F2 Clinical Supervisor

 

Key Points

  • All F2 doctors will have one Educational Supervisor for the year.
  • You will fulfil the role of the Clinical Supervisor for the doctor whilst 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.
  • In the Hub and Spoke models (see later) the F2 may have a Clinical Supervisor who will supervise clinical activity ensuring that the Foundation doctor only performs tasks without supervision that they are competent so to do. This is part of the spoke with a GP Educational Supervisor forming part of the hub.

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.

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.

The GP Clinical Supervisor must record the Clinical Supervisor’s report on the F2 doctor’s ePortfolio at the end of the attachment. It is recommended that the CS also records the Induction Meeting and comments on progress throughout the attachment.

Back to the top.

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.

Back to the top.

Non-Standard F2 Rotations

We said at the beginning of this guide that the standard F2 rotation in general practice was for 4 months.  However there are some innovative variations to this within the Deanery but even within these variations all of the principles outlined in the guide will still apply.

Examples of other rotations may be:

  • A four month rotation in general practice but with one to two days each week spent in a speciality such as Medical Education (academic programme), Public Health (academic programme) Public Health (clinical), sexual health or psychiatry.
  • A three month rotation.

Back to the top.

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.

Back to the top.

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.

Back to the top.

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.

Back to the top.

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 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.

Back to the top.

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

 

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.

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.

Also see Curriculum & Competences document.

Back to the top.

Useful Documents

Back to the top.