What is a trainer?

A trainer is an appropriately trained and experienced doctor or healthcare professional, who has responsibility for the education and training of foundation doctors in the clinical workplace. A trainer provides appropriate supervision and is involved in and contributes to the learning culture. They provide feedback for learning and may have specific responsibility for assessment.

Support for trainers

Trainers should be supported in their role by the learning education provider (LEP) and foundation school. Trainers must also receive training for all their different roles, which contribute to postgraduate education. Trainers should negotiate adequate time within their job plan to carry out agreed postgraduate training roles to a high standard.

What do trainers need to know about the foundation programme curriculum?

All trainers should read the introduction, how to use the curriculum and the assessment sections of the curriculum. They should be familiar with the definitions and responsibilities of the named clinical supervisor and educational supervisor.

Trainer roles

Trainers fulfill a number of different formal and informal roles to support learning activities. The needs of the doctor in training should determine which role is adopted, and trainer roles will change over time and according to the situation. Trainer functions include:

  • providing educational support in the workplace and leading a culture of education and learning where every clinical encounter affords an opportunity for the foundation doctor to improve
  • ensuring patient safety whilst supervising, mentoring and advising the foundation doctor in their practice
  • undertaking and directing supervised learning events (SLEs) in the workplace and giving immediate feedback and action points for the foundation doctor's development
  • teaching and training both in the workplace and as part of structured learning programmes and contributing to other forms of learning
  • encouraging foundation doctors to develop skills for managing both acute and long-term conditions
  • helping the foundation doctor to understand and manage their e-portfolio
  • providing judgement about the foundation doctor's progress based on personal observations of their practice in the workplace in order to inform the assessment process
  • performing assessment and appraisal
  • undertaking formal roles such as that of clinical or educational supervisor.

Skilled educators move in and among these roles as necessary and will ensure that sufficient time is allocated to develop these roles and relationships. Trainers should aspire to mutually negotiated and fair outcomes and take into account clinical context, the learning environment and any personal issues when considering whether the achievements of the foundation doctor are on course to meet or exceed the minimum expected level of performance in each of the foundation professional capabilities.

Trainers should also recognise that supervision always involves a balance of power between the supervisor and the foundation doctor, which will differ according to context. Good educational practice requires a balance of the following aspects:

  • support
  • challenge
  • clarification of the standards to be achieved
  • clarification of the consequences of non-achievement.

Specific roles in training

Trainers may sometimes hold specific positions in the foundation programme. Key roles are the named clinical supervisor (CS) and educational supervisor (ES). Organisations are required to collect evidence to ensure that CS and ES meet the criteria to be trainers. It is anticipated that the GMC will seek to approve those working as CS or ES. Recognition is not currently required for other doctors whose practice contributes to the teaching, training or supervision of medical students or doctors.

Clinical and educational supervisors will be encouraged to identify trainee-centred educational opportunities in the course of clinical work. Liberating Learning (2010) provides more detail on how this might be achieved in day-to-day practice.

Educational supervisor

All foundation year 1 (F1) and foundation year 2 (F2) doctors must have a named educational supervisor. This is a trainer who is selected and appropriately trained. The ES is responsible for the overall supervision and management of a specified foundation doctor's educational progress across a series of placements, typically for at least 1 year. Only clinicians committed to and engaged in teaching and training foundation doctors should undertake the role. ES must enable foundation doctors to learn by taking responsibility for patient management within the context of clinical governance and patient safety.

Responsibilities of educational supervisors

The named educational supervisor will be responsible for:

  • Ensuring that the training programme is appropriate for foundation doctors' needs
  • Discussion about and completion of the foundation doctor's educational agreement
  • Meeting with the foundation doctor at the beginning of each placement to discuss the foundation doctor's learning and development needs to maintain or achieve a trajectory for end of year sign off across all 20 foundation professional capabilities.
  • Helping foundation doctors to review their learning needs in the light of achieved goals
  • Making a judgement on the collated assessments from clinical supervisors, trainers and other assessors who have worked with the foundation doctor (members of the Placement Supervision Group)
  • Reviewing the foundation doctor's learning e-portfolio
  • Conducting appraisals
  • Reviewing the feedback from team assessment of behaviour (TAB) and ensuring that the TAB is valid by confirming that the correct healthcare professionals have completed it.
  • Providing supportive feedback (where necessary) on the results of TAB before releasing it to the trainees
  • Meeting with the foundation doctor to assess whether they have met or exceeded the requirements of the placement in terms of their clinical and professional practice in each of the four sections of the curriculum
  • Completing the educational supervisor's end of placement report form for each placement. This will incorporate the clinical supervisor's report and information from the e-portfolio. This report is a judgement of whether the trainee's performance is on track to meet or exceed the minimum levels performance required for sign off of each foundation professional capability by the end of the year of training
  • Supporting the doctor through any difficulties
  • Ensuring that the foundation programme director/tutor, director of medical education and/or foundation school director are informed, of any serious weaknesses in the foundation doctor's performance that have not been dealt with and any other problems an individual has with the training programme. The supervisor should advise the foundation doctor of the content of any information about them that is disclosed to someone else. There may also be situations where the clinical director, head of service or medical director should be informed about the foundation doctor's performance issues
  • Ensuring that all training opportunities meet the requirements of equality and diversity legislation
  • Giving appropriate handover to the next educational supervisor with the foundation doctor's knowledge.

