The supervisor–registrar relationship
The supervisor should ensure that learning is not limited to clinical skill development, and should incorporate all aspects of professional development required in general practice. Research identifies four domains that represent the perceived interpretation of learning-focused clinical supervision:21
- Domain 1: To partner – establish relationships, develop common views about the purpose and process of the supervision
- Domain 2: To nurture – aid transitioning and socialising the registrar into the new learning context and establish their position as part of the team
- Domain 3: To enable – recognise, promote and encourage opportunities for engagement in healthcare provision
- Domain 4: To facilitate meaning – guide the registrar’s understanding of how educational and clinical worlds combine in importance, application and relevance to practice.
A relationship of respect, trust and a strong educational alliance are of the utmost importance in the remote situation because the supervisor will need to ‘find the truth’ about how the registrar is progressing.23
The supervisor needs to be able to trust that the registrar has the knowledge and skills needed for the context in which they are working and that they have insight into those situations when they need to ask for feedback or assistance. A ‘call for help’ list or the use of entrustable professional activities (EPAs) will assist with assessing the need for supervision with various activities.24,25
As one of the stakeholders said, ‘As trust increases, the level of intervention of the supervisor decreases.’
The initial orientation period is an important time to develop the supervisor–registrar relationship. Remote supervision is unlikely to be successful if a good relationship is not built up with the initial face-to-face contact. The establishment of such an educational alliance based on mutual respect will facilitate learning.
The remote supervisor will behave more as a ‘coach’, encouraging the registrar to explore the clinical reasoning behind decisions rather than immediately providing answers. Such ‘coaching’ of the registrar, including promoting self-reflection on knowledge gaps, attitudes and beliefs that may impact on patient care, is likely to be more difficult remotely.5
Useful tools include the General practice supervisory relationship measure (supervisors) and General practice supervisory relationship measure (registrars).
The face-to-face orientation period enables the registrar and remote supervisor to:
- become familiar with each other’s skillset, knowledge base and communication style
- learn each other’s subtle and non-verbal cues, which may be difficult to pick up online
- become familiar with strengths and weaknesses well enough to nurture growth and development
- begin to develop a two-way relationship where the supervisor openly discusses with the registrar how their own backgrounds and assumptions are translating into their work as clinicians
- establish and develop a relationship of trust and respect that is important for sensitive and appropriate support while the supervisor is off-site.
If the registrar–supervisor relationship is not supportive, particularly in serious or emergency situations, the registrar should discuss this with their medical educator, the RACGP local training coordinator or a clinical teaching visitor.