MRCGP & GP Training
Clinical Supervision & The CSR (Clinical Supervisor's Report)
What is a Clinical Supervisor?
Clinical Supervisors are qualified specialists who have responsibility for the day-to-day supervision, training and assessment of trainees who are doing a placement in their specialty. In a GP post, your Clinical Supervisor is therefore your GP Trainer. Sometimes, it might be other GPs in the practice. In hospital, your Clinical Supervisor will be the hospital consultant nominated to oversee your day to day clinical work. Make sure you find out who yours is. Your Clinical Supervisor should be a nice warm and friendly person.
The Gold Guide requires that each trainee should have a named Clinical Supervisor for each placement, usually a senior doctor, who is responsible for ensuring that appropriate Clinical Supervision of the trainee’s day-to-day clinical performance occurs at all times, with regular feedback.
The roles of a Clinical Supervisor
All Clinical Supervisors should:
- Understand their responsibilities for patient safety.
- Be fully trained in the specific area of clinical care.
- Offer a level of supervision necessary to the competences and experience of the trainee and tailored for the individual trainee.
- Ensure that no trainee is required to assume responsibility for or perform clinical, operative or other techniques in which they have insufficient experience and expertise.
- Ensure that trainees only perform tasks without direct supervision when the Clinical Supervisor is satisfied that they are competent so to do; both trainee and clinical supervisor should at all times be aware of their direct responsibilities for the safety of patients in their care.
- Consider whether it is appropriate (particularly out of hours) to delegate the role of Clinical Supervisor to another senior member of the healthcare team. In these circumstances the individual must be clearly identified to both parties and understand the role of the clinical supervisor. The named Clinical Supervisor remains responsible and accountable for the care of the patient and the trainee.
- Be appropriately trained to teach, provide feedback and undertake competence assessment of the trainees in the specialty.
- Be trained in equality and diversity and human rights best practice.
How often should I meet with my Clinical Supervisor?
Well, you should be seeing your Clinical Supervisor on most days you and they work – after all, you are working in their department, and they should be around most of the time somewhere at the place of work on the days they work.
In terms of the actual formal CSR meetings…. clinical Supervisors will meet with their trainees roughly three times per post – at the beginning, during the middle, and then towards the end.
- On a day-to-day basis, they will clinically supervise your work.
- Throughout the post they will do various WPBA assessments on you.
- Finally, in the last meeting, they are expected to write a report about you (called the CSR – Clinical Supervisor’s Report; more below) which MUST be done before your Educational Supervision meeting for that post
What the difference between Clinical and Educational Supervisors?
Try not to confuse your Clinical Supervisor with your Educational Supervisor.
- The Clinical Supervisor oversees your day to day work and will change with each change of post.
- Your Educational Supervisor oversees your progress throughout training and will usually remain the same person throughout your 3 year training period. Their aim is to keep you on track for training (primarily) and help you identify and meet your learning needs.
Tell me more about the Clinical Supervisor's Report (CSR)...
The Clinical Supervisor (GP Trainer or hospital consultant) will be asked to do a report on you (called the CSR – Clinical Supervisor’s Report) towards the end of your attachment with them. This CSR is an electronic form embedded within your ePortfolio. The CSR must be filled in BEFORE the official Educational Supervision meeting for that post. You will probably need to remind them! Actually, for hospital posts the CSR form should be done by the consultant who knows the trainee’s work best even if the e portfolio doesn’t have their name as nominated Clinical Supervisor. The CSR covers things like:
- Your relationship with patients and team colleagues
- How good you are at making decisions
- How good you are at managing yourself or others (i.e. organisational skills)
- Something about professionalism – your honesty, integrity, attitudes and the like.
The electronic form provides reminders of the definitions of the competencies to make writing the report easier. See the CSR document in the DOWNLOADS section above for a more detailed look.
Example of a Clinical Supervisor's Report (CSR)
The trainee should be graded in relation to the standard expected at certificate of completion of training (CCT). Provide constructive feedback on the trainee’s performance and suggestions for improvement based on your own observations as the Clinical Supervisor as well as observations from colleagues during the post.
