Hospital clinical supervisors and the eportfolio

The hosp clinical supervisors have a hard task. It may not be feasible....

They may focus on GPRs being “good eggs” generally and mark them as competent or excellent, which they are not, in eportfolio terms, as they are not being ranked in competency terms as an independent GP as the WBPA requires, but as an ST1 or ST2 trainee. There is no solution to this as far as I can see, because if, say, a GPR is doing an ENT post, at the end of it he is being assessed by the ENT clinical supervisor as competent in ENT for general practice, not as a competent GP in every respect.

This makes this are of the WBPA unfit for purpose as it currently stands. I think we need to have different approaches to hospital clinical supervision feedback of competencies, therefore. The hospital clinical supervisors feedback comments are “naturally occurring evidence” and should be viewed by the educational supervisor in this light, and his advice to the ARCP panel moderated accordingly.

Flash points and Balint

Champagne moments
Or…
Even champagne has unwanted effects

Flash points

Balint described the flash technique where doctors become aware of their feelings in the consultation and sometimes interpret the feelings back in a way that can give the patient some insight into the problems that are presented.

This applies to teaching GPRs too
Teacher gets emotional feedback > encourages him to continue


Danger – GPR is very vulnerable > the apostolic function (P216 of "Doctor, patient illness")

It is almost as if every (doctor) trainer had revealed knowledge of what was right and what was wrong for (patients) registrars to expect and endure, and further, as if he had a sacred duty to convert to his faith all the ignorant and unbelieving amongst his (patients) registrars.

….if asked, he will readily quote impressive reasons for his choice, but these on closer examination reveal themselves to be secondary rationalsations.


“Practice” = “habitual action”
Vs
Showing humanity – we all make mistakes


“Trainer as drug”
Vs
Modelling


In spite of our almost pathetic lack of knowledge about the dynamisms and possible consequences or “reassurance” and “advice”, these two are perhaps the most often used forms of medical treatment (p116)

“Simple supportive treatment”, “advice”, “reassurance” in dealing with GPRs with problems > our need to make it right
Vs
Appropriate challenge, devolvement of responsibility fro problems and actions
(but what about mental health issues?)