Clinical Supervision of Trainees

An appropriate level of supervision should be available at all times, and is:

• Required to develop clinical competence and the skills for safe independent practice
• Determined dynamically, and tailored based on:
  • The attributes of the trainee
    • Competence
    • Reliability
    • Honesty
    • Humility
  • The experience of the supervisor
  • The familiarity of the supervisor with the trainee
  • The nature of the work
    Critical procedures may demand an ↑ level of supervision, e.g.:
    • Major interventions
    • Communication
• Inclusive of administrative and non-clinical duties, including:
  • Documentation
  • Research
  • Audit
  • QI programs

Levels of Supervision

Clinical supervision is divided into:

1. Direct Supervision
   Requires direct observation, prompting, or active collaboration with the supervisor.
2. Proactive Supervision
   Requires presence and availability of the supervisor in the unit.
3. Responsive Supervision
   Requires the supervisor in the hospital and available for consultation and assistance.
4. Oversight
   Requires the supervisor to be readily contactable, but not in the hospital.
5. Independent
   Performs at the level of a junior FCICM, and can supervise junior trainees.

Special Circumstances

Each ICU may set a policy that mandates discussion with the supervisor. Examples may include:

• Patient admission
• Referral or refusal of admission
• Unplanned discharge
• Unexpected or unexplained deterioration
• Performance of or requirement for complex therapy
• Management of children
• Major changes to management
  • Brain death determination
  • Withdrawal of cardio-respiratory support
  • Organ procurement
• Major discussions affecting management
  • Patient
  • Family
  • Other medical teams
• Interhospital transfer

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References

1. CICM. IC-4 Guidelines on the Supervision of Vocational Trainees in Intensive Care Medicine. 2020.