East of England supervision training resources – programme workbook

Descriptions of supervision can include:

• A regular contact which is protected
• Setting of expected standards
• Monitoring/assessment of practice
• A reflection on practice
• Reviewing workload
• Identification of areas for development
• Offers support and guidance

Description: This e-lfh module provides an awareness and understanding of the general principles of supervision and considers the supervisory role in supporting trainees and qualified professionals in clinical education and practice settings. Several definitions of supervision in healthcare are explored and different approaches to supervision are considered.   

Learning objectives: 

• Be familiar with supervision and the role in supporting learners and colleagues


• Be familiar with the different concepts and definitions of supervision within healthcare 


• Be familiar with approaches to supervision


• Define the principles of supervision and its relation to the context of clinical education

This module can be found at: http://portal.e-lfh.org.uk/Component/Details/725430 

Or on https://www.e-lfh.org.uk/: Educator Training Resources (ETR)>01-Supervision of Learners>Supervision 

All practitioners working at advanced practice level should have developed the knowledge and skills as outlined in the Multiprofessional Framework for Advancing Practice in England HEE, 2017).  The Framework is built upon the following definition of Advanced Practice in England and has been designed to facilitate a consistent understanding of advanced practice:  

“Advanced clinical practice is delivered by experienced, registered health and care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master’s level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education, and research, with demonstration of core capabilities and area specific clinical competence. Advanced clinical practice embodies the ability to manage clinical care in partnership with individuals, families, and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people’s experience and improve outcomes” (HEE, 2017).

The transition from experienced professional to advanced practice trainee and then to qualified advanced practitioner requires significant adjustment. Role transition, unfamiliarity with new situations and expectations, and challenges from colleagues can lead to struggles with professional identity, self-doubts of competence, and feelings of disconnection and isolation. High quality supervision can support with the above and other matters that will arise in training and practice.

As a supervisor it is important to understand that the developmental path to advanced practice may be different for individuals from a range of professional backgrounds.  Current trainees will either be enrolled on a Higher Education Institute (HEI) direct entry MSc in Advanced Practice or an Advanced Practice Degree Apprenticeship. Level 7 (master’s) academic development is combined with workplace development of advanced level capabilities. These capabilities are developed across the four pillars of advanced practice: clinical expertise, research, education, and leadership/management. The ePortfolio Route is another pathway provided to offer recognition of advanced level practice by The Centre for Advancing Practice. This route is for existing experienced practitioners working at advanced level who can evidence the knowledge, skills, and capabilities, as mapped against the four pillars of advanced practice and the 38 capabilities in the Multiprofessional Framework (HEE, 2017).

Please click the links for further information on the following:

*Please note that advanced practitioners may have completed or are undertaking non-accredited advanced practice programmes; however, these programmes may not meet all criteria for NHS England recognition of advanced practice level. In this situation, please seek further advice from the organisational advanced practice lead.

The NHS England Workplace Supervision for Advanced Clinical Practice Guidance (NHSE, 2024) recommends, ‘Those developing in advanced practice should have: 

Coordinating Education Supervisors and Associate Workplace Supervisors may also have responsibility for workplace assessment and verification of the trainee’s advanced level capabilities.’ 

An integrated approach is recommended by NHS England (2024) because there is no consistent approach to advanced practice supervision in the workplace and one may encounter varying terminology and models across clinical settings and locations.

In some settings, the medical trainee supervision model and the terms ‘Education Supervisor’ and ‘Clinical Supervisor’ have been implemented; however, there are areas where there is limited overlap between an advanced practitioner/trainee and that of a medical trainee, therefore, this model should be applied with due consideration. An Associate Supervisor can support the clinical pillar (just as the clinical supervisor in medical training); however, can also support expert knowledge in one of the other pillars of advanced practice: leadership/management, research, or education.

Please review section 6.1 and 6.2: An integrated multiprofessional approach to workplace supervision for the developing advanced practitioner in the Workplace Supervision for Advanced Practice Guidance for a more detailed description of the role and responsibilities of each supervisor. 

Registered professionals working in health and care settings are expected to understand supervision and engage in supervisory activities as per employment and professional registration requirements. 

