Clinical supervision in general practice training: the interweaving of supervisor, trainee and patient entrustment with
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Clinical supervision in general practice training: the interweaving of supervisor, trainee and patient entrustment with clinical oversight, patient safety and trainee learning Nancy Sturman1 · Malcolm Parker2 · Christine Jorm3 Received: 5 August 2019 / Accepted: 17 August 2020 © Springer Nature B.V. 2020
Abstract Australian general practice trainees typically consult with patients from their first week of training, seeking in-consultation supervisory assistance only when not sufficiently confident to complete patient consultations independently. Trainee help-seeking plays a key role in supervisor oversight of trainee consultations. This study used focus groups and interviews with general practice supervisors to explore their approaches to trainee help-seeking and in-consultation supervision. Supervisor approaches are discussed under three themes: establishing a help-seeking culture; perceptions of in-consultation assistance required; and scripts for help provision. Within these themes, three interwoven entrustment processes were identified: supervisor entrustment; trainee self-entrustment; and ‘patient entrustment’ (patient confidence in the trainee’s clinical management). Entrustment appears to develop rapidly, holistically and informally in general practice training, partly in response to workflow pressure and time constraints. Typical supervisor scripts and etiquette for help-provision involve indirect, soft correction strategies to build trainee self-entrustment. These scripts appear to be difficult to adapt appropriately to under-performing trainees. Importantly, supervisor scripts also promote patient entrustment, increasing the likelihood of patients returning to the trainee and training practice for subsequent review, which is a major mechanism for ensuring patient safety in general practice. Theories of entrustment in general practice training must account for the interplay between supervisor, trainee and patient entrustment processes, and work-related constraints. Gaps between entrustment as espoused in theory, and entrustment as enacted, may suggest limitations of entrustment theory when extended to the general practice context, and/or room for improvement in the oversight of trainee consultations in general practice training. Keywords Medical education · General practice training · Patient safety · Help-seeking · Clinical supervision · Clinical oversight · Entrustment
* Nancy Sturman [email protected] Extended author information available on the last page of the article
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Introduction General practitioner supervisors are believed to play a key role in promoting trainee learning and autonomy while ensuring patient safety (Clement et al. 2016; Ingham 2012; Morgan et al. 2015; Morrison et al. 2015). Questions have been raised, however, about the robustness of supervision and oversight in a number of clinical settings (Franzone et al. 2015; Kennedy et al. 2007), with calls for more explicit and defensible oversight of trainees (Cianciolo and Kegg Jason 20
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