Junior doctors' supervision relationships forge their development, professional identity, values, aspirations, and wellbeing. Good experiences with supervisors have a lasting positive influence on junior doctors and it is rewarding for supervisors to feel they have contributed to this.
However, it can be challenging to know how best to support junior doctors and reconcile this support with the uncertainties and demands of medicine. For instance, as part of their role, supervisors sometimes: make judgments that impact on JMOs' autonomy; intervene in their clinical management; give well intentioned negative feedback or deliver disappointing news. Meanwhile, JMOs sometimes: struggle to obtain clinical experience that extends their confidence and competence; misunderstand or fail to forecast individual preferences of supervisors and other more senior doctors or languish under a multitude of tasks required by numerous different doctors, nurses or patients.
Working these challenges is particularly difficult if supervisors and JMOs are not available to dedicate time to supervision. As in all workplaces, interpersonal conflict is inevitable, at some level, at some time. Perceived and actual power imbalances exacerbate this. These challenges can diminish openness and trust with the result that our supervision relationships fail to reach their full potential or can be counterproductive.
At the end of the day, we all want things from our jobs in medicine - to provide good care to patients, to enjoy rewarding professional relationships, to progress with our careers, to go about our work in a manner that enables us to feel safe, valued, healthy and stimulated, and to enjoy life outside of work.
The 7 principles of effective supervision, shown here in the Flipside initiative, reflect contemporary, humanistic concepts of medical supervision. Here, social and psychological factors influence how we respond to our environment and relationships. These include themes of social inclusion, conflict resolution, and to borrow a term from simulation, psychological safety.
The principles express our values when interacting with our supervisors and what we expect from our supervisors, and vice versa. The values charters are practical frameworks that express the 7 principles as measurable behaviours. It is unrealistic to promise to uphold all of these behaviours all of the time, however, we can pledge to strive for this. In doing so we send a message to the other about our good intentions.
Clinical Associate Professor Leonie Watterson, Director, Sydney Clinical Skills and Simulation Centre
Clinical Associate Professor, John Vassiliadis,
Director Prevocational Training, Royal North Shore Hospital