Core Revision
Supervising well, in the time you actually have
Most of what supervisors need is not more theory. It is knowing what a useful COT comment looks like, where the grade boundary sits at ST1, and what to do on the Tuesday when something is clearly not right.
Everything here is free and open, including to trainees. There is nothing on this page we would not want them to read — and a trainee who understands what their supervisor is trying to do is easier to supervise.
Who does what
| Role | Accountable for | Signs |
|---|---|---|
| Clinical Supervisor | Day-to-day clinical oversight in one placement, and the safety of the trainee’s practice in it. | The Clinical Supervisor’s Report at the end of the post. |
| Educational Supervisor | The trainee’s progress across the whole training year, drawing together evidence from every placement. | The Educational Supervisor’s Report each review period, plus the interim review. |
| Training Programme Director | The programme, the ARCP process, and support when a trainee is in difficulty. | Programme-level documentation; sits on or feeds the ARCP panel. |
The boundary that matters most in practice: a Clinical Supervisor reports on the placement, an Educational Supervisor makes a judgement about progress. If you are a CS being asked to comment on overall progression, that is a question for the ES.
Grading, and being consistent about it
This is the thing supervisors ask about most and find written down least. The same performance means quite different things at different stages, and the honest answer is that calibration is learned by comparing notes.
A trainee takes a full history, misses the ideas and concerns entirely, and produces a safe but generic plan.
At this stage this is expected for the stage, not a deficiency. Structure comes before flexibility, and a trainee concentrating on not missing anything has no attention left for the patient’s agenda.
Useful feedback: name one specific thing to add next time — “ask what they were worried it might be, before you give the plan” — rather than grading them down for it.
The same performance.
Now it is below the expected standard, because by this point a trainee should be able to run the structure automatically and still have room for the person. The gap is not knowledge; it is that the consultation has not become fluent.
Useful feedback: be direct that this is not yet at the level for the stage, say specifically what is missing, and agree how you will look at it again. Softening this at ST3 does the trainee no favours at ARCP.
It is a description of trajectory, not a criticism.
Early in training, most ratings should be developmental. A portfolio where an ST1 is rated as competent across the board in month three tells a panel that the assessments were not discriminating, not that the trainee was exceptional.
The question to ask yourself is not “were they good?” but “were they where I would expect somebody at this point in training to be?”
Two habits that improve consistency more than anything else
Compare notes with another supervisor. Take one anonymised assessment each and grade the other’s. The conversation about where you differ is the calibration.
Write the evidence, not the impression. “Did not check understanding before closing” can be calibrated by anyone. “Good consultation” cannot.
Comments a trainee can act on
| Instead of | Write | Why it is better |
|---|---|---|
| Good consultation, no concerns. | Clear structure and a plan the patient repeated back. Next time, ask what they were worried about before you explain — you gave the explanation first and she was still waiting to say the word cancer. | Names what worked, names one thing to change, and gives the specific moment. |
| Needs to read more around the topic. | The management was right but you could not say why the alternative was wrong. Before next week, look at the NICE suspected cancer referral criteria for this presentation and we will discuss it. | Actionable, bounded, and checkable. |
| Communication skills need work. | You used three medical terms without checking — “ambulatory”, “conservative management” and “reflux”. Try saying each in plain words as you go. | Turns an abstract judgement into three concrete words. |
| Excellent, keep it up. | The way you handled the interruption and came back to her original concern was genuinely good — that is a hard skill and worth logging as evidence. | Praise that identifies the transferable skill, and points at the portfolio. |
Feedback lands better when the relationship is safe enough to hear it. That is not a soft observation — a trainee who is defended against feedback learns nothing from any of these assessments, however well you write them.
Writing a CSR or ESR a panel can use
- Write from evidence, not memoryOpen the portfolio while you write. A report that refers to specific assessments and specific entries is worth several that describe a general impression.
- Say what you actually sawPanels can tell the difference between “consistently safe” and “I observed four consultations across the post; all were safe and the last two showed clear improvement in closing”.
- Address anything a panel will queryIf the assessments are all clustered in the final month, say why in the report. An explanation in the ESR is far better than a gap the panel has to interpret for itself.
- Do not save bad news for the reportIf you are going to write that progress is not adequate, the trainee should have heard it from you weeks earlier. Nothing in a report should be a surprise — and a surprise is the thing trainees most reasonably complain about.
- Be honest when it is not glowingA report that softens a real concern helps nobody, and it makes it harder for the next supervisor. Concern documented early, kindly and specifically is how trainees get help in time.
Sessions you can pick up and run
Filter by how long you have and what you want to work on. Each one has an aim and a way to run it — no preparation beyond reading it.
These are sessions we would actually run
Not a list padded out to look comprehensive. Every one of the thirteen capabilities has at least two, and the ones trainees find hardest have more. If you have run something that worked, we would genuinely like to hear about it.
When a trainee is struggling
Indicators of Potential Underperformance (IPUs)
The RCGP capability framework now carries Indicators of Potential Underperformance — behavioural markers sitting within the progression point descriptors, designed to make underperformance easier to recognise early so that support arrives while it can still be light-touch.
They are worth reading properly, because they change what you are looking for. The point is not to build a case; it is to notice a pattern early enough that a conversation and an adjusted learning plan are enough.
Noticing early
The signs are usually administrative before they are clinical: log entries stop, assessments get postponed, emails go unanswered, the trainee is suddenly hard to find at coffee. Running late and struggling to close consultations often comes next.
Health, home circumstances and confidence are more common causes than knowledge. Ask about the person before you ask about the portfolio.
Opening the conversation
Do it early, privately, and with a specific observation rather than a general worry — “I noticed there have been no entries since March, and you have looked tired. How are things?” That is much easier to answer than “is everything all right?”
Then listen for longer than is comfortable. The first answer is rarely the real one.
Documenting fairly
Record what you observed and what you agreed, at the time, in neutral language. Contemporaneous notes protect the trainee as much as they protect you — they are what shows that support was offered early.
Agree the plan in writing with the trainee, including what you will both do and when you will review it. Vagueness at this stage is the thing that later looks like nobody helped.
Support, and when it becomes remediation
Support is what you offer within the placement: more supervision, protected time, adjusted workload, a clear plan. Most difficulties resolve here and never go further.
Remediation is a formal programme with defined objectives, usually involving the programme director. It is not a punishment and it is not the end of a career — but it does need the programme involved, and involving them late is worse for everyone than involving them early.
Two failure modes are common and both are avoidable: leaving it far too long out of kindness, and escalating something formally that needed one honest conversation.
Development and reapproval
Trainers have an evidence problem of their own, and almost nobody helps with it. Worth collecting as you go rather than in the month before reapproval:
- Feedback on your trainingAsk trainees for it in the middle of a post, not at the end, when it can still change something. Written, and kept.
- A record of what you taughtTutorial topics, dates and what came out of them. A one-line log after each session is enough.
- Your own developmentTrainer workshops, courses, and — most usefully — the calibration conversations you have had with other supervisors.
- Reflection on a difficultyA trainee who struggled, what you did, what you would do differently. This is the strongest evidence of educational skill there is.
Look at the same map your trainee is looking at
The Evidence Tracker is open to everyone. Going through it together in a tutorial turns a conversation about paperwork into a conversation about the work.
Open the Evidence TrackerRevision aid, not clinical advice. This page is educational material written for exam preparation. It is not a substitute for the current guideline or for clinical judgement, and must not be relied on for the care of any individual. Always check up-to-date national guidance and verify independently before acting on anything here.