Becoming an F2 Supervisor

Being an F2 supervisor is an extremely rewarding role, and F2 doctors tell us that having a GP placement makes them more likely to consider GP as a career. All the information you need should be in the F2 Clinical Supervisors and Practice Managers handbook  (found here) but here we include a few frequently asked questions and key points.

 

Foundation Doctors supervision

  • All F2 doctors will have one Educational Supervisor for the year, and as a GP you will fulfil the role of Clinical Supervisor while they are in your practice.
  • If the first rotation is in general practice you will need to carry out an initial appraisal and work with the F2 to identify their learning needs and discuss with them how to maintain their portfolios, Personal Development Plans and keep appropriate records of their assessments.
  • For second and third rotations you will need to start by going through the portfolios and discuss their learning to date in order to help them identify the learning needs they wish to address during the rotation with you.
  • We recommend that you obtain formal feedback from every F2, which can be used as formative feedback for your development as a Clinical supervisor. For example, the Tyndale questionnaire. This is an addition to formal feedback that is collected by the GP centre for every F2 doctor at the end of their GP placement.

Induction Meeting and Review Forms

At the start to the F2 placement, you will need to conduct an ‘Induction Meeting’ with the F2 trainee and record this on an Induction Meeting form.  A ‘Mid-point Meeting’ can be carried out halfway through the placement; this is not compulsory, but strongly advised.  The Clinical Supervisor’s Report must be completed 2 weeks before the end of placement and forwarded to the trainee’s Educational Supervisor.  These meetings are recorded on standard forms available within the Foundation ePortfolio.

An Educational Agreement should also be completed between the Supervisor and the F2 trainee, signed and retained at the Practice.

At Induction please also check that the F2 has:

  • Informed their indemnity provider that they are in a GP rotation
  • Informed their car insurance provider if using their car for home visits (business use)
  • Registered with a GP locally

GP Access to ePortfolio

GPs may ask to be set-up as Clinical Supervisor (CS) on the Foundation ePortfolio. This enables access to the trainee’s ePortfolio. Alternatively, the F2 will ‘ticket’ the GP to receive e-mail copies of the assessment forms for completion.

 

Performance Issues

The vast majority of F2 doctors will complete the programme without any major problems. However some doctors may need more support than others, for example due to ill-health, personal issues, learning needs or attitude. If you feel at any time that the doctor under your educational or clinical supervision has performance issues you should contact the Foundation Programme Director for General Practice who will work with you to ensure that the appropriate level of support is given both to you and the F2 doctor.

It is very important that you keep written records of the issues as they arise and that you document any discussions that you have with the F2 doctor regarding your concerns.

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The Supervision Payment/Trainer’s Grant

The level of the supervision payment is based on the available funding to the Wessex Deanery.

  • You can if you have sufficient capacity in terms of space and resources have more than one F2 at any one time.
  • To claim the supervision payment, complete and submit the appropriate invoice during the final month of the F2 placement. A Supervision Payment Invoice can be downloaded from the Foundation School pages of the Wessex Deanery web site.

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Role of Clinical Supervisor in GP

The Clinical Supervisor supervises the Clinical Work with the F2 Doctor in the Practice.  The supervisor will be able to:

  • Organise the clinical attachment and be directly involved with the trainee in organising their assessments.
  • Supervise the clinical work of the F2 or arrange for this to be covered by a colleague.
  • Ensure that there is always appropriate cover available to the F2 doctor.
  • Enable the practice to facilitate the learning necessary to fulfil the objectives of the Foundation Programme.
  • Liaise with the trainee’s Educational Supervisor regularly and promptly if any difficulties are emerging during the training.
  • Sign relevant employment related paperwork on behalf of the Trust while the trainee is working in the practice.
  • Demonstrate that they have a level of competence in training and education and be able to apply this to the appraisal and development of an appropriate PDP for the trainee.
  • Complete the Foundation Clinical Supervisor’s report at the end of the placement.

