Time to define the "who" and "what" of GP supervision

When is a supervisor a supervisor??

Over the last three years, I've lost count how many times GPs have approached me at conferences and other events about becoming a supervisor. On the face of it, this is really promising for the future supervision workforce. Without enough supervisors invested in quality placement experiences, can general practice survive as a profession?

But 90% of these individuals have talked about supervision as if it starts and ends with AGPT trainees, not recognising that they are already "supervising" even when the beneficiary of their clinical oversight, support and wisdom is a medical student, prevocational doctor, IMG, vocational trainee on a non-AGPT pathway, or a Fellow under remediation.

So how should we define the supervisor in general practice?

In the teaching hospital context, the hierarchical structure combined with the reference in most doctors' employment contracts to the supervision of less senior medical staff as part of their remit provides clarity around the supervision role. So when that hospital-based doctor transitions into the flattened hierarchy of general practice as a trainee, who do they see as a supervisor? Anyone and everyone with more experience in that setting, or only the one clinician designated to provide (and potentially be paid for) the formal educational component of their clinical experience?

Does this align with your own perspective?

What are the key elements of supervision that help define the supervisors in a GP setting?

As an organisation, we define the supervisor as pivotal to the clinical and personal development of all types of learner in the general practice environment - whether that learner is a medical student, prevocational doctor, specialist international medical professional, or a GP/RG registrar.

We list the responsibilties that come under the broad banner of GP supervision as:

• Clinical Overseer – ensuring safe and effective patient care while learners observe and participate
• Educator – providing instruction and imparting knowledge tailored to the learner’s level of expertise
• Mentor – guiding the learner through both professional challenges and personal growth
• Role Model – demonstrating best practices and professional standards in everyday clinical work
• Assessor – evaluating the learner’s progress and competencies in a structured manner
• Coach – supporting the learner in developing particular skills and fostering their self-efficacy
• Pastoral Carer – attending to the emotional and psychological well-being of the learner

But do all of these responsibilities need to be fulfilled by one person? Or should the GP the learner feels most comfortable to go to with their questions and concerns - even though that GP does not perform any assessment or formal education function - be recognised as a supervisor too?

And what about the remote or off-site supervisor whose most valuable role might be that of pastoral carer, offering a neutral platform outside the employment context to reinforce the importance of the learner's wellbeing?

Is the supervision of medical students less - or more - important than supervising vocational trainees?

We've recently added a new webpage to support best practice supervision of medical students. Aside from the fact medical students are the ideal cohort to introduce to the benefits of general practice as a future career (before being swept up in the comparative excitement and "bro" culture of the hospital-based specialties), mastering the teaching skills involved in supervising medical students is typically considered both more challenging and rewarding than vocational training - involving the conscious unpacking of your clinical role to offer this level of learner an appropriate amount of foundational explanation and signposting throughout their placement. In all other ways, the key tasks of the GP supervisor  differ very little according to which end of the educational continuum the learner belongs:

1. Establish and maintain a safe and high-quality learning environment
2. Orientate the student/GPiT to the practice and community
3. Monitor patient safety
4. Facilitate teaching and learning
5. Assess competence and give feedback on performance
6. Support wellbeing
7. Undertake ongoing professional development

So, if anything, effectively supervising a medical student - where success is measured less by assessments than by the increased ranking of general practice as a possible career destination developed by the end of the student's GP placement - could be seen as more important than supervising AGPT or other vocation trainees.

Why then do those involved in supervising students and prevocational doctors feel less worthy of the "supervisor" title?