As a supervisor, am I legally liable if my registrar makes a
medicine may be a team sport, it’s also important that each of us
understand our roles and responsibilities in delivering patient care.
Unfortunately the question of responsibility also comes to the fore when
something goes wrong. The much-discussed case involving Dr Bawa-Garba prompted
comment about the responsibility and liability that should attach to a
trainee’s supervisor in that situation.
Being a GP supervisor is a wonderful opportunity to contribute
to the development of competent GP registrars who are equipped to provide safe
and appropriate patient care. Providing effective supervision is also one of
the best ways of protecting both you and your registrar against things going
Leading by example
It is important to set up a learning environment from the
start. GP registrars need to feel comfortable discussing any matters of concern
with their supervisors at the practice. You can encourage them to do this by
making it clear your practice is one where all the doctors in the practice
share their concerns and seek help from each other with the difficult
situations GPs face frequently.
Making time for and encouraging them to ask questions, as
well as reviewing records regularly to help registrars learn what matters
require discussion are important steps towards establishing an open learning
You may need to spell out that ‘no question is too silly and
we would rather you ask, than guess’. You may also need to be clear that you
want to hear about the complex or emotionally charged consultations, even if
they would rather forget about them and move on.
As a supervisor you can make it clear that asking good
questions is a skill in itself. By teaching the registrars to think and frame
their questions carefully to ensure the key issues of uncertainty are
identified, you can help them to develop this skill, and improve the quality of
your supervision sessions.
This is a learning zone
It is in the best interests of practices and their doctors
to inform patients that GP registrars are training and under supervision at
their practice, so they can make a conscious decision about who they see for
treatment. Signage indicating the practice is an accredited training practice
and who the GP registrars are, is one way of informing patients of this. It can
also be noted in practice brochures, online booking tool, or on the practice’s
website or Facebook page.
It is also a good idea to let patients know that if they are
unhappy with the advice or care they have received from a registrar, they can
contact one of the GPs at the practice to review the matter. This is an
opportunity for the GP to provide the registrar with constructive feedback and address
any patient care issues before they escalate into a formal complaint or claim.
Being an effective supervisor
To ensure you are effectively supervising and supporting
your registrars, here are some other tips from Avant’s senior medical advisors:
- don’t assume GP registrars know and understand
common GP tasks and skills
- assess your GP registrar’s skills and experience
early into their term and often throughout it
- identify procedures they can and cannot perform
- implement a level of supervision commensurate
with their skills and experience
- put in place an individualised learning plan,
regularly assess their progress and provide feedback
- have a system in place to identify and address
errors – inform GP registrars of this system and encourage open disclosure
- keep good records of the training provided and
address any gaps immediately.
What if something goes wrong?
Registrars have substantial autonomy and are expected to
exercise their judgement in determining the best course of management for
patients. GP supervisors play an important role in assessing a registrar’s
level of competence, setting appropriate boundaries, and ensuring an
environment where the registrar is comfortable to seek advice when an issue is
beyond their experience or expertise.
GP registrars usually see and advise patients independently
and, to a degree, determine when they seek assistance from a supervisor. Therefore,
GP supervisors cannot be responsible or liable for every decision a registrar
However, the practice is required to provide an adequate
standard of care to patients and this extends to the supervision and training
of GP registrars.
A GP supervisor (or the practice) may be brought into a
claim or complaint if:
- the registrar sought clinical advice from their
supervisor and relied on it, to the patient’s detriment – in this case the supervisor
is responsible for his/her contribution to the patient’s care in the same way as
if they had treated the patient
- the patient or registrar alleged the supervisor
or practice provided insufficient training or support for the registrar.
Liability may extend to any doctor in the practice who
supervised the GP registrar (to the extent they relied upon the doctor’s advice
to treat the patient), not just the formally appointed supervisor. Although it
is more likely that formal supervisors will be involved in a claim or complaint
as they have regular contact with the registrar.
If a complaint or claim does arise and you believe you may
be brought into it, contact our Medico-legal Advisory Service at email@example.com or call 1800 128 268 for
expert advice, 24/7 in emergencies.
- Be aware of your responsibilities as a GP
supervisor and take action to address these responsibilities.
- Provide support and supervision commensurate to
your registrar’s level of experience and skills, and establish a tailored
learning plan to facilitate the registrar’s professional development.
- Foster an open communication environment and
provide frequent, constructive feedback.
- Make sure you inform patients that registrars
are training at your practice.
Complete our webinar, Clinical supervision at the point of care:issues and insights, for more insights about supervising trainees
and guidance on how to manage potential issues that may arise.
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