Supervision

You will be extensively supervised and supported during your Internship year!

As an Intern with provisional registration, you are required to be under supervision 100% of  the time you are involved in clinical activity. Clinical activity is defined as preparing for patient interactions, any patient interaction, and following up on patient interactions. ‘Under supervision’ is defined as the supervisor being physically present on site while the intern is involved in clinical activities. ‘On site’ is defined as being within the bounds of the health service that constitutes that site so that immediate contact and immediate response is able to be facilitated between the intern and the individual providing immediate supervision.

Effective supervision is required to ensure patient safety, and also to assist you to learn as much as you can from clinical experiences.

Specialist and visiting medical educators will be contracted by the program for additional experience and supervision.

Interns within the CBI will participate in a limited range of after-hours work. Supervisory arrangements in this instance remain the same as above and in addition, the organisational standard escalation policy will be applied.

The supervisory cascade is well known in hospital settings. The consultant supervisor may not directly supervise all doctors-in-training in their charge but may devolve direct supervision to registrars and to residents. In this relationship, it is the responsibility of each level of doctor-in-training to understanding the limits to their scope of practice and to their ability to supervise certain scenarios. Where sites have multiple levels of learners it is appropriate to adopt this supervisory cascade as long as the basic concepts described are followed.

Conversely, the intern may first discuss a case with a Hospital Medical Officer, then a registrar, and then their consultant supervision. Where such hierarchy exists in community settings, the same process may be implemented by the intern.

Community rotations

At the commencement of any community component, and as a default position throughout the community term, standard parallel consulting methods are to be employed where all clinical decisions made by the intern are to be reviewed by the supervisor.

This may change dependent on the progress and ability of the intern and will be determined by the Primary Supervisor. A method to determine the level of supervision required at the beginning of the internship may be to begin with observed consultations. Again, the appropriateness and effectiveness of this is approach is to be determined by the supervisor.

The figures below present a timetable for parallel consulting while in community sites. In the first the intern sees one patient per hour and in the second they see 2 patients per hour.

Time Supervisor Intern
9.00 See patient 1 Prep for patient 3
9.15am See patient 2 See patient 3
9.30am Present patient 3 to supervisor
9.45am See patient 4 Complete patient 3
10.00am See patient 5 Prep for patient 7
10.15am See patient 6 See patient 7
10.30am Present patient 7 to supervisor
10.45am See patient 8 Complete patient 7

(Adapted from GPET PGPPP Practice Guidelines 2010)

Time Supervisor Intern
9.00 See patient 1 Prep for patient 2
9.05am See patient 2
9.15am Present and discuss patient 2 with supervisor
9.30am See patient 3 Prep for patient 4
9.35am See patient 4
9.45am Present and discuss patient 4 with supervisor

The Primary Supervisor, in partnership with the intern and co-supervisors, may determine that the intern is able to move beyond immediate supervision through standard parallel consulting methods. Evidence for this decision is to be documented. The figure below displays an example of parallel consulting.

Time Supervisor Intern
9.00 See patient 1 See patient 5
9.05
9.10
9.15 See patient 2
9.20 See patient 6
9.25
9.30 See patient 3
9.35
9.40 See patient 7
9.45 See patient 4
9.50
9.55
10.00 Review patients 5, 6 & 7 with supervisor
10.05
10.10 See patient 8 Follow up about the first 3 patients
10.15
10.20 See patient 10
10.25 See patient 9
10.30
10.35

(Adapted from GPET PGPPP Practice Guidelines 2010)

Exact supervisory methodology that moves beyond parallel consulting is to be developed by the Primary Supervisor and the intern.