Management of underperforming surgical trainee - Essay Example

Management of underperforming surgical trainee The purpose of this handbook is to provide a guide for the clinical supervisor in the performance of his/her duties in the hospital. This is designed to give the supervisor with resources and models for the supervision work and to orient the supervisor on the clinic supervision program. This is also a manifestation of our expressed commitment to provide students with excellent academic preparation. The materials contained in this manual are not intended to substitute existing ones, but rather to supplement the information. Relevant forms are attached for supervisor’s use. The Clinical Supervision The clinical supervision is a professional preparation. The experience gathered in this exercise provides the student with an opportunity to carry out professional responsibilities. The clinical supervision allows the student to integrate the academic theories learned from school to actual practice under the guidance of a clinic supervisor Clinical Supervision is defined as “formal process of professional support and learning that enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice, and enhance patient protection and safety of care in a wide range of situations (“clinical supervision”). It is a statutory requirement for midwives, and recognized by the Nursing and Midwifery Council as an important part of clinical governance. The underlying principles of clinical supervision are: A safe, trusting working relationship that promotes a learning alliance A counselor-centered program with a culturally and contextually responsive focus. Active promotion of professional growth and development. Shared clinical responsibility ensuring that the client’s treatment goals are addressed. A rigorous process that ensures ethical and legal responsibility. An individualized approach based on the learning needs and style of the supervisee. Congruence with the values and philosophy of the agency. Adopted from: Part 2, Chapter 2, NCBI Resources The Clinical Supervision Defining the characteristics of an Effective Clinical supervisor a. The Clinical Supervisor’s objectives The clinical supervisor’s foremost objective is to establish a positive supervisor-supervisee relationship that promotes client’s welfare and professional development of supervisee. The Clinical Supervisor has a well rounded personality as he acts as a teacher, coach, consultant, mentor, evaluator and administrator (TIP 52). The Clinical Supervisor has the following objectives in doing his jobs: 1. To help the less experienced worker improve his/her skills. 2. To ensure that patients receive the best medical care . 3. To have e clear contract of expectations, ongoing review and feedback; and a commitment to professional developments. These objectives will be discussed more thoroughly in succeeding sections of the manual. The Clinical Supervisor b. The Clinical Supervisor’s Duties and Responsibilities Responsibilities The clinical supervisor is committed to work with other departments in order to provide an outstanding customer experience. The role calls for coordinating management and clinical activities. Responsibilities include the following: Staffing Budgeting Personnel management Staff development Occasional clinical coverage and weekend house supervision Source: Adopted from Ephrata Community Hospital Duties Oversees department’s services in a manner that reflects customer excellence and the organizational mission. Responsible for education/training and assessment of staff competency in conjunction with department services. Assists in the development of policy and procedure and ongoing preparation for Hospital review by regulatory organizations. Ongoing review of financial reports for budget control and cost saving measures. Ability to provide objective data related to budget variances. The Clinical Supervisor Actively involved in continuous Quality Improvement and the identification and of Services Quality Improvement initiative for the annual Services Report. Ensures correct and timely payroll completion. Ensures completion of monthly statistics by the 6th of each month. Contributes information on Services Quality Improvement, staffing, and budget for monthly reports. Maintains a basic clinical competence in order to understand and address clinical issues. Maintains open communication channels and timely resolution of issues. Competent to assume Supervisor, including Incident Command role, as needed. Ensures sufficient staffing for department. Submits annual budget for the department he/she is assigned. Source: Adopted from Ephrata Community Hospital Qualifications BSN or bachelor’s degree in related field required. Holder of a master’s degree in counseling, psychology or social work, preferred. Evidence of strong customer excellence, interpersonal communication, clinical and leadership skills required (028 PA Code 704.6) The Clinical Supervisor Detailed duties and responsibilities The principle of novice to expert A clinical supervisor assumes the role of an expert who must evaluate the readiness of the novice to assume greater responsibilities, thus transforming the status of novice to expert (RCOCE Conceptual Framework). In the case of clinical teaching, the clinical supervisor must decide on the goals for instruction, know the students needs, find out the learner’s characteristics, and individual differences. The Clinical Supervisor must be responsible for education/training and assessment of staff competency in conjunction with department services. The supervisor has the responsibility to see to it that supevisee are