Interventions and strategies
The introduction of a structured training curriculum and workplace-based assessments should enable supervisors to bring together a range of helpful ‘diagnostic data’ and indicate the type(s) of learning experience trainees may need to overcome difficulties. The primary goal is to identify the nature and extent of the difficulties they face (see Assessing educational needs and Setting learning objectives for more guidance).
Personal development plans, if used effectively, can help trainees recognise gaps in their experience, skills or knowledge and be used to set goals for future development. The educational supervisor can assist the trainee in difficulty to identify the underdeveloped areas in their learning portfolio while encouraging the trainee to take the lead in this process. Facilitating ‘developmental conversations’ which highlight the possibilities for further personal growth and understanding through a consideration of new ideas and ways of addressing areas of difficulty are vital. The Supervision module has suggestions on how to structure these conversations.
Workplace-based assessments can be extremely helpful, if colleagues have used them authentically and honestly, with a strong emphasis on the formative elements of their use. These tools provide a means of capturing early warning signs of the trainee in difficulty. Multi-source feedback is particularly useful, with careful interpretation of data to identify profiles of underperformance. Trainees who consistently over-rate their own performance may be a particular cause for concern.
Observation of a trainee’s practice in the workplace, either formally or informally, is particularly useful in contextualising reported behaviour provided by others in the team. It may facilitate the possibility of distinguishing between occasional and systemic difficulty on the part of the trainee in a particular assessment. Thus direct observation of, say, a consenting procedure by a trainee, may simultaneously give insight into communication skills and technical understanding. The latter may be a small weakness in knowledge base, the former an underlying behavioural characteristic.
See the module on Workplace-based assessment for further guidance.
The educational supervisor is in a position to have a direct and positive impact on the trainee’s programme of learning. For the trainee in difficulty consider the following.
- What information do I need to ensure an accurate ‘training needs analysis’ and an appropriate development plan?
- Do workplace-based assessments indicate consistent areas of underperformance?
- What information might I gain from directly observing the trainee with patients or working with other team members?
- Which tools and strategies might I use to help the trainee to internalise appropriate learning objectives and to engage them in the process of addressing development needs?
Common areas of difficulty and how to approach them
|Area of difficulty||Approaches to identification||Possible educational interventions|
|Practical skills/procedures||Assessed or observed practice
Feedback from colleagues
Specific feedback and guidance
|Communication skills||Mini-Cex, multi-source feedback, observation
Feedback from patients, carers, colleagues
|Specific feedback and guidance
Video recording with self-review
|Clinical reasoning||Case-based discussion, clinical teaching (on rounds, in clinic, etc.)
Over-reliance on investigations
|Developing knowledge base
Use socratic questioning techniques in supervision
Data interpretation (results of investigations, etc.)
Informal case-based discussion with a focus on rationale for choices made, along with consideration of alternative options (diagnosis, investigations, management)
Increased clinical exposure (clerking, history taking) and requirement to present cases
|Insight into performance||Multi-source feedback
Evidence in feedback (capacity to self-evaluate) and supervision sessions
|Encourage independent review of performance in all feedback sessions
Encourage trainee to self-rate assessments before sharing your ratings – then discuss difference in perceptions (with evidence to back up)
Develop competence through increased opportunities to practise (being able to recognise a competent performance is a key step to developing insight)
Regular feedback, with specific supporting examples and guidance
|Team working||Multi-source feedback, feedback from colleagues and observed behaviour||Shadowing team members to develop awareness of their roles and contributions
Case-based discussion to explore who else to involve in patient management (and why)
Specific feedback, guidance and goal setting