Communication and effective use of technology
In order to best manage the complexity of remote supervision, the registrar–supervisor relationship should be one of mutual respect and understanding between colleagues.
They will have a ‘shared understanding of performance and standards, negotiating agreement on action plans, working together toward reaching the goals, and co-creating opportunities to use feedback in practice’.26
This ‘educational alliance’ will also involve the registrar looking for the supervisor’s commitment to the training and their credibility as a clinician and an educator.19 This also includes the ‘nurturing’ aspect of supervision, with an enthusiastic, open and collaborative registrar–supervisor relationship, including the ‘recognition and response to emotional needs of the trainee’.27
Suggested communication methods, depending on the circumstance and purpose, include:
- regular, planned catch-ups via videoconference that are scheduled in advance
- telephone/video calls (eg FaceTime) to address urgent issues
- text, email or other agreed methods of communication for ‘checking-in’ or non-urgent issues.
Different technology will be used depending on the purpose of the communication. For example:
- daily ‘check-in’ may be by SMS
- quick ad hoc questions may be triggered by SMS and then a telephone call
- more complex questions may involve sending images and then may involve a videoconference
- three-way discussions with the registrar, supervisor and patient may occur using videoconferencing – this could include the supervisor watching a physical examination or having a discussion with the patient
- the supervisor can audit the registrar’s notes, results or referrals using remote access to the clinical software
- the supervisor can directly observe the registrar’s consultations using a videoconference log-in on a second device in the room while simultaneously accessing the registrar’s notes, either using remote access or a screen-share function
- case-based discussions and random case analysis (RCA) can occur by telephone or videoconference with both the registrar and supervisor remotely accessing a patient’s files or using a screen-share function.
Clinical activities while remote
Providing digital images or clinical photography is valuable to allow the remote supervisor to make their own clinical judgement on patient presentations. If digital images of any kind are used during remote supervision, the registrar and remote supervisor are both advised to follow the local medical service guidelines regarding digital photography and patient consent, as well as the RACGP’s guidelines, Using personal mobile devices for clinical photos in general practice.
The following are also useful resources:
The ability to look at the registrar’s notes and see or talk to the patient if necessary is also beneficial for remote supervision. Remote access to clinical software is ideal, but sometimes not possible. A camera could be placed on a tripod in the consulting room that could be used to see the patient as well as the registrar’s notes. The ‘share screen’ feature on platforms such as Zoom, GoToMeeting, WebEx, HealthDirect or Microsoft Teams can also be used to allow the remote supervisor to see the registrar’s notes.
Equipment to support remote supervision
Training site equipment essential for a safe and effective remote supervision placement includes:
- webcam and headset
- two-screen option – a laptop, tablet computer, telephone or other portable device that can be taken to other rooms or placed elsewhere in the clinic
- phone stand
- an IT equipment system compatible for the local/regional health referral system
- where internet connectivity is unreliable, the training site could consider arranging a Starlink package for the registrar (Starlink is a satellite system that delivers global internet coverage using a portable satellite dish mount and Wi-Fi router).
Additional equipment relevant to the context of the placement should be included in training site accreditation for remote supervision placements. Examples include:
- appropriate equipment for ear canal foreign bodies (eg Jobson–Horn probe)
- sonosite ultrasound machine/bubble ultrasound, if deemed appropriate and depending on location
- other equipment required for solo extended scope of practice.
The remote supervisor will require:
- webcam and headset
- screen, tablet or laptop with a second screen.