properly trained for their jobs. The major role of a clinical supervisor is ensuring that the supervisee’s professional competence is commensurate to the requirements of the job. (Sharrief, 2011 & CS Protocol) . a. Assessing educational needs The Clinical Supervisor must review the competencies on job description of the position then compare it to the required education for the position. A job description is ordinarily given to a supervisee upon entrance to duty to be informed of the essential duties and the performance indicators of the job. By using the 4-point scale method, the supervisor can now identify areas of weaknesses where training competencies are required. The scale is illustrated below: 1 –needs assistance The Clinical Supervisor 2 –progressing 3 – proficient 4 –exemplary. Source: Adopted from Shareiff, 2011 Goal of the assessment In assessing the performance of the employee, the Clinical Supervisor must establish a clear goal, such as : What is required of the employee? What the employee will be required to do as a result of the developmental process. Two categories of development emerge, one is a “must” or “can” category that will require intervention from supervisor (Accel Team) In “must” situation, a supervisor is required to provide development training to the subordinate because: It is the policy of the hospital. He/she is not performing satisfactorily. In the “must” intervention, subordinate employee is obliged to follow the company policy for development. In “can” intervention, supervisor believes training will benefit the employee and the hospital, and there is no compelling reason behind. Here, the question to be asked is: “Is the employee interested in career development?” When the employee accepts the offer for training and development, it is believed that trust of The Clinical Supervisor the subordinate employee is developed. c. Career Development Once it is established that there is a need for education and training, supervisor helps subordinate employee assesses his/her career goals. In doing this, supervisors should follow good counseling practices as shown below. *** Supervisors should avoid doing the following: Criticize the employee’s evaluation of his/ her own future Evaluate the subordinate’s future (as the supervisor sees it) Try to solve the employee’s career problems, and Stating opinions about what the employee “should” do. Supervisors should not give false hopes to the subordinates. A possible problem with career development is the raising of hopes that employee will be promoted. Supervisors should be sincere on this and explain to subordinates the possible outcome from the training. The Clinical Supervisor d. Planning development strategies. Once development need is determined, the clinical supervisor’s next step is to put this into action. Steps in doing this are outlined below: 1. Select which is the priority need of the employee, i.e. training, education or development. 2. Describe in writing the performance standards in meeting the development objectives. 3. Discuss the activities that will help subordinate accomplish the development objectives. 4. Set review dates In setting the development activity, supervisor and subordinate should discuss this along with the framework of work schedule in the hospital, budget and other contingencies. Supervisor makes the decision and gets the commitment of the subordinate. Next, supervisor sets written measurable goal for development. He sets a date for review process such as three months, or six months. In between this period, supervisor checks on progress and deal with problems that may arise. As needs and goals may change during the three to six months target, subordinate should be open for possibilities of change. The Clinical Supervisor Documentation requirements Whenever there is a supervisory session with the subordinate, notes should be taken. The issues discussed, solutions suggested and agreed upon action should be recorded and kept in the folder for each personnel. The folder should also contain the summaries and personnel actions like memos, commendations and other pertinent issued on the subordinate employees. The subordinate employee is permitted to have access to the folder for her review. Clinical supervision frequency The supervisor needs to spend 4 hours of supervision to a supervisee every month. In separate instances, a combination of individual and group supervision may be used for supervision. Supervisors should ensure that a minimum of 50 percent of this time is devoted to clinical supervision and the rest of the time is for administrative and other purposes. Review and feedback The supervisor gives an annual performance evaluation to the employees according to job expectations and the clinical skills learning plans. Written records of the subordinate employee will be reviewed on a regular basis. Specific feedback in written form is given to the employee with emphasis on the strength and areas for improvement. The Clinical Supervisor The direct observation of clinical work is used in the supervision system so as to ensure a direct focused feedback. This system hopes to increase the degree of trust and safety, and an accurate evaluation of skills development programs. Observations are pre-arranged and is done thru a sitting session, co-facilitating or Videotaping. The subordinate employee is required to present a case of at least once a month. Supervisors are encouraged to follow the following steps in giving feedback: 1. Before giving feedback, make sure that goals, norms, rules have been agreed and established. 2. Make sure that the relationship has sufficient trust. Ask permission to give feedback, and do this thru a written report. 