Like clinical capabilities, supervisor capabilities will develop over time through a variety of professional training as well as learning and practice experiences. Effective advanced practice supervisors will apply supervisor knowledge and skills along with specific advanced practice expertise. 

The Advanced Practice Supervisor Capabilities (NHS England, 2023) (Figure 1) sets out learning and development principles for practitioners supervising advanced practice trainees. These capabilities discuss the knowledge, skills, and behaviour necessary for effective and inclusive supervision while applying specific advanced practice dimensions.

The capabilities are to be used in conjunction with the Centre for Advancing Practice supervision guidance and minimum standards. This workbook is mapped against these capabilities, it is essential to read and be familiar with these and the other supervision guidance documents.

The Minimum Standards for Supervision (NHS England, 2024) states “High quality supervision for healthcare professionals moving into trainee advanced practice roles is essential for supporting the development of confidence and capability and underpins patient and practitioner safety.”  

NHS England’s Workplace Supervision for Advanced Practice (2024) provides further in-depth, evidence-based information and recommendations on how to develop quality supervision in the workplace.” These documents will offer invaluable guidance to support practitioners who are developing as supervisors and underpins much of the content and learning within this programme.  

This suite of videos prepared by The Centre for Advancing Practice in 2020 provides an introduction and overview of key points related to supervision within advanced practice that will be discussed more in depth throughout the workbook. There are seven fundamental principles for the supervision of developing advanced practitioners found in the Centre for Advancing Practice workplace supervision guidance as seen in diagram below.

The following videos discuss the seven fundamental principles of supervision:  

1. Supervision in Advanced Clinical Practice (1m43s) 

1. Practice Context (2m26s) 

1. Competence and Capability (3m4s) 

1. Multiple Professional Registrations (6m16s) 

1. Individual Learning Plan (5m15s) 

1. Professional Development and Transition (6m15s) 

1. Integrated Approach (7m1s) 

1. Supervisor Development (6m44s) 

1. Final Thoughts (3m1s) 

Please watch the following video from NHS England (2022) which discusses key fundamentals of advanced practice supervision with a useful overview of the NHS England supervision documents which highlight essential points to consider when supervising an advanced practitioner or advanced practice trainee. 

 
Effective Supervision for Advanced Practice and Minimum Standards Documentation), (21m47s)  

All advanced practitioners are expected to maintain advanced level practice portfolios across the four pillars (see diagram below). The trainee will require supervision spanning across the pillars. At various points, the HEI programme supervisor may provide supervision required to meet learning needs; however, it is important to keep portfolio evidence up to date as a supervisor, to maintain the knowledge, skills and behaviours to support trainees.

Choose and complete one of the three thinking points below. You can use the box on the next page for your notes:

Thinking point 1:
How would you define supervision?

Thinking point 2:

With reference to the diagram below, review your experiences of supervision and consider where you would ‘plot’ them in the Venn diagram.

• Where on the diagram is your emphasis?


• How might you extend your (or others’) practice to ensure supervision has a broader scope?

Thinking point 3:

Consider how you have prepared for supervision in the past:

Notes for activity: Thinking points

There are multiple clinical supervision models suited to different organisations and team dynamics. Models can be helpful in providing frameworks for both supervision and for supervisor training and development. There is no current model designed or used specifically for advanced practice. As with all models and frameworks, it is important to apply critical awareness and consider the strengths and limitations of each model in the context in which it is used.

Please click the link below:
Clinical supervision models (NHS Employers, 2022)

Choose a supervision model from the activity link above and list the strengths and weaknesses of using this model as a supervisor within the context of a clinical environment.

Description: This module aims to provide learners with knowledge of supervision methodologies and principles and will give an overview of how to support supervisors and supervisees in effectively engaging with the process of clinical supervision.

 Learning objectives:

• Become familiar with reflection


• Identify key purposes of effective clinical supervision


• Explain the benefits of clinical supervision for yourself and your practice


• Explain the importance of preparation for clinical supervision


• Demonstrate at least three ways supervision can be practised

This module can be found at: http://portal.e-lfh.org.uk/Component/Details/684286 or on https://www.e-lfh.org.uk/: Supervision for Multi-Professional Teams (CSM)>Supervision for Multi-Professional Teams>Introduction to Core Supervision>Core Supervision Model.