Clinical supervisor

Every foundation doctor will have a named clinical supervisor (CS) for each placement.
The named clinical supervisor will usually be the consultant/principal in general practice to whom a foundation doctor is directly responsible for their clinical work. There will be frequent contact between them. The clinical supervisor is selected and appropriately trained to be responsible for overseeing a specified foundation doctor's clinical work during a placement and providing constructive feedback. At the end of the placement the CS must form a judgement whether the foundation doctor's professional and clinical practice is expected to meet or exceed the minimum levels performance required and on course for end of year sign off across each of the 20 foundation professional capabilities. The doctor responsible for direct supervision in the clinical workplace may change on a daily basis for each foundation doctor, but the named clinical supervisor will remain the same throughout each placement.

Responsibilities of the named clinical supervisor

The named clinical supervisor is responsible for:

  • Guaranteeing suitable induction to the ward/department/practice
  • Meeting with the foundation doctor at (or before) the beginning of each placement to discuss:
    • what is expected during the placement
    • available learning opportunities
    • the foundation doctor's learning needs and to identify the placement supervision group to the foundation doctor
  • Ensuring that the clinical experience available to the foundation doctor is appropriate and properly supervised
  • Undertaking and facilitating supervised learning events (SLEs)
  • Monitoring, supporting and assessing the foundation doctor's day-to-day clinical and professional work and indicating whether it is expected to meet or exceed the minimum levels performance required for sign off of each foundation professional capability by the end of the year of training
  • Providing regular feedback on the foundation doctor's performance. Ensuring that all training opportunities meet the requirements of equality and diversity legislation
  • Allowing the foundation doctor to give feedback on the experience, quality of training and supervision provided
  • Discussing serious concerns with the educational supervisor about a foundation doctor's performance, health or conduct
  • Seeking formal feedback from the placement supervision group regarding the foundation doctor's progress and whether it is in keeping with the performance required for sign off of each foundation professional capability by the end of the year of training
  • Completing the clinical supervisor's end of placement report (which can include recording achievements of outcomes and competences) at the end of the placement. This report is a judgement of whether the trainee's performance is expected to meet or exceed the minimum levels performance required for sign off of each foundation professional capability by the end of the year of training.

Some training schemes appoint an educational supervisor for each placement. The roles of clinical and educational supervisor may then be merged.

Placement supervision group (PSG)

Within any placement, an individual healthcare professional is unlikely to build up a coherent picture of the overall performance of an individual foundation doctor. Whenever possible, the named clinical supervisor will seek information from senior healthcare professionals who will work with the foundation doctor during the placement. These colleagues will function as a placement supervision group, commenting on whether the foundation doctor's clinical and professional practice is expected to meet or exceed the minimum levels performance required for sign off in each of the 20 foundation professional capabilities at the end of the year.

The named clinical supervisor nominates the members of the PSG and is responsible for identifying them to the foundation doctor. The makeup of the placement supervision group will vary depending on the placement but is likely to include:

  • Doctors more senior than F2, including at least one consultant or GP principal
  • Senior nurses (band 5 or above)
  • Ward pharmacists
  • Allied health professionals
  • In a general practice placement, the faculty may be limited to one or two GPs.

The placement supervision group (PSG) members' observations and feedback will inform the clinical supervisor's end of placement report. Not every placement will have a PSG but there should be one in place for most ward-based specialties. During certain placements, the foundation doctor will only work with one or two doctors. In these cases the pool of health care professionals making the assessment of performance will be smaller, the degree of interaction and number of interactions between foundation doctor and trainer will be expected to be greater.

Responsibilities of the placement supervision group

The PSG will help the clinical supervisor form a balanced judgement of a doctor's performance, based on observation of the latter in the workplace and their engagement in the educational process. Such an approach will prevent any individual having undue influence over a doctor's progression.

The PSG is responsible for:

  • Observing the foundation doctor's practice in the workplace
  • Undertaking and facilitating supervised learning events (SLEs)
  • Providing contemporaneous feedback on practice to the foundation doctor
  • Providing structured feedback to the clinical supervisor
  • Raising concerns immediately if unsatisfactory performance by the foundation doctor has been identified.

The feedback from members of the PSG should indicate whether, in their opinion, the doctor's clinical and professional practice is expected to meet or exceed the minimum levels of performance required in order to allow sign off of each foundation professional capability by the end of the year of training.

Local education providers (LEPs)

LEPs must ensure that educational and clinical supervisors are appropriately trained for their roles and that they have support and resources, which will include adequate time to undertake their training role.