3. Use neutral conduct to avoid blame and judgment. Be aware of nonverbal communication and tone. 4. Be timely and give feedback quickly as possible, but avoid the “heat of the time”; at times when you cannot control emotions wait until you can. 5. Be relevant. Feedback should focus on moving forward, not something about the past will never happen again. Giving feedback about past events serves no purpose and can damage trust. 6. Focus on behaviors that are within the employee’s control. Beating people up for things outside of their control is unreasonable.  The Clinical Supervisor 7. Be specific and descriptive. Describe the behaviors or data rather than giving generalizations. Do not drag in third-party observations and do not give into demands for “what other people think.” Remember you are the manager, and what matters is what you think.  8. Be open and ready for a variety of outcomes. If you are just giving feedback to be helpful, don’t expect gratitude or enthusiasm. If there is a request, hopefully, the feedback will be received and acted upon. If so, pay attention to efforts and be ready to endorse and praise. If there is a demand and/or requirement that need to be acted upon, be ready to work with the person to ensure compliance. Be ready to discuss structure (when and how they will do what is needed), accountability (how you and others will know they are on track) and support (how you and others can help). Finally, be ready to follow up with consequences for failure. Source: Witt. 2009 Managing trainee with difficulty or under stress. Supervisor should recognize signs of trainee with difficulty. This is manifested by poor clinical performance, unexplained absences, inability and outbursts, and sometimes serious problems of probity. Trainees ordinarily encounter difficulty during their training period and it is expected that supervisor provides support to them (Brocket & Morries, 2010) . According to Black & Welsch 2009, and Paice , 2009 factors that affect the trainee are training environment, The Clinical Supervisor personality issues, craft development, generic professional development and professional behavior . Clinical supervisor should consider these factors in the evaluation of the trainee’s clinical performance. Supervisor should determine the reasons behind the issues and should answer the following questions. Is training development due to mismatches of trainer and trainee, excessive workload, harassment, bullying, wrong level of expertise expected of the junior doctor? What are the personal issues affecting the trainee. Is it health, emotional difficulties (partner/spouse relationship, critical family illness) or wrong career path? In craft development, does the trainee experience problems with procedures, manual dexterity, depth of understanding, and clinical decision-making? Does trainee establish rapport with patients, staff and families, respect for people holding different views, cultural acclimatization, and acting effectively within the team. Is the trainee motivated, matured or lacks insight? Does the trainee practice time management and possess basic organization skills? Source: Black & Welsch 2009 Supervisor should also check if the source of difficulty in professional behavior is integrity, probity, reliability or substance abuse. Upon tracing the particular difficulty of trainee, intervention can be done. Supervisor has the following intervention remedies (Paice 2009) Occupational health services Directed supervision Giving more time Change of post The Clinical Supervisor Counseling or mentoring Workplace based assessment Trainees are required to undergo workplace based assessment as part of their curriculum in medicine study. Workplace based assessment (WBA) refers to “the assessment of day-to-day practices undertaken in the working environment” —or, more simply, workplace based assessment is an “assessment of what doctors actually do in practice.” (Beard, 2010) Purpose of WBA is to aid learning thru constructive feedback and to check knowledge or skills learned. Based on the studies of several authors, the WBA is now a widely used system of assessment for trainees and has contributed to the improvement of their performance (Shamila, et. al, 2009, Miller & Archer, 2010). Chana (2009) believes that if “WBA is carried out well, assessments will reconnect teachings and testing to the benefit of the learner.” In WBA, clinical supervisor uses the clinical evaluation exercise (CEX) to evaluate trainees in the hospital. The CEX method is considered in separate studies as appropriate evaluation procedure for clinical setting( CIPHER, n.d. and Norcini, 2008). CEX was developed by the American Board of Internal Medicine to substitute for the oral examination as a method of evaluating the performance of residents’ performance (CIPHER). The duty of a clinical supervisor is the observation of the trainee in carrying out a thorough history taking and physical examination, presenting of findings and diagnosis and a written The Clinical Supervisor report of conclusions. The supervisor schedules an assessment that usually takes 1 up to 2 hours, once a year. An evaluator is assigned and done with a pre-arranged patient encounter. Instrument description: Mini-CEX encounters are short, usually taking between 15-20 minutes, incorporate an opportunity for feedback from the evaluator (between 5-10 mins.), done on multiple occasions with different evaluators and in different settings, with the trainee-patient encounter being evaluated on 7 dimensions of clinical performance. The CEX form also provides additional space to record