Models of supervision and frameworks can highlight criteria, dimensions of, and influences on the trainee’s/advanced practitioner’s practice and can guide the supervisor in their support; however, this does not guarantee appropriate or effective supervision. The diagram below highlights the different aspects of developing an advanced practitioner which should be considered by the supervisor. These aspects are not exhaustive; each will be explored throughout the advanced practitioner supervisor training resources.

Dr. Deborah Harding, (2019), states: “Ultimately, supervision is perceived to be optimal when both supervisor and supervisee care about and care to resolve practice uncertainties or developmental needs, and when supervisor and supervisee adopt a cluster of facilitative behaviours and characteristics. Practitioners who display these characteristics can be described as ‘permeable practitioners’; they expect and anticipate uncertainty in day-to-day practice and seek to resolve uncertainties in a variety of reflective and learning activities, one of which may be supervision.”

While it is important to have regular protected time for supervision, it is the perceived quality and not the quantity of the supervision which will determine the adequacy and effectiveness of that supervision. The supervisor, along with the trainee/advanced practitioner, will mutually agree on the frequency and duration of the supervision. This will be based on the trainee’s/advanced practitioner’s current capabilities and learning needs, as well as the organisational service requirements. The supervisor should be responsive to the above but ensure both professional and public safety are paramount.

• Read: The Permeable Practitioner

• The Permeable Practitioner self-assessment resource is available on the Permeable Practitioner website.

Models of supervision are sometimes accompanied by models of professional development and skills’ acquisition. Those of Benner (1984) (adapted from the Dreyfus Model of Skill Acquisition, 1980) and Peyton (1998) are routinely cited.

Benner presented a theoretical framework titled “From Novice to Expert” (1984) which addresses the different stages of professional growth of nurses specifically, but has been used in other clinical professions, see diagram below.

Peyton’s approach, see diagram below, outlines a 4-step approach to teaching incorporating the following steps of demonstration, deconstruction, comprehension, and execution (1998).

Some regard such models as too prescriptive, suggesting a final point or a ‘best place’ for the practitioner to be positioned (Dall’Alba and Barnacle, 2015).

Learning is a lifelong process and learning models have evolved over years; from learning models focused on the ‘educator-centred’ approach to ‘learner-centred’ approaches. Three main terms can describe how knowledge is acquired at various levels, see diagram below:

• Pedagogy – Educator-centred learning where a teacher imparts knowledge onto a learner and is usually structured in nature, such as in a primary school.
• Andragogy – Adult-centred learning where the learner is self-directed and has active participation in their education, includes case studies, practical examples. This term was coined by Knowles in 1968 to highlight the differences in adult learning compared with child-centre learning.
• Heutagogy – Self-directed learning where the learner directs their own studies based on curiosity and motivations.

Please watch the following videos which discuss key fundamentals of adult learning theory and adult learning assumptions:

• Adult Learning Assumptions (CDC, 2018), (3m01s)
• Adult Learning Theory (University of BC, 2017), (3m14s)  

In the previous section, several theorical perspectives were described, however the clinical environment is dynamic. As healthcare is so variable, healthcare professionals are required to adapt to working environments and remain innovative while being challenged in practice. The article following this section offers a guide for healthcare professionals to put adult learning theories into context.

A learning model called the Master Adaptive Learner (MAL) (Cutrer et al., 2017) was born from American medicine and developed within context, for example the dynamic clinical environment, and explains four phases of learning:

The mind of the MAL requires the identification of gaps of knowledge, engagement in learning, testing newly learned material, and using this learning in practice. Each phase requires specific skills to be able to complete each phase. The MAL focuses on cognitive learning and requires critical thinking and reflection for every phase. This may be useful for supporting trainee advanced practitioners in developing skills in a fast-paced and variable environment.

Read: Adult Learning Theories in Context: A Quick Guide for Healthcare Professional Educators (Mukhalalati and Taylor, 2019)

Take some time to reflect on the learning theories within this chapter and decide which theory relates to the development of advanced practitioners and why.

