Providing feedback to the registrar is central to the work of a supervisor. It’s a complex skill that takes time to develop and master and is impacted by the relationship between supervisor and registrar. An effective supervisor-registrar relationship that is conducive to feedback is one that operates as an alliance, where the registrar perceives the supervisor to be acting in the registrar’s best interest and provides the correct balance between challenge and support.
It’s important that feedback is provided frequently and not just when completing assessments. Small amounts of feedback provided often works best. Feedback conversations can occur any time a registrar’s performance is observed. For example, after a problem case discussion, consultation observation, ad hoc supervisory encounter, or random case analysis.
It’s generally best to obtain the registrar’s own assessment of their performance first and uncover the issues they had with their performance before you give them feedback. Ensure your feedback is specific and about behaviour. It can take time to establish a feedback culture. Doctors are known to invest considerable effort in ‘saving face’ (avoiding others losing respect for them) and being seen as credible by colleagues. A registrar may be reluctant to expose their weaknesses, particularly if they see their supervisor as overly judgemental. One way to overcome this is for you to demonstrate a willingness to be vulnerable by seeking feedback when you’re unsure about your own clinical practice. Another is to demonstrate this with the wider practice team by inviting shared reflections in your regular meetings.
It is worth being aware of the ways cultural differences can affect how feedback is given and received. What may be appropriate for one registrar may be perceived as blunt and disapproving by another. Developing the skills of feedback is an ongoing subject in supervisor professional development.
Supervisory relationship when undertaking assessments
Assessment adds a further level of complexity to the provision of feedback as it can change the feedback dynamic. Assessment requires feedback on performance to be given in reference to a standard.
Without care, assessment that emphasises the gap between current performance and the assessment standard can damage the registrar-supervisor relationship. The registrar may then become defensive and more likely to dismiss feedback given in subsequent conversations. On the other hand, supervisors being reluctant to honestly assess their registrar (called failure to fail) results in missed opportunities to provide more or better targeted educational assistance to help a registrar progress through GP training.