details about the context of the encounter. Rating should be accomplished within 24 hours. (CIPHER) The supervisor rates the trainee according to his competency on the following factors: History taking or medical interviewing skills Physical examination skills Professionalism or humanistic qualities Organization/efficiency Management skills Inter professional relationship skill In the assessment, the supervisor used a rating scale, described as follows: 1, 2, 3 rating are unsatisfactory/below level; 4 is marginal; 5-6 are satisfactory/meets expectations and 7, 8, 9 are superior/exceeds expectations The Clinical Supervisor Annexes: Relevant template Supervision Note Sample Professional Development Plan Current Focus Goal/TAP Competencies Objective Date of Expected Completion             Supervision Content Issue Discussion Recommendation/Action Follow-up                                 Progress on Professional Development Plan Objectives Supervision Contract Template This document serves as a description of the supervision provided by (supervisor name, credentials, title) to (supervisee, credentials, title). Primary Purpose, Goals, and Objectives Monitor and ensure client welfare Facilitate professional development Evaluate job performance Provision (Frequency) of individual supervision at (day and time) (Supervision model and case review format) will be used Clients of the counselor will give informed consent for supervision of their case Counselor will have a minimum of (amount) of supervision for every (number) of client contact hours All client cases will be reviewed on a rotating basis based on need Documentation (Form name) will be used to document the content and progress of the supervision Informal feedback will be provided at the end of each session Written formal evaluation will be provided (frequency) Supervision notes will be shared (at the supervisor’s discretion or at request of counselor) Duties and Responsibilities The supervisor at a minimum will: Review all psychosocial histories, progress notes, treatment plans, and discharge plans. Question the counselor to justify approach and techniques used. Present and model appropriate clinical interventions. Intervene directly if client welfare is at risk. Ensure that ethical guidelines and legal statutes are upheld. Monitor proficiencies in working with community resources and networking with community agencies. The counselor at a minimum will: Uphold all ethical guidelines and legal statutes. Be prepared to discuss all client cases. Discuss approaches and techniques used and any boundary issues or violations that occur. Consult supervisor or designee in emergencies. Implement supervisor directives. Adhere to all agency policies and procedures. Procedural Consideration The Individual Development Plan’s goals and objectives will be discussed and amended if necessary. The quality of the supervisory relationship will be discussed and conflicts resolved. If conflicts cannot be resolved, (name) will be consulted. In the event of an emergency, the counselor is to contact the supervisor. If unavailable, contact (alternate’s name, title, and other relevant back-up information). Crises or emergency consultations will be documented. Due process procedures (as explained in the agency’s policy and procedure handbook) have been reviewed and will be discussed as needed. Supervisor’s Scope of Competence Title/date of credentials/licensure. Formal supervisory training and credentials. Years providing supervision. Current supervisory responsibilities. This agreement is subject to revision at any time on request of either person. Revision will be made only with consent of the counselor and approval of the supervisor. We agree to uphold the directives outlined in this agreement to the best of our ability and to conduct our professional behavior according to the ethical principles and codes of conduct of our professional associations. Supervisor_______________ Title_______________ Date_______________ Supervisee_______________ Title_______________ Date_______________ This agreement is in effect from (current date) to (annual date of review or termination) Source: Part 2, Chapter 2 . Clinical Supervision and Professional Development of the Substance Abuse Counselor: A guide for administrators Individual Development Plan (ID) Employee Name:__________________________________ Date:_______________ Job Title Department:______________________________ Department:_____________________________________ 1.0 Training Needs/Assessment (skills and knowledge requirements for improving or maintaining satisfactory performance)   Degree of Proficiency Need Priority High Adequate A B C 1.1           1.2           1.3           1.4           1.5           2.0 Career Goals 2.1 Short Term (within 2 years)   2.1.1 Target date 2.1.2 Target date 2.1.3 Target date 2.1.4 Target date 2.2 Long Term (Beyond 2 years)   2.2.1 Target date 2.2.2 Target date 2.2.3 Target date 2.2.4 Target date     3.0 Education and Development Needs (to achieve goals in section 2) 3.1.13.2 3.1 Target date 3.2 Target date 3.3 Target date 3.4 Target date 4.0 Development Objectives (Specific performance indicators to show needs have been met)   4.1 Target date 4.2 Target date 4.3 Target date 4.4 Target date 5.0 Development Activities (ways to prepare for development objectives)   5.1 Target date 5.2 Target date 5.3 Target date 5.4 Target date Next review (date)__________________________ Signature Supervisor______________________ Source: Accel Team The Clinical Supervisor LIST OF REFERENCES 12.028 Pennsylvania Code 70.6. Qualifications for the position of Clinical supervisor Retrieved 15 March 2011 Read More