Resources to support supervision of medical trainees in nephrology (renal medicine)
Educational supervisors' role | local interpretation | The End Product | Problems? | Useful documents
Trainees with something distinctive to offer. More info
General info
- Curriculum: You can download the full renal and G(I)M curriculum from the JRCPTB specialty pages The trainees page is the place for info on the formal educational programme covering the knowledge components.
- The Gold Guide is the successor to the Orange Book and lists regulations, requirements and procedures for training. It is only available as an electronic document that prints out as an expensive, slow, grey, index-free guide on my printer yet is too massive to read on-screen. Note that it may be updated each year, and the bundle of regulations/guidance that it includes refers only to trainees starting in the year of its publication! (I guess this could be ST1 not ST3 if they're from the run-through generation?). Link to the grey Gold guide (it looks as if this link will change unpredictably each year, so you may need to use Dr Google).
- Assessments - the MRCP(UK) Specialty Certificate Page has info on knowledge tests (= exams): the Renal Association with the Federation of RCPs organise this (in theory others could propose an alternative assessment to the GMC). Info on workplace-based assessments is all linked from the JRCPTB assessment page (main page and links to left of it). Methods of assessment videos, from the JRCPTB site.
- Out of Programme Experience, Acting Up, LTFT etc - forms and some guidance from the JRCPTB OOP page, but discuss with Educational Supervisors and Training Programme Director well in advance.
- Last resort documents on the JRCPTB documents library page - but we have some useful ones that are otherwise hard to find at the foot of this page.
- Portfolio? From late 2009 in South East Scotland we had an ePortfolio for ST3+ renal docs. Older material mentioned as for the ePortfolio must be bundled into a big file which the trainee keeps. The ePortfolio does make keeping track of things easier.
- Training committee - local training committees oversee UK training programmes. Our training committee page may have papers and info on our local committee.
Educational supervisors and clinical supervisors: formal roles
The responsibilities of Educational supervisors (longitudinal responsibility for supervising training) and Clinical supervisors (the clinician responsible for the trainee during an attachment) responsibilities are described in section 4.22 of the Gold Guide which has been extracted and can be downloaded at the foot of this page. Key elements are that Educational supervisors should (bullets from the Gold Guide, except where in italics):
- be adequately prepared for the role and have an understanding of educational theory and practical educational techniques e.g. have undertaken formal facilitated training or on-line training
- programme or participate in relevant training the trainers programmes
- be trained to offer educational supervision and undertake appraisal and feedback
- undertake training in competence assessment for specialty training
- be trained in equality and diversity (elsewhere it says this should be refreshed every 3 years)
- provide regular appraisal opportunities which should take place at the beginning, middle and end of a placement (or 3 times a year?)
- develop a learning agreement and educational objectives with the trainee which is mutually agreed and is the point of reference for future appraisal
- be responsible for ensuring that trainees whom they supervise maintain and develop their specialty learning portfolio and participate in the specialty assessment process (it is the trainee's responsibility to organise all the elements of assessment but they may come to you if they cannot get anyone to help)
- provide regular feedback to the trainee on their progress
- ensure that the structured report which is a detailed review and synopsis of the trainee’s learning portfolio (Appendix 5, Educational Supervisor's Structured Report - completed online in the ePortfolio, or if impossible download from foot of this page) is returned within the necessary timescales
- contact the employer (usually the medical director) and the Postgraduate Dean should the level of performance of a trainee gives rise for concern (contact the Training Prog Director first if possible to be sure all comments coordinated)
- be able to advise the trainee about access to career management
- be responsible for their educational role to the training programme director and locally to the employer’s lead for postgraduate medical education (in Scotland this will be the Director of Medical Education in your Hospital/Trust/Health Board).
- Formal appraisal (formal, as opposed to the multiple occasions above) - Educational supervisors are responsible both for the educational appraisal of trainees, and also for review of their performance based on Good Medical Practice. This links educational appraisal and performance review (workplace based NHS appraisal) of trainees. Essentially (paras 7.24 – 7.27 of the Gold Guide) you must appraise your trainees after the ARCP (RITA) and the 'workplace based appraisal documentation' should form a permanent part of the trainee's learning portfolio. The forms and guidance for this are in the Gold Guide, but will appear via trainees from the ePortfolio or otherwise. Feedback from ARCP is of course relevant.
Clinical supervisors (which must mean all consultants) are as always supposed to make sure that trainees only do what they are competent to do and that they are appropriately supervised, but note two specific requirements, that they must:
- be appropriately trained to teach, provide feedback and undertake competence assessment to trainees in the specialty
- be trained in equality and diversity and human rights best practice.
Responsibilities of educational supervisors - localised version
Educational supervisors monitor and guide the educational experience of their trainees. This includes ensuring that they become highly competent, but usefully extends to making them irresistible to appointments committees.
