospital, aged care)
- wider local services or resources that can be accessed
- meeting with local community members so that the registrar has a clear understanding of various roles in the community; this may include:
- local paramedic/s
- local pharmacist
- community elders
- local council mayor
- orientation to community and cultural issues by a local cultural advisor
- local social, education institutions, sporting teams, activities, religious institutions, calendar of events
- listed resources that outline the history and features of the location, if available.
Establishing a clinical supervision plan
Orientation of the registrar also involves giving clear information and discussing about how remote supervision and teaching will happen throughout the term. This includes:
- How and when to ask for help – a 'call for help' list should be agreed to and formalised during orientation and then reviewed regularly
- The arrangements for backup supervision if the usual supervisor/s is/are non-contactable
- Early discussion of learning needs and a plan to address them
- Formal, scheduled teaching – how and when it will happen
- Opportunistic teaching from questions or cases
- How assessments will happen remotely, including direct observation and clinical case analysis
- Feedback – what it looks like and how it happens. The registrar should be encouraged to develop a trust relationship with the onsite supervision team that allows feedback in an appropriate and constructive manner.
All registrars should be made aware that it is an expectation that they seek advice as much as they require. This may involve reassuring them of the supervisor’s willingness and availability to help.
These arrangements should be discussed with everyone in the onsite supervision team, and relevant aspects communicated with the whole practice.
These arrangements should be formalised in a Clinical supervision plan.