How do you supervise the students?

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There are two 4th year pod students attending for a placement at the public hospital where I was working at. The acting podiatry manager commented that I should leave the clients and it's up to the students to treat the patients. While my responsibility is to check on patients' feet only AFTER the students had a go on the patients. The manager suggested I should have a cuppa tea and relax at one corner till the feet has been done.

I disagreed totally.

After assessing the pod student on my first client, the techniques which the students engaged are not competent enough!! My preferred 'method' is to sit in and observe the students. If necessary, I may advice and guide them along during the treatment period.
Anyhow, I don't think I can sit and wait for a student who takes 40mins on a general nail treatment.


In general, I would like to ask the fellow pods that how you would choose to supervise your students in the most appropriate manner?

 

In final 4th year here, the amount of contact time with clients would seem to be minimal, Especially in the last 2 semesters. I am aware of 4th year students who are working 4 days a week so that means they are not in clinic at Uni. How much will change between now and Nov, Dec when they have their peice of paper? How would you treat that same colleague in Nov or Dec once they have their piece of paper??
Just reminiscing on my skills in the last moments of Uni and into the real world. I probably took twice as long at that stage too?

 

We have a fair few fourth year students through our dept completeing upto 308 hours each. The level of supervision varies by the patient or condition being treated, ie: I will supervise wound care and new patients more closely than regular return clients, and will supervise more closely at the begining of a placement than the end.
Remember that you are ultimately responsible for the patients' care, but for the student having someone looking over your shoulder all day can be a little unnerving, and patients will often then speak to you rather than the student about their foot issues. I try to stick my head in a couple of times during the consult to ensure all is OK, but allow the students some freedom in their care plans, remembering that for 2nd semester placements these students are only a couple of months away from registration when the placement finishes.

Below is an extract and link to Latrobe's clinical placement guide, which contains information on supervision
Latrobe External Placement Guide

 

Clinical supervision can be a multi headed serpent. I trained as an instructional designer at one point in my career and specialised in clinical education after reading the topic at Centre for Medical Education Dundee University for a year.

Clinical education start from day one and builds throughout the years in an accumulative way until in the final stages the students go into the job situation as interns. In an organised curriculum all stages are planned for and assessments appropriate to students progress scheduled. This should come in the form of a published outline. Many educational centres will, in the elementary years, use national standards of clinical practice (competencies) as their goals. These meet the criteria of professional bodies and registration authorities. As interns an expectation would be the accepted behaviours of competencies were maintained throughout in both normal and modified circumstances. Higher abilities such as clinical decision making pathway planning and treatment review would be the focus for senior students as well as maintaining an appropriate work load commensurate with their level and experience.

Assessments are set to measure these achievements but that can be as varied as centres of education (and resources available to them). To be equitable programs and assessments must be both valid and reliable. National placement in the UK has made this incredibly difficult because of the vastness involved and so there is a tendency to use placement assessment as time fillers. Now there are some exceptional examples of placement education but not all are of the same calibre. These variations and an absence of a course standardisation mean issues such as you described, arise.

Australian centres have similar circumstances .

One of the most common complaints from clinical supervisors in annual course reviews was a general dissatisfaction with the overall performance of students (every year) yet when the supervisors were advised to register the student as a fail in their placement, clinicians were reluctant to do so because the general feel was that was something that should be done at the university. After many years I tend to agree and have long been on the opinion placement events should be recorded as "student profiles ", set to an agreed criteria which accumulates to the overall clinical education objectives. Rather than a pass-fail situation, the profile would be available to potential employers as a kind of job performance appraisal which under direct supervision.

.Meantime in an ideal world having appropriate placements with well prepared (trained) staff and students completely conversant with what is expected of them is perfect. To relate this to another posting (Mark's and his comments about small schools) a suberb advantage small foot hospitals had was on site clinical facilities with a demographic appropriate to all levels of training. This gave a sound basis for preparing the student for their chosen vocation.

However we are not in an ideal world. Preoccupation with a 1000 hours apprentice is an anachronism, which is stubbornly upheld by professional bodies within the commonwealth and can create challenges to most podiatry centres based within the university sector. Concentration on actual doing repetative things does in my opinion prevent more meaningful learning in a well thought out curriculum.


Cameron

 

I just wanna add on that these 4th year students are a few months away from stepping into the real world of being a pod. They did verberlize that they were not shown how to do a proper general treatment at the uni upon questioning them.
Of course, to my horror, the more i felt that i am obliged to spend more time to observe their techniques and giving them a few tips along the way. However,I am not sure what would the rest of you can think of in order to improve their clinical skills of these students? eg, on the first patient, student A had her nails cut way toooo short and started to bleed a little on each toes of each foot.Obviously, if you know that patient with involuted nail type, you gotta be more careful when cutting it.

*note: I don't sit in with them on every patients
One of the students had only done nail care on 3 patients for the last semester. The problem is also lack of patients booking through the uni clinic.
.
On the other hand, I'll not be the one assessing the student's performance at the end of placement. The manager didn't even ask for my feedback either.-_-

 

I was fortunate when I was a student, 20 yrs ago, to have a very experienced 'old fashion' Podiatrist who relished training her students on technique, posture and care for patients. Thank you for your experience Noni Arnold.

When I employed new graduates in my clinic they would work beside me, first observing , then being observed and finally after 1 month of both of us being fed up with the supervision, they would be 'released' onto the full paying patients. This does take alot of time, patience and diplomacy, but in the end they actually become great hands-on Podiatrists.

It is unfortunately the norm for most professions now, that the old style of training be it Podiatry, Nursing or any other Allied Health, that they are great with the theory but lack practical skills ( though they - the new grads- don't know it yet). Technique needs to be shown, corrected and perfected rather than read in a book.

It would be idealistic to expect new grads to be skilled when they graduate. Taking the time and possibly losing money while you train a new grad is worth it. You end up with a competent employee and the profession gains a better Podiatrist.

Pass on your Experience.....our Profession will Prosper !

Trudi

 

I haven't supervised any 4th years, but all other years have passed through my clinic room.

I do try to pass on snippets of helpful guidance regarding time management, file notes and ergonomics as well as actual clinical skills.

I would agree with this.

 

Hi gangrene

I am sure the students who were placed with you would really appreciate your feeback and advice on their technique and skills. I not only supervise students in my clinic but I help organise placement sites through a university. This 'real world' experience they gain is so valuable and we receive feedback on many techniques supervisors use.

As you stated, you have a responsibility for the care of the patient and it is your choice how the student fits into this role on a client by client basis. Some sites allow only observation of their fully trained staff while others allow the students to actively treat. Obviously issues like time management, patient satisfaction and skill level influence this decision.

I am sure your role in taking placement students and helping in their training is greatly appreciated by the students and the universities.

regards

claire