Poor performance. Tips for clinical supervisors


This article about managing poor performance was originally written by Lake and Ryan (2005) to assist with guiding and supporting junior medical officers in practice. However, the information pertains to any emerging health professional that equates clinical supervision during work integrated or workplace learning environments.

The authors discuss the issue from both the supervisor and learner perspective. They suggested the inability to address poor performance early impacts negatively on patient safety and outcomes; may contribute to self-harm or drop out of clinicians. They state the reasons for this may include:

  • Embarrassment due to fear of exposing their own inadequacies;
  • believe it may compound issues;
  • fear of reprisal through legal action against their judgement; or
  • lack of time to address issues.

Lake and Ryan (2005) indicate if there is a problem there is need to identify the contributing factors. These may include personal; supervisor or system factors. Stress, mental health, substance abuse, cultural differences, poor communications skills or lack of clinical knowledge are suggested as some of the personal factors. Systems factors may include lack of feedback or support; overwork; interpersonal problems with supervisors or patients or first time experiences related to serious illness, death or patients their own age.

The authors suggest a range of strategies to manage the issues mentioned. They suggest support, change of placement; referral to health professionals for assistance; or time off. It is essential to gather objective information, initiate early intervention and confidential discussion with the learner. Documentation may be necessary for the future.  The critical intervention is having a private discussion with her learner to establish the contributing factors to the situation. Therefore it is important to set aside time in a confidential setting; use positive critique; define the issues involved; determine remediable causes; agreeing on an action plan; and monitoring outcomes and following up with feedback.

If you have any comments or suggestions about how to manage poor performance you are welcome to comment here or join me on Twitter @PEPCommunity.

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