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Delegation and supervision

Responsibilities of supervisors and trainees

Clinical learning environment

Physician and 2 learners at bedside of patient

In the clinical environment, trainees learn and apply crucial skills such as clinical decision-making, communication with patients, care coordination in teams, and technical procedures. However, rather than simply assuming that trainees will acquire skills through repeated exposure, competency-based medical education places greater emphasis on monitoring trainees throughout the learning process.

Trends in medical education

Stethoscope and trending dataIn recent years, many practising physicians have become involved in supervising medical trainees, with distributed medical education occurring at rural and regional training sites. Medical students, residents, clinical fellows, and international medical graduates (including those training in Canadian residency programs and those being integrated into the Canadian healthcare system through alternate pathways) can be found in hospitals, community clinics, and private physician offices, as well as in more remote locations. Clinical supervision not only benefits learners, but also provides opportunities for supervisors to ensure their skills and knowledge are continually updated.

Academic programs have shifted from learner-centred silos to being fully integrated within clinical settings. The use of 360-degree evaluations continues to rise, so that the evaluation of medical trainees frequently includes input from inter-professional team members, patients, and families. Beyond that, there is an emerging trend for patients to be involved in co-creation (or co-development) of clinical programs and curricular elements, ensuring that the provision of healthcare remains patient-focused.

A learning culture

Group of learners listening attentively in classroomThere is now a better understanding as to how to establish a learning culture in academic settings, and how to assess the learning environment through program accreditation standards. Important components include appropriate levels of supervision; respect in communications and mentorship; and fostering a trusting, supportive, and non-judgmental culture.

Patient safety remains a significant focus in Canadian healthcare. The updated CanMEDS 2015 Physician Competency Framework makes explicit the necessary patient safety and quality improvement competencies necessary to improve medical care. Future physicians will learn how to participate in or even lead quality improvement initiatives and help foster reliable healthcare workplaces and cultures. The adoption of this framework will benefit patients and families, communities, physicians, and other health professionals.

For example, the CanMEDS Collaborator role highlights the importance of physicians being respectful members of healthcare teams. How does one engage in respectful shared decision-making with one's colleagues? The relevant key competencies include working effectively with others, resolving conflicts, and communicating appropriately at transitions of care. Supervisors need to role-model the desired attitudes and behaviours and provide trainees with feedback regarding these teamwork-related competencies.