Read: Models of Reflection and Reflective Practice  (HEE, 2025).

Current approaches to supervision encourage reflective practice. Schön’s (1983) distinction between reflecting after an event (‘on action’) and circumstances in which an experienced practitioner adjusts practice while reflecting ‘in action’, remains influential. There are those who caution that experienced professionals should not become over-reliant on ‘reflection in action’ and that this should be accompanied by regular, scheduled opportunities such as workplace supervision to review the taken-for-granted, thus moderating tendencies to turn to off- the-peg solutions (Eraut, 1994). There are many readily available frameworks and models to support such scheduled reflection on action (Gibbs, 1988; Moon, 1999).

What is Critical Reflection? Introducing the “What, So What, Now What” Model (2mins44s)

These are available for trainees, advanced practitioners, and supervisors to support development in this area:

• Reflective Practice Resources (NHS England, 2024)
• ENHANCE programme at Transformative reflection (NHS England, 2024)

Use the space below to reflect on your own style of reflective practice. Is there one preferred model or a range of models depending on the type of reflection?

As a supervisor, you will be required to give regular feedback to the learner while they develop as an advanced practitioner. This feedback is usually directly to the learner and will include both strengths and areas that require improvements. Below are three different tools that can be used to deliver feedback in a measured and considered way; they include the feedback sandwich, the SHARE debrief tool, and the BUILD model. Giving effective feedback will also be explored further in the practical day and will offer a chance to develop feedback skills in a safe environment.

• Feedback sandwich

The feedback sandwich starts and concludes with positive feedback, and what can be considered as the more critical feedback (or what may be classed as ‘negative’ feedback), is “sandwiched” between the positive aspects. This can be used in everyday clinical practice; however, if used continuously, it has the chance of becoming predictable. It can be useful to give positive feedback on its own when the opportunity arises. If coworkers feel acknowledged daily, they will be more open to all kinds of feedback when applicable (Hardevella et al, 2017).

• SHARE debrief tool

The SHARE debrief tool (NHS, 2022), see diagram below, supports health and care teams to engage teams and staff who may be affected by a learning response outcome.

It can be used to:

• present findings from a learning response (such as an incident investigation, MDT review and clinical huddle) and define and agree areas for improvement.
• collaboratively develop and prioritise safety actions in response to defined areas for improvement.
• corroborate thinking regarding safety actions before agreeing to implement them.
• debrief after the completion of learning.

• BUILD Model

The BUILD model (University of Otago, 2020) is a structured approach to giving feedback in a respectful and constructive manner. By utilising this model, feedback conversations can be more productive, less confrontational, and focused on growth and improvement. The BUILD model consists of 5 key steps as outlined in the table below:

• ‘Behaviour’ sticks to facts rather than opinions or beliefs
• ‘Understand’ builds empathy before providing feedback
• ‘Impact’ provides clarity on the consequences
• ‘Listen’ by asking open questions and actively without interrupting or passing judgement
• ‘Do differently’ encourages self-reflection and empowers the individual to come up with solutions

Description. This session offers suggestions on how you can improve your feedback to ensure you are better able to help motivate and develop learner’s knowledge, skills, and behaviours.

Learning Objectives:

This module can be found at: https://portal.e-lfh.org.uk/LearningContent/Launch/725842Or on https://www.e-lfh.org.uk/:Educator Training Resources (ETR) >01 – Effective feedback

Coaching and mentoring are helpful tools to support supervisors and trainees. Coaching focuses on learning from previous experiences to improve how things are done currently (NHS Improving Quality, 2015). Mentoring allows more senior staff to share knowledge and experiences, whilst supporting other staff in learning and development (NHS Leadership Academy, 2014).

Coaching implements techniques to help supervisors access resources and capabilities to facilitate the achievement of success. Whether as a one-to-one or within a group context, coaching is often perceived as the single most effective development intervention that clinical staff in a variety of roles can access. As coaching skills can take time to develop and requires further training to become proficient, the expectation is to be aware of coaching approaches and skills that may be helpful to the trainee. If further coaching development is desired, enquire about training opportunities or speak to your education team.

