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PRACTICE

This section is a video of a foundation year two doctor (FY2) taking blood from a patient. He has asked a clinical supervisor to observe him and to sign him off for this procedure. The FY2 and supervisor have worked together briefly before but do not know each other well.

Watch the video and think about what feedback you would give to the FY2:

 

 

Write down some of the things that the FY2 does well and some that he needs to improve on.

 

Next, click on the buttons below to reveal the subsequent sections of the video, answer the questions and review the suggested answers:

 

(PART 1) What happened when the FY2 and the supervisor sat down together afterwards:

 

Play the next section of the video which shows what happened when the FY2 and the supervisor sat down together afterwards.

  1. How does the educational supervisor set up the feedback?
  2. If you were the supervisor what would you say or do at this point? Write down the actual words you would say.

 

(PART 1) SUGGESTED ANSWERS

Suggested answers (try to answer yourself first):

  1. The supervisor checks what is expected and negotiates the time for the feedback. This gives the FY2 some control of the situation and may help him to feel appropriately empowered at this point.
  2. The supervisor starts by asking about the things that went well and gives both verbal and non-verbal encouragement. The supervisor does not mention everything she observed in her feedback. She tries to get the FY2 doctor to become a more active participant in the conversation by asking him to describe what he has observed others doing. It requires professional judgment alongside responding to the other person in the moment to decide what to cover. The feedback needs to balance support with a suitable level of challenge for the individual concerned.
  3. You can compare what you have written with what the supervisor says and does in the next section of video.

 

(PART 2) Watch the next section of video and then answer these questions:

 

  1. How does the FY2 appear to show a lack of insight?
  2. What would you say to the FY2 now? Write down the actual words you might use.
  3. How does the supervisor deal with the situation?

 

PART 2 SUGGESTED ANSWERS

Suggested answers (try to answer yourself first):

  1. His facial expression is sometimes blank and sometimes appears hostile. He responds to the supervisor in an abrupt manner. He does not offer much information about what he can do to improve and is rather passive in his responses. He repeats his assertion that the main thing was to get the blood as quickly as possible and does not demonstrate any learning from the process or from the feedback. However at the end he acknowledges that he didn’t give the patient any opportunity to ask questions.
  2. You can compare your answer in the next section of video.
  3. The supervisor holds her authority (she is clearly in charge of the process) and also allows the FY2 to speak without interrupting and offers him an opportunity for reflection. When the FY2 appears to show a lack of insight into his own deficiencies the supervisor gives some objective examples of what she observed.  She continues to encourage the FY2 to reflect and she speaks from her own experience of what is effective.
(PART 3) Play the video to see what happened next:

 

  1. How does the supervisor appear to respond to the FY2? Does she seem to be flustered or irritated? How does this show? What difference might this make to how the conversation proceeds?
  2. Do you feel that the final outcome is fair?
  3. How much has the FY2 appeared to move towards being more insightful?
  4. Overall what did the supervisor do that was helpful for the FY2’s learning?
  5. What could the supervisor have done more effectively to promote insight?
  6. What have you learnt from this scenario?

 

PART 3 SUGGESTED ANSWERS

Suggested answers (try to answer yourself first):

  1. The supervisor appears to remain very patient and non-confrontational. When she gives an example, her frowning facial expression mirrors the patient’s rather than reflecting anger with the FY2, but he may not interpret it that way. The supervisor speaks with quite a lot of authority. She leads up to making the judgement that the FY2 has not achieved the required standard and she states this clearly, suggesting a time for the doctor to repeat the observation. This may help to “put the FY2 in his place” and you may feel that this is appropriate in this situation. These responses could be helpful for some people but could also be quite irritating and may have the effect of making the FY2 more defensive.
  2. The FY2 seems to have a lot to learn still about the technical and communication aspects of taking blood and it would not be appropriate to sign him off as being competent based on the performance assessed.
  3. The FY2 appears to be a little more accepting of the information from the supervisor towards the end of the conversation. His body language is less confrontational. He is able to make some of his own suggestions and he nods in agreement with some of those from the supervisor.
  4. The supervisor was patient. She gave positive feedback about what the doctor had done well. She gave bite-sized chunks of information about her observations and what the doctor could do to improve. She gave the doctor time to go away and practise with an arrangement to re-assess him.
  5. In the same way that the supervisor suggested to the FY2 that it would be helpful to spend a minute at the start aiming to put the patient at ease; she could have done the same in the feedback session. This was not made easy by the FY2’s approach at the start which was likely to have made the supervisor feel pressured for time. The supervisor did not check with the FY2 about how the conversation was going for him and what he made of her feedback. These could have been useful questions to ask.
  6. This is for your personal learning comments.