How can you teach students when to call in their supervisor? 

Any colleague in a new role will go through stages of competence (Psychology Fanatic, 2024; The Mind Collection, 2024). There will be some tasks where they were not aware they misunderstood something or weren’t performing a skill correctly (unconscious incompetence), and some where they know they are lacking (conscious incompetence). The role of supervisors is to move students through these stages to the point of conscious competence. Supervisors need to identify those areas where the student is not aware they are lacking by regular observations, feedback and discussions around patient encounters. This will help the student better identify situations where they may require support. Helping the student to understand levels of risk, both in terms of clinical procedures and in terms of patient signs/symptoms, will help them refine when they call on their supervisor. This is a continuous process throughout the period of supervision but starts with a clear set-up conversation.

The set-up at the start of the period of supervision, as well as regular progress reviews throughout, should clarify ways of working and expectations of both student and supervisor. 

Students will require more guidance during their first few weeks so establishing how the supervisor-student relationship will work is helpful, for example:

• When they should ask for help
• How they ask for that help. Is it a knock on the door or waiting until the supervisor finishes with a patient?
• Not to advise patients until they’ve discussed the case with the supervisor

For trainee contact lens opticians (CLOs) and pre-reg optometrists, discuss the following in week one: 

• What tests/activities should be completed before seeking advice
• When direct supervision is required (supervisor present, e.g. contact tonometry and RGP insertion/removal)

This discussion helps both the student and the supervisor meet the GOC standards for supervision (Standard 9) and the student to work within their scope of practice (Optical Student Standard 5). 

Understanding when to ask for help is only part of the story, as the supervisor must create a supportive learning environment where the student feels they can ask for help. Being approachable and understanding forms a clear foundation for the professional relationship. Even when there are times the supervisor feels “well they should know that”, they should take care to not let the student feel chastised or dismissed. This will only lead to the student avoiding bringing things to the supervisor’s attention and could lead to potential complaints or errors. The supervisor should always be striving to create an environment of psychological safety. This doesn’t mean ignoring issues but does mean you can talk about them without fear for both parties. 

How can we encourage effective clinical decision making in trainee DOs, CLOs and pre-registration optometrists?

Checking all aspects of a student’s work all the time does not promote independent thinking and encourage effective clinical decision making. Understanding the suite of tools to check a student’s work is important. The clinical record can tell you much about their thinking. Have they asked all the necessary follow-up questions in history? Have they justified their dispensing choice with recorded task and prescription analysis? Are there tests relevant to presenting symptoms that have not been carried out? Modern practices also often have retinal imaging, such as OCT, which can provide useful comparisons for their observations. 

Another important consideration in promoting effective clinical decision making is navigating feedback. When a student has finished with a patient, and they haven’t completed the necessary tests or asked the right questions, do you just go and finish for them or tell them what to do next? Neither is probably the best approach, although they might often be quicker. A great coach would ask them to think about what the tests they have conducted, and what else they are missing. Once completed, ask them what decision they have made and what advice they propose giving the patient. Asking them to complete any further activities before the supervisor checks will help them to do things differently next time they encounter a similar situation. 

If the supervisor has been consulted because of a gap in their knowledge, rather than a skill, then setting a task or reading promotes independent thinking. The supervisor should ensure they set a time to check in with the student to follow-up. 

Regular progress reviews should help the student reflect on those times where the supervisor has been called in, or things haven’t gone well, as well as recognising the successes and areas they have developed in.