The main characteristics of coaching are:

• The relationship has a fixed duration.
• The meetings are structured and regularly scheduled.
• Short-term and focused on specific areas of development, goals, and challenges.
• The coach does not need direct experience of the role of the individual being coached.

Mentoring guides and supports an individual with professional development.  Priority is placed on the needs of the individual encouraging independence and autonomy while identifying opportunities for further development.

The characteristics of mentoring are:

• The relationship is ongoing.
• Meetings can be more informal.
• Long-term career and development focused.
• The mentor is usually a more senior or experienced individual working in the same sector/profession.

Please review the following for further information on coaching and mentoring:

NHS Improving Quality Coaching Learning Handbook

CIPD Coaching and Mentoring

Discuss the benefits of coaching vs mentoring. Reflect on your own experiences in practice. When would you choose one method over the other and why?

Mediation is a voluntary process led by an impartial third party to resolve conflict. Conflict can occur in any employment relationship and is best dealt with early at source. If left unchecked, it can fester and escalate, potentially leading to grievance and discipline procedures or employment tribunals. Mediation avoids these more formal and costlier routes by guiding participants towards reaching mutually acceptable solution (CIPD, 2023).
As a supervisor, there may be a time when dealing with a challenging trainee and conflict resolution skills will be crucial in maintaining a healthy supervisor/trainee relationship. Most organisations will offer conflict resolution training, either by eLearning or in-person taught sessions. For further training, search your organisation’s intranet site or contact your line manager/ education team.

In the NHS England East of England Faculty for Advancing Practice document Readiness for advanced practice: A guide for aspiring and trainee advanced practitioners (2024), there are three ‘Trainee in Difficulty’ pathways located in the appendices. Please familiarise yourself with these pathways for awareness:

• Trainee in need of support


• Trainee requiring support in the placement areasTrainees requiring support with advanced practice MSc programme/education provider

As part of this document, trainees are advised to gain support in the form of a ‘learning community’ as this will aid motivation and value throughout the training. Trainees can also seek support and guidance from the education provider, their organisation, their ICS, library services, and social media.

Description: This session provides an overview of the impact of professional and personal difficulties on trainees.

Learning Objectives:

This module can be found at: https://portal.e-lfh.org.uk/Component/Details/725848

Or on  https://www.e-lfh.org.uk/:

Educator Training Resources (ETR) > 01 – Supervision of Learners > Video: Training Support – Trainees with Difficulties

Equality, diversity, and inclusion (EDI) is ‘everyone’s business’ as described by the NHS England EDI improvement plan (2023). As you are aware there are 9 protected characteristics under the Equality Act 2010 as shown in the diagram below below. The NHS EDI improvement plan has 6 high impact actions with related success measures.

Measures that advanced practice supervisors can take to support trainees from an EDI background include:  

This list is not exhaustive and if any support is required to improve on equality, diversity, or inclusion measures, your local EDI champion or lead can support. To find out more about NHS England’s approach to diversity and inclusion, please access: Diversity & Inclusion (NHS England, 2023).For a deeper dive: Leadership Listens, episode 5: The importance of compassion and inclusion (NHS Leadership Academy, 2022).

Description: Equality, diversity and inclusion (EDI) are central to the NHS, in terms of both employment and service delivery. This session offers the opportunity to consider your role in relation to EDI and explore the key principles involved. Throughout the session you will be given an opportunity to apply the learning to your own practice through carrying out activities and reflecting on these.

Learning Objectives as set out in the module: 

This module can be found at: https://portal.e-lfh.org.uk/Component/Details/725230

Or on https://www.e-lfh.org.uk/ Educator Training Resources (ETR) > 01 – Supervision of Learners > Diversity, Equal Opportunities and Human Rights    

Ensure familiarity with your own organisation’s EDI policies and procedures and how they address discrimination. Take some time to read through them so you are aware of what actions to be taken if issues arise. EDI training is mandatory; however, it is important to be familiar with your specific organisational policies.

After reading key EDI policies and procedures, use this learning for the following activity: You overhear a racially discriminatory comment being made to your trainee in the middle of a clinical assessment observation; what action would you take?

