Ranked supervision strategies that foster adoption of a learning stance: This tool was developed for the family medicine program at the University of Sherbrooke in Quebec in 2003.
| RESIDENT’S PERSPECTIVE | SUPERVISOR’S PERSPECTIVE |
|---|---|
| 1. Periodically identify with my supervisor where I am in my training, share my concerns, and specify my supervision goals and expectations, because it is my training | 1. Periodically determine with the resident where he or she is in the training process by having the resident share concerns and specify supervision goals, because it is the resident’s training |
| 2. Identify to what degree I feel competent in the various activities in my rotation and discuss with my supervisor the next hurdle to clear to feel more competent | 2. Ask the resident about his or her feelings of competence in the rotation’s various activities and discuss what could make him or her feel more competent |
| 3. Ask my supervisor to verbalize his or her expectations with respect to my performance given my level of training. They could be quite different from what I perceive the expectations to be | 3. As the supervisor, relate my expectations in terms of performance to the resident, taking into account the resident’s expectations and objectives for his or her level of training |
| 4. Turn off the pressure I put on myself with respect to knowledge to be gained and tasks to be accomplished and, if needed, discuss with my supervisor what is important at my level of training | 4. Turn off the resident’s self-imposed pressure with respect to knowledge to be gained and tasks to be accomplished by sharing my own experiences with the resident and underscoring what is important at his or her level of training |
| 5. Take advantage of the cases discussed to relate to my supervisor one or two questions that I have been asking myself and to answer them together | 5. Take advantage of supervised cases to encourage the resident to share a question or two and arrive at an answer together |
| 6. Negotiate specific, realistic, dedicated times with the supervisor to discuss an issue in greater depth | 6. Set aside specific, realistic, dedicated times to discuss an issue in greater depth |
| 7. Before requesting feedback, begin with a self-assessment of my work and convey it to the supervisor | 7. Before providing feedback, begin by asking the resident to perform a self-assessment of his or her work and then enhance it through questioning |
| 8. Trust myself! Congratulate myself on my successes! Validate them with my supervisor | 8. Clearly underscore the resident’s successes and areas for improvement in such a way that he or she does not focus solely on the latter |
| 9. After being supervised, discuss the area for improvement in terms of objectives to work on during the next period of supervision | 9. After a supervision session, transform the area for improvement into an objective to work on during the next period of supervision |
| 10. Listen to the positive and negative points of feedback when being supervised and discuss how the feedback received changed my self-assessment | 10. Subsequent to feedback, find out how the resident has interpreted the strengths and areas for improvement and discuss how the feedback received changed his or her self-assessment |
| 11. When facing a difficult interaction with a patient, before the interview, agree with my supervisor on an objective or intervention plan (pre-coaching) and discuss adjustments made during the interview | 11. Conduct anticipatory supervision (pre-coaching) by reviewing with the resident his or her action plan and important points to consider before seeing the patient and then discuss the adjustments made during the interview |
| 12. After a consultation with time constraints during which I felt incompetent in dealing with a difficult patient, go back over what I was able to cover during this encounter | 12. After a consultation with time constraints during which the resident felt incompetent in dealing with a difficult patient, go back over what he or she was able to cover during this encounter |
| 13. Ask the supervisor if I can observe him or her in interview situations with difficult patients so as to observe competencies and discuss them after the interview | 13. Let the resident observe how we deal with difficult situations so that he or she can better see his or her competencies and discuss them after the interview |
| 14. When the supervisor and I see patients together (eg, during hospital rounds), alternate the roles of observer and caregiver, then critique the conversations and discuss controversial issues | 14. When seeing patients together with the resident (eg, during hospital rounds), alternate the roles of observer and caregiver, then critique the conversations and discuss controversial issues |
| 15. Use video to observe myself during interviews for subsequent viewing with my supervisor to identify my strengths and means for improving my performance | 15. Use video to allow the resident to observe his or her strengths and see how to improve and adopt a healthy distance with respect to his or her performance |
| 16. Present my case to my supervisor, summarizing it as if I were transferring it to a colleague. If needed, summarize the case in writing, specifying the questions I have | 16. To help the resident realize his or her synthesis skills, before discussing a case, ask the resident to summarize it and state any questions in writing as if he or she were transferring it to a colleague |
| 17. Learn to manage my time effectively. Discuss with my supervisor how I could save time with a given patient and how I could cut down on the time taken during my interview or examination | 17. Teach how to manage time effectively. Show the resident how time could have been gained with a patient, and how the interview or examination could have been shortened |
| 18. View myself as the patient’s “attending physician” and consider the supervisor as a coach and colleague rather than simply as an evaluator | 18. Invite the second-year resident to go through the next few weeks as if he or she were an attending physician and to view me as a coach or colleague with whom he or she can discuss how to improve performance |
| 19. When a second-year resident, use the 2-piles-of-charts technique: the first pile for fast review and the second pile reviewed based on questions I have about the cases | 19. With a second-year resident, use the 2-piles-of-charts technique: the first pile for fast review; the second pile for review based on the resident’s questions |
| 20. Give feedback to the supervisor on his or her supervision, with respect to my own expectations | 20. Ask the resident for feedback on my supervision |
Adapted from Giroux and Girard.8