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Supervision

 

Information About Supervision for Registrars:

This is to help new registrars who may not be sure what is meant by supervision during psychiatric training, or how to get the most out of it. The RANZCP requires you to have 1 hour of individual supervision from your main consultant supervisor each week, and 3 hours of general clinical supervision (or 1.5 hrs of general clinical supervision weekly if you work half-time). This is the College's information Link about Supervision.

Individual Supervision
These weekly one-hour sessions are scheduled at a regular time. Sessions can focus on whatever is most needed for your stage of training - for example, academic topics you're trying to get to grips with, in-depth discussion of interesting or difficult cases, ethical dilemmas, doing Workplace-Based Assessments (WBAs) or other training tasks, or coaching in aspects of the College examinations. The exact focus should be determined by you, especially as you become more experienced. Initially, first-year trainees may feel a bit at sea and need some help from their supervisors to structure these sessions. You can use the time to review your progress in training, to practice specific skills such as presentation and formulation (possibly as part of a CbD or OCA), or to discuss especially complex patients. General clinical reviews of your caseload should occur in the other three hours - it's a waste of your one-on-one supervision to fill it up with routine clinical handovers to your consultant. The time can be used to debrief or talk about your reactions to a patient or family and how you handled a situation, to discuss your multidisciplinary team's dynamics, patients encountered when on call, etc. As above, you can use the time to cover some academic material, but the sessions shouldn't become just a series of lectures by your supervisor. One or two focussed sessions before presenting a Case Conference or Journal Club will however often be needed, to organise and discuss your presentation with your supervisor. As you tackle the Psychiatric Written Case (case history) and the examinations, you'll need to use these individual sessions to discuss these and practise specific skills such as Written questions or OSCE scenarios, selecting a suitable patient for the PWC, planning a Scholarly Project, and so on. 

During first year you'll need to get basic skills like history-taking, mental state assessment, case-presentation and understanding of phenomenology sorted out, and you're required to have more individual supervision in 1st year (2 hours per week) compared to later years of training. Only one of those 2 hours is expected to be 1:1 training-focussed supervision though - the other hour will probably be clinical supervision or used for completion of a Workplace-Based Assessment. Every three months, individual supervision should be used for a more in-depth feedback session, with a feedback form (the mid-run ITA) being completed. There's a detailed feedback report (the end-of-run ITA) at the end of the 6 months attachment which is sent to the Training Centre (then the College) and which accredits the run. Again, this should be a record of the feedback discussion with you, and you should keep a photocopy of the form before sending it to the Training Centre. 

Aim to schedule your 1:1 supervision in the first half of the week so that if for some unavoidable reason the session has to be postponed, you can fit it in later in the week. Supervision is very important and it's vital to be punctual and not to miss sessions or chop and change with the times - there needs to be a commitment from you and your supervisor that it's a priority - more important than general clinical work in fact, for a registrar in training. Put a "do not disturb" sign on the door and try to prevent interruptions from cellphones or pagers - ideally, get the team receptionist to screen your calls across the hour or at the very least turn phones to 'silent'. Supervision isn't a social event or a 'break' - so while it's fine to bring in a cup of tea or coffee, it's not appropriate to do 1:1 supervision over lunch, in a car while driving, or in a social setting like a café.

Clinical Supervision This can take a number of forms as well. Discussion of your patients - of assessments and aspects of management - is a common focus, but it mustn't all be in team Review Meetings, especially in modern multidisciplinary teams where the focus is not on your training needs. Time spent doing a Mini-CEX or observing your consultant interviewing and practising this in front of them, with feedback and discussion afterwards, is all useful clinical supervision, as is time spent working alongside your supervisor and then discussing patients and family meetings. Clinical supervision may occur in longer stretches of an hour or so, or as briefer discussions in person or by phone - it's all clinical supervision. Clinical supervision can also happen in a small group or team setting - most DHBs offer group supervision for all their registrars, each week. In teams where the registrar and consultant work quite autonomously, it often needs to be specifically timetabled for at least 1 hour weekly, to make sure that it happens. 