Neurodiversity describes the population as a whole and recognises the diversity of different brains. Neurotypical describes the majority group that perceives work, learns, and expresses themselves in ways that are seen as the societal norm. Neurodivergent describes the minority group that diverts from said norm.
For more information, please see: HEE’s Guide to Practice Based Learning for Neurodivergent Students.

Description: This session explores the role of the clinical or HEI health professional’s teacher in assessing the educational needs of learners. The session considers the roles of the different individuals and organisations involved in defining learning needs (including the learner, the teacher, the professional and health care organisations) and sets this in the broad context of health professionals’ education.

Learning objectives:

This module can be found at: https://portal.e-lfh.org.uk/LearningContent/Launch/725433Or on https://www.e-lfh.org.uk/ : Educator Training Resources (ETR) > 01 – Supervision of Learners > Assessing Educational Needs

An individual learning plan or personal development plan (PDP) is an action/learning plan with objectives based on self-awareness, values, reflection, goal setting, and planning for training or career development. Advanced practice trainees are encouraged to review learning, goals, and achievements on a regular basis throughout training and development. Learning outcomes should be clear, realistic, desirable, and achievable. A first step is to look at strengths, preferences, values, and preferred learning styles. For more information please see: Personal development planning.

Developing an individual learning plan or PDP begins with an appraisal of the trainee’s learning needs:

• Understanding existing professional knowledge, skills, experiences, behaviours, and characteristics.
• Agreeing which aspects of the existing knowledge, skills, experiences, behaviours, and characteristics must be augmented in training and off-the-job, to ensure competent, capable, safe, and effective advanced clinical practice.
• A baseline against which to track and record development in the specified capabilities and competences for the target advanced clinical practice role.
• The acknowledged added value different professional registrations bring the practice setting for patient benefit.

Supervisors are often required to work with individual trainees to set formal learning objectives with regards to knowledge, skills or behaviour learning needs. Using a framework, such as Bloom’s Taxonomy (1956, 2001) (see diagram below), is an effective way to structure how educational objectives are agreed and defined for the cognition of knowledge, moving through the remembering, comprehension, application, analysis, synthesis and evaluation of information.

It is important to consider the current level of the trainee’s knowledge, skill, and behaviours as well as the stage the trainee is at in their advanced practice education. It is advisable that SMART goals to increase success in achieving the learning outcomes are set and will be explored in the in-person or virtual teaching session.

SMART stands for specific, measurable, achievable, realistic, and time-based. Example SMART objectives log (NHS England, 2021).

Description: The session introduces the topic of setting learning objectives in the clinical context and links closely with the session assessing educational needs (758/002). This session briefly considers the roles for the different individuals and organisations involved in setting learning objectives (including the learner, the teacher, the professional and health care organisations) and sets this in the broad context of clinical education.

Learning objectives:

This module can be found at:  https://portal.e-lfh.org.uk/LearningContent/Launch/725954

Or on https://www.e-lfh.org.uk/: Educator Training Resources (ETR) > 01 – Supervision of Learners > Setting Learning Objectives

Take some time to consider a SMART objective for a first-year advanced practice trainee for  knowledge, a skill, or a behaviour that requires development for one of their modules. Bring this SMART objective to the practical day as this will be discussed in more detail.

Healthy teams lead to healthy patients. NHS England (2024) offers a guide to supporting teams seeking to improve their health and wellbeing, through culture change. Inspired by the NHS health and wellbeing framework (NHS England, 2021), this guide has been co-designed with colleagues across health, social care, and voluntary sectors. It is aimed at teams looking for inspiration and guidance when creating a local culture of wellbeing in a practical and engaging way.

For more information please access:  NHS Looking after your team’s health and wellbeing guide. (NHS England, 2024) (3m55s)

As an advanced practice supervisor, the trainee may feel safe to confide about mental or physical health issues. It is useful to understand what available support could be offered to the trainee in your local area or workplace.

Take a few minutes to note a few different available options or signposts you could offer a trainee if they confided they were struggling mentally with stress at work or home life. You may wish to review your organisation’s intranet.