Neil Turner is the Nephrology Specialty Training Adviser and Training Programme Director for South East Scotland, and Colin Selby is the overall G(I)M mentor for nephrology trainees.
Meetings with trainees: a typical year
- At least 4 meetings annually at approximately quarterly intervals (stated minimum is 3)
- They should generally be of the nature of informal appraisal, or include some of that.
- The first should be an Induction meeting in the first year, and should every year include setting targets for the next 12 months.
- One, best 1-2 months before ARCP/RITA, must include formal review of assessments undertaken – to ensure all appropriate milestones and forms are completed for the year. Complete formal supervisors report listing all of these for the year.
- One - following ARCP - must include formal appraisal with completion of similar documents to consultants appraisal.
- In any case a short note is useful to confirm that the required meetings have taken place; keep a note yourself if the ePortfolio doesn't have a way to do it.
- Formal reports: make sure to note any concerns that have been raised, even slight ones. The free text box at the bottom is best place for this.
What should we do at these meetings?
Review recent experience and activity
- On wards – acute, general, transplant
- In clinics
- In care of dialysis patients
- In audit. Try to ‘close the loop’.
- In clinical research/ case reports
- Attendance at educational courses and meetings, for senior trainees including management courses. Remember GIM too.
Review assessments/feedback
- DOPS (line insertion early in training; biopsies when possible; "6 over 4 years"). If a skill has multiple satisfactory DOPS it can be considered signed off, and further forms only required if there has been a significant break in experience (e.g. long research spell). Line insertion may be signed off before ST3 but check it's documented if so. Tunnelled line insertion is optional but there is a form on the JRCPTB website if relevant.
- CEX (4 per year)
- CBD (4 per year)
- Multisource feedback (MSF) is expected at least twice during 4y of training. It seems that one is expected in ST3 or 4 for dual trainees; in ST3 for just-nephrology trainees. At least one of these must be renal, and one should be within the last 18 months of training. A third may be reasonable with one during G(I)M? Check whether needed and go over when necessary.
- You can (or at any rate the ARCP panel could) request additional assessments if thought necessary.
Note attendance at elements of regular activity which contribute to the formal programme:
- Academic meetings (including presenting at them)
- Biopsy meetings
- Radiology meetings
- Audit, governance, critical event etc. meetings
- Any formal programme covering the knowledge base of the curriculum
Identify any deficient elements
Go over the curriculum at intervals to identify these; to some extent this may be a local Training Committee matter. Locally relative weaknesses have been (1) renal biopsies, (2) training in care of dialysis patients, (3) audit. All of these relatively more difficult aspects of training are common to many other training centres. Consider when opportunities:
- Will arise in the future
- Have not arisen when they should have
- Need to be arranged separately and specifically
- Are there any ‘extras’ that the trainee would like to fit in? – special interests, experience in other units or overseas? This may need to be discussed with the Training Prog Director or others as appropriate.
The end product
In addition to fulfilling the objectives of the curriculum, supervisors and trainees should remember that consultant appointments committees will look for the following:
Clinical publications
- A few can be enough, if there are other distinguishing qualities. Quality better than quantity.
- High-prestige presentations help but do not replace.
Something extra to offer – for instance one or more of:
- Research – clinical, laboratory or whatever, with evidence of productive use of time (otherwise it may be a millstone).
- Areas of particular clinical expertise, experience or training – e.g. new modes of haemodialysis; a particular disease or group of diseases; experience in a special area (e.g. amyloid, paediatric issues, transplantation).
- Major teaching commitments/ achievements – undergraduates or postgraduates, medics or nurses or other. But some teaching is expected of everyone.
- Politics/ management/ IT projects or other distinguishing area of activity.
- A higher degree or other qualification (e.g. educational) contributes to evidence of productivity. Lack of it after a significant break can be perceived as a weakness. It’s much better to have it than to plead ‘it’s nearly finished’.
- High quality publications are more valuable than a degree, but to have both is even better.
Problems?
Educational supervisors should encourage (kick) trainees to attend to deficiencies where it is primarily up to them – for instance in writing things up, undertaking audit, attending scheduled meetings and training sessions, making best use of opportunities in practical procedures; or any of the other objectives listed. If a trainee remains deficient in any of these or other areas, this should be pointed out to them, and confirmed in writing on their reports, so that these issues can be considered at ARCP/RITAs. Don't leave things out just to be nice.
Where there are deficiencies in ‘the system’ this should be brought to the Training Committee if not simply solved by discussion with colleagues or other relevant people or bodies.
Useful documents and links
Do you really need these? Where trainees are using the ePortfolio, almost no paper forms should now be necessary. If old-type SpRs who aren't on the ePortfolio yet need them, check the JRCPTB forms page for definitive paper copies. Or anyone could do this if the ePortfolio is broken. Note that for SpRs, it was apparently now 'never intended that WPBA should be compulsory' - but it's best to do it in any case. Selected hard-to-find forms below plus some additional resources.
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