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Role of Educational Supervisor

The Role of the Educational Supervisor During the F2 Doctors Attachment in General Practice

  1. This person will supervise the F2 doctor for the whole year and is responsible for the overall development of the programme through all three placements. At present, this is usually a nominated consultant at the Acute NHS Trust.
  2. The Educational Supervisor MAY also be the Clinical Supervisor for one post in the rotation. This is not always the case. Currently, there are many different arrangements for supervision of F1 and F2 doctors. It is hoped that eventually there will be one Educational Supervisor for each trainee for the whole Foundation Programme.
  3. The Educational Supervisor has regular meetings with the trainee and should be in contact with each Clinical Supervisor when the trainee is in post.  He/She is responsible for signing the Foundation Achievement of Competency Document (FACD) at the end of the F2 programme.
  4. The Educational Supervisor liaises with the Foundation Programme Director in the Trust.  There is an expectation that they will have experience of managing trainees in training posts and have some knowledge of educational theory. They should have completed a course to qualify as an Educational Supervisor.

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Becoming a CS of Foundation Doctors in GP

The role of General Practice has never been more important in the training of new doctors irrespective of their chosen career path.

The Deanery is keen to encourage GPs to train as Clinical Supervisors for Foundation Doctors. Therefore, we are running courses at Wessex Deanery to train GPs for this role.

The criteria for eligibility for becoming a GP Clinical Supervisor (CS) are available on the Wessex Deanery website.

The Process is simple. You need to attend a course which is held on 2 Wednesday afternoons at Otterbourne. Completion of the Course gains 10 CPD Credits and, providing you satisfy the criteria listed in the application form, you can complete the form.

The Foundation Supervisor application form should be completed by you and your partners and practice manager and submitted together with supporting documents to your local Associate Dean’s Patch Office. The addresses are on the Wessex Deanery website.

The Patch Office will check your application is complete and then the AD will arrange a visit to your Practice unless you are working in an approved GP-Training Practice which is known to the AD and the Deanery.

Following a successful Practice visit the AD will submit your application forms to the GP Specialty Training Committee at Wessex Deanery with a recommendation that you should be approved as an F2 CS initially for one year, and subsequently for 3 years.

The Practice inspection cycle will, thereafter, be once every 3 years.

GP-Trainers automatically qualify as CS and Training Practices will usually be suitable for Clinical Supervision of F2 doctors providing there is sufficient space for adequate supervision and learning.

 

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Training Assessment

The Foundation Year 2 assessment programme is intended to provide objective workplace-based assessments of the progress of the Foundation doctor through the Programme.  The assessment will be used by the Deanery to decide whether the doctor can be signed up as satisfactorily completing the programme.  The Foundation Competencies must be achieved prior to commencing Specialty Training.

N.B. The number of assessments completed during F2 will depend on whether the trainee is following the old or new curriculum.

  • The assessments are designed to be supportive and formative.
  • The Foundation doctor can determine the timing of the assessments within each rotation and to some degree can select who does the assessment.
  • It is important that all assessments are completed within the overall timetable for the assessment programme.
  • Each F2 doctor is expected to keep evidence of their assessments in their portfolio.  These will then form part of the basis of the discussions during appraisals.
  • The F2 doctor is an adult learner and it will be made clear to them that they have responsibility for getting their assessments done and for getting their competences signed off.

The Assessment Tools

You are obliged to attend a training session on all of these tools which will be provided by the Deanery.