When approaching supervision, it can be good practice to establish a supervision agreement between participants, so that both the trainee and supervisor have a clear and shared understanding about what the supervision will entail. Please click on the link for an example of a template Supervision Agreement Template (HCPC, 2024).

A successful supervision relationship must incorporate time for developing trust, collaboration, and open dialogue.

The clinical learning environment is important in ensuing the trainee has the correct resources and support to allow for productive and safe learning. As part of the Clinical Learning Environment Strategy for East of England  (HEE, 2022), “Developing a culture of inclusive and compassionate learning” is discussed and goes into further detail:

The Safe Learning Environment Charter supports the development of positive and safe cultures with continuous learning across all learning environments in the NHS. It is underpinned by principles of equality, diversity, and inclusion (EDI). Please review the following document: Safe Learning Environment Charter-what good looks like (NHS England, 2024).

Description: This session explores some theoretical perspectives on workplace learning and consider some suggestions on how to support learners in the clinical environment. 

Learning Objectives as set out in this module:

• Recognise the opportunities for learning that present themselves in everyday working practice.
• Identify ways to create an environment where learning can take place.
• Describe the wider range of strategies to support learning.

This model can be found at: https://portal.e-lfh.org.uk/LearningContent/Launch/726638

Or on https://www.e-lfh.org.uk/: Educator Training Resources (ETR) > 04 – The Learning Environment > Facilitating Learning in the Workplace

Description: Health professions teachers and managers need to evaluate the quality and effectiveness of their teaching and of the learning that takes place. Evaluation generally occurs within defined quality assurance frameworks that have common features. Understanding quality assurance systems and evaluation methods will help teach us to improve the student/ learner experience. 

 Learning objectives as set out in this module:

 Or on https://www.e-lfh.org.uk/: Educator Training Resources (ETR) > 04 – The Learning Environment > Assuring and Maintaining Quality in Health Professions Education

Supervision provides opportunities to share, explore and resolve practice uncertainties in a safe space. Registered health care professionals are expected to understand the purpose of and engage in supervision and continuous professional development as per the registrant’s professional regulatory body. For further information about professional regulator bodies, please choose from the following links:

• Health and Care Professions Council standards of proficiency
• Nursing and Midwifery Council standards of proficiency
• General Pharmaceutical Council standards and guidance  
• General Medical Council professional standards

It is the responsibility of the advanced practice trainee to work within their registered profession codes of conduct whilst training and when qualified. Supervisors may be required to supervise a trainee that is registered in a different profession. For further information on other professions’ codes of conduct, please click the relevant code:

• HCPC Standards of performance and ethics
• NMC ‘The Code’
• Royal Pharmaceutical Society Governing Documents

Trainees and advanced practitioners should have relevant competencies and capabilities to work safely within their scope of practice. Scope of practice refers to the boundaries within practice based on level of education, training, and competencies/capabilities and defines the duties and responsibilities that can be legally undertaken. It is essential for multi-professional advanced practitioners to operate within those defined scopes of practice to ensure patient safety, personal safety, organisational safety and delivery of quality care. This is underpinned by maintaining competencies/capabilities that are discussed and signed off during the annual appraisal process.

For further information relating to patient safety, please access: The NHS Patient Safety Strategy.

Employers also have responsibilities for ensuring adequate supervision and training for employees. Please review this document: Health and Care Act 2008- regulations 12 & 18.

Registrant accountability in advanced practice refers to the responsibility of health care professionals working at advanced level to make decisions in a context of complexity, uncertainty, and varying risk, and to have accountability for decisions made (HEE, 2017).

Advanced practice development takes place in a live and dynamic clinical setting with multiple stakeholders from clinical, operational, and educational governance organisations. Each stakeholder’s immediate governance focus may differ; however, the overarching aim is to support practitioner development while ensuring safe and effective care. Organisations have a liability to ensure appropriate governance for advanced practitioners.

Supervisors should know and ensure trainees are aware of the organisational/ICB governance frameworks/policies and procedures and trust/practice requirements. The clinical governance that is in place is to protect both patient and professional safety, see diagram below:

Please review the following checklists and action plan from the Centre for Advancing Practice website.