Includes being respectful, diligent and self-directed in their approach to patients and others and to their own learning needs, developing resilience, making appropriate ethical decisions
Areas of strength
XXX is a diligent learner – and looks up things if she does not know them.
She consistently analyses things in the ethical dimension – both in log entries and during professional conversations. Has a good understanding of ethical frameworks.
Always contributes to team meetings.
Areas to develop
To think about her work-life balance and look after herself.
Think about how she wants to work. Does not have to do 10 minute consultations – many places happy with 15 min as long as same number patients see. Remember to pace herself. And not get too flustered by her stammer which to many of us is not that overt.
Includes communication with patients, establishing patient rapport, managing challenging consultations, third-party consulting, the use of interpreters
Areas of strength
Phenomenal improvement in Communication Skills. I have actually seen her use quite a few advanced consultation skills like Motivational Interviewing.
She has a very good understanding of the Calgary Cambridge Consultation model.
Her explanations have improved phenomenally well and is now able to use analogies.
Areas to develop
Consider going on a Motivational Interviewing course and remember to continue building on consultation skills post qualification.
Includes working effectively with others, sharing information with colleagues, leadership, management and team-working skills
Areas of strength
We have loved having Dr XXX as part of Ashcroft Surgery. Everyone her really likes her. We will miss her when she goes as she feels part of the fabric of Ashcroft Surgery.
She has been a great team player – contributing good ideas to team meetings.
She handovers well to colleagues (especially in secondary care).
There have been times when a secondary care colleague suggested a patient did not need referral, but XXX stood by her decision making – especially as she was the one who had seen the patient and on discussion with a supervisor, she did the right thing.
Areas to develop
Dr XXX written skills are very good. Perhaps signposting, a bit more might help structure the verbal consultation with colleague a bit more and make you sound less waffly and easier to follow.
Includes patient history, Clinical Examination and Procedural Skills (CEPS), choosing investigations, and making an appropriate diagnosis or decision. Please also comment on clinical skills that have been observed
Areas of strength
All CEPS achieved. No concerns from myself or colleagues about her examination skills. Uses appropriate examinations.
Areas to develop
The more you experience, the even better you will become. And over time, you will get quicker.
Includes recognition and appropriate management of medical conditions encountered in the role, prescribing safely, and taking account of co-morbidity, poly-pharmacy. Managing uncertainty & risk
Areas of Strength
Has pretty good clinical knowledge in terms of the latest guidance for common presentations.
Knows the NICE guidelines .
No concerns over prescribing.
Does NOT over investigate. Does NOT over prescribe. Does not over refer.
Areas to develop
Continue to go on GP update courses – don’t forget. I always go once a year. A good way of keep abreast of a wide variety of clinical topics
Includes showing an appropriate use of administration systems, effective and appropriate record-keeping and use of IT for the benefit of patient care
Areas of strength
Very good clear concise documentation.
Very structured too. Entered in a timely way.
Is also good with IT systems – able to use all of System1, ASSIST and Ardens in the surgery to a competent level.
Areas of development
There is nothing I would suggest. Just remember, your entries are better when you are not flustered. So perhaps the suggestion here is to write up notes when not flustered?
Includes seeking to understand and support patients through an appreciation of the interplay between their disease and their lives and considering local pathways, formularies and resources
Areas of Strength
Regularly explores the patient’s ideas, concerns and expectations.
Also explores the psycho-social-occupational impact of a problem on a person’s life.
Lot’s of examples of this in her log entries – very evident.
Also is familiar with local pathways.
Areas to develop
Remember, if you move to a new geographical place, remember – you will need to see what is available and it may not be similar to Bradford.
A few final questions...
The CS report helps you and your Educational Supervisor:
- Highlight areas where the trainee has shown particular strengths
- Identify any significant developmental needs identified during a placement
If there are serious issues of professional performance or ill-health during a placement these will need to be handled by normal acute trust/primary care trust/deanery mechanisms. In such circumstances always liaise with the Programme Director of the training scheme and with deanery as EARLY as possible.
If a trainee is in an integrated post working concurrently in more than one specialty, then get EACH Clinical Supervisor to complete a CSR. You are allowed more than one CS report in any post.