  1. Case based discussion (CbD) This is a retrospective look at a clinical case where the F2 doctor has been involved in the care of a patient.  There is a structured format for the assessment and feedback. Guidance notes for the trainee and the trainer can be found on the MMC web-site along with the assessment form that is completed at the time of the assessment.
  2. Direct Observation of Procedural Skills (DOPS) This is a real-time assessment where the trainee completes a clinical skill that has been previously agreed and the trainer makes an assessment of competence against agreed criteria and gives feedback to the trainee.  The trainee must have previous training in the skill and have reference to guidance notes as part of the training.
  3. Multi-Source Feedback (MSF) [Team Assessment of Behaviour TAB]. This is a shortened form of 360’ appraisal. It takes place at 2 specified times in the year for all trainees. The trainee completes a self-assessment form and nominates 8 (minimum) colleagues to anonymously complete the form.  Feedback is normally given to the trainee and their Educational Supervisor within 6 weeks of the assessment.
  4. Mini Clinical Evaluation Exercise (mini CEX) This is another real-time assessment where the trainee performs an observed clinical encounter (usually between a doctor and Patient) that is assessed by the supervisor and feedback is given to the F2 doctor immediately afterwards.

The Assessment Programme

The table below is an example of how many of these assessments are likely to be carried out in each 4 month rotation. It also shows the purpose of the assessment.

Tool What it Assesses How Assessment is Made…
2 x Clinical evaluation exercise (mini-CEX)
  • Clinical Skills
  • Professionalism
  • Communication
Sitting in with F2
2 x Direct observation of procedural skills (DOPS)
  • Practical Skills
  • Professionalism
  • Communication
Observing practical procedures
2 x Case based discussions (CbD)
  • Clinical Reasoning
  • Professionalism
Case review in 1:1 discussion
1 x Multi-source feedback (TAB)
  • Professionalism
  • Clinical Care
  • Communication
By colleagues in all roles of Primary Care

 

What are the issues in assessment?

  • This is a supportive but formative developmental process for the trainee.
  • The supervisor should be competent and trained to carry out the assessment and able to give structured feedback.
  • The F2 doctor determines the timing of assessments within an agreed overall framework for the year. They have some choice of assessor.
  • The assessments do not have to be carried out by the doctor who is the nominated trainer.
  • You can and should involve other doctors, nurses or other health professionals that are working with the F2 doctor.
  • It is important that whoever undertakes the assessment understands the assessment tool they are using.

The assessments are not intended to be tutorials and although they will need to have protected time this could be done at the beginning, end or even during a surgery.

Each Foundation doctor will keep a learning portfolio/e-portfolio. It will be the means by which they will record their achievements, reflect on their learning experience and develop their personal learning plans.  This is an excellent opportunity to develop the habit of keeping an electronic ‘Learning Log’.

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Curriculum and Competences

Foundation

The Curriculum came into effect in August 2010 and is being used by those doctors who entered their F1 in August 2010. Trainees starting F2 in August 2010 could choose to follow either the 2007 version of the curriculum or 2010 curriculum. However, trainees were required to clarify which curriculum they were following with their trust Foundation Programme Director at the start of the F2 year.

The full syllabus and competences can be downloaded from the Foundation Programme website: http://www.foundationprogramme.nhs.uk/pages/foundation-doctors/key-documents

The 2010 curriculum defines outcomes and competences under the following headings:

  1. Professionalism
  2. Good Clinical Care
  3. Recognition and management of the acutely ill patient
  4. Resuscitation
  5. Discharge and planning for chronic disease management
  6. Relationships with patients and communication skills
  7. Patient safety within clinical governance
  8. Infection control
  9. Nutritional care
  10. Health promotion, patient education and public health
  11. Ethical and legal issues
  12. Maintaining good medical practice
  13. Teaching and training
  14. Working with colleagues

It is important to remember:

  • The rotation in your practice is part of a programme.
  • The Foundation doctor will not cover all competences during his/her time in General Practice. It is intended that the Foundation doctor will work through the curriculum during the 2 year Programme.
  • Some competences may well be more readily met in general practice than in some other rotations e.g. Relationships with Patients and Communications.
  • The GP Supervisor and the F2 doctor should work together to identify the areas most appropriately covered in the Primary Care setting and in their unique Practice.

 

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