At The Start of a New Run
It's important to spend the first one or two sessions talking with your new supervisor about where you're at with your training, whether there are any problems you need to focus on or sharpen up, what you'd like to use supervision for, and setting up regular sessions at the same time and place each week. In the first session, it's also crucial to write a short list of goals you want to achieve during that 6 months - then review these at the end of three and six months, with your supervisor. In the Northern Region programme, we expect you to have a Training Folder - a manila file (or similar) in which you keep copies of all your College feedback and accreditation forms and any other relevant training documents such as a print-off of your College database record. You are expected to bring this folder to the initial 1:1 session with a new supervisor, so that you can both discuss past feedback and identify any areas that need to be focussed-on across the coming six months.

Managing any Problems
The College requires that you have 40 individual supervision sessions per year, and this is difficult to achieve with weeks-of-nights and leaves. You're likely to need to have an extra catch-up session after a week of nights and if your supervisor takes leave for more than two weeks an alternative 1:1 supervisor should be arranged for you. Clinical supervision would of course always be arranged as there must always be a clear line-relationship to a responsible consultant, for all your patients. 

Remember, the College is very clear that if you are not receiving your supervision according to the RANZCP requirements, and you report this to your local Training Facilitator or the Director of Training, you won't be penalised or your time disaccredited. But you must take responsibility for contacting the Director or Training Facilitator if there is a problem, as soon as it's clear that there is one - you won't get much sympathy if you leave it until the end of the 6 months before complaining. If a serious problem in the relationship with your supervisor develops and you cannot resolve this with them, it's important to talk to your local Training Facilitator or the Director of Training. Alternatively, you could talk to one of the Trainee Representatives on the Regional Training Committee - Fiona at the Training Centre can tell you who they are, if you're not sure. 

If you think that you may be being bullied or harassed by a work colleague or boss, you could talk to Occupational Health within your DHB, as they can advise you confidentially and help you to decide what, if anything, to do. The RANZCP has a strict no-tolerance policy for workplace bullying and harassment and of course you can and should let your Training Facilitator or Director of Training know, but if you don't feel able to do so, then talking to Occupational Health is an alternative. Your Training Facilitator or Director of Training would feel compelled to intervene and to investigate a complaint of bullying or harassment so you might want to talk to someone else as an initial step. You could also contact the College directly, to report bullying or harassment. See the RANZCP policy on bullying and harassment. 

Information About Supervision for Supervisors:

Consultants accredited as RANZCP supervisors in NZ must have either Provisional Vocational or Vocational registration. Most are College fellows, but in New Zealand, many supervisors have overseas specialist qualifications. All supervisors must be formally accredited via the Director of Training. College Fellows need to do a initial supervisor training workshop, so as to supervise. Apart from the initial workshop, an update workshop is required every five years. The Training Centre runs these intermittent workshops and keeps a database of all local supervisors. Supervisors must also attend a peer discussion session about supervision, or otherwise undertake peer review regarding their role as a supervisor, a minimum of 3 times per year. There are quarterly supervisor meetings within each DHB, at the mid- and end-of-run points. These are organised by the Director of Training and supervisors are notified about them by email. Supervisors are also trained up about using "Intrain" - the college's electronic records and forms system for training. They are added to Intrain after the initial workshop.  

Overseas specialists require special Approval paperwork so as to be accredited, as well as the workshop training and Application form. Contact the Director of Training to organise the accreditation of any new supervisor, whether a College Fellow or from overseas. For overseas consultants, a CV needs to be emailed to the Director of Training. 

Here is the College's information Link about Supervisors.


Supervision Workshops
Workshops on Supervision are provided intermittently at the Training Centre. New supervisors will be contacted to arrange workshop training as soon as possible, after their arrival or when they take up a post. Supervisors will also be contacted to organise the 5-yearly Update Workshops, when these are needed. Information on whether there is a workshop pending can be obtained from the Director of Training. The workshops are run by the Director of Training and take half a day, with pre- or post-workshop reading taking another half-day.

 

Useful Links and Resources about Supervision for Registrars and Supervisors