• Employer’s advanced practice supervision action plan


• Readiness to become an advanced practitioner


• Supervisor readiness checklist, guidance for supervisors

It is important to ensure you have the experience, knowledge, and expertise to provide good quality supervision.An employer seeking to introduce advanced practitioners into the workforce must factor the provision of workplace supervision for advanced practice development into the local workforce strategy, recognising that this will require investment in coordinating education supervisor and associate workplace supervisor capacity, capability, and competence.

Health and care professionals engage in career- long learning and development. In advanced practice development, employers must ensure that the balance between employee and trainee demands are maintained. Job plans offer one way in which this can be agreed, documented, and monitored. Job planning the clinical workforce-allied health professionals guide (NHSE, 2019) provides further information about the purpose and benefits of job planning.

Here is an example job template. Please review your working week where supervision time can be included in your job plan; bearing in mind that the minimum standards for supervision of a trainee is 1 hour per week. Please see Appendix D for full size job plan template for this activity.

Take a couple of minutes to note in the box below. How will you keep up to date with supervision as CPD/appraisal process?

Multi-professional advanced practice is a rapidly developing field of multi-professional practice across a growing range of settings such as physiotherapy, paramedicine, nursing, pharmacy, and radiography, with advanced level capabilities across the four pillars of clinical, leadership and management, education and research, as set out in the Multi-professional Framework for Advanced Clinical Practice in England. It is acknowledged that there will be justifiable variation in supervision arrangements associated with geography, pathways, practice context and roles.

Although supervision practices are well-established in health and social care, this resource has been developed because:

• There is variation in the extent to which advanced practice and advanced practitioners are established and recognised across the health and care system.
• Current supervision practices tend to be profession specific.
• Advanced practice is multi-professional.

Within workplace supervision of advanced practice, knowledge and skills development is likely to include some supervision across traditional professional boundaries (NHS England 2024). There are already resources, courses and programmes that aim to develop registered professionals as workplace, practice-based educators, supervisors, and assessors, for example, medical professions have structured learning opportunities for those supervising postgraduate medical trainees. Historically these supervision training resources have been developed within and for single professional registrations such as nurses, doctors, pharmacists, physiotherapists and so on. The content, or curricula of these supervision practices may have some common features as listed in the figure below.

It is important for all supervision programmes to provide tools to signpost for personal, professional, or psychological support. This includes ensuring the supervisor can clearly maintain clinical and professional governance such as patient and professional safety, risk management, confidentiality, statutory duties, and duty of candour. For examples, see table below.

We have seen the commonalities across supervision resources, courses, and programmes. Some barriers apply to all supervision across the health and care system, while others are barriers more specific to the advanced practice context. The table below shows some of the barriers that can be found.

Please access the following link for more information on barriers to supervision and ways of overcoming them: https://advanced-practice.hee.nhs.uk/our-work/supervision/#Appendix-5 (NHS, 2020)

Choose 2 of the barriers discussed in the above link and discuss possible solutions to overcoming these challenges?

Inter-professional working is not a new concept and has been a historical feature of the NHS. Inter-professional supervision is, however, a newer concept, and advanced practice embraces the integration of multi-professional education and supervision, valuing what each profession can offer in relation to the commonality of supervision knowledge and support.

Team culture means the sharing of beliefs, behaviours, practices and values for a particular organisation. Advanced practitioners may join together in a number of beliefs, behaviours, and practices at an advanced level of practice, and although each NHS organisation will have a variation of their own values, the 6 overarching core values of the NHS connects us all and what we all have in common regardless of profession

See: The NHS values | Health Careers:

• Working together for patients
• Respect and dignity
• Commitment to quality of care
• Compassion
• Improving lives
• Everyone counts

Description: This session explores some theoretical perspectives on workplace learning and consider some suggestions on how to support learners in the clinical environment. 

 Learning Objectives:

 This module can be found at: https://portal.e-lfh.org.uk/Component/Details/728329 Or on https://www.e-lfh.org.uk/: Educator Training Resources (ETR) > 05 – Approaches in Education > Interprofessional Education

 ArticleFor a deeper dive into the challenges arising within a multiprofessional workforce:Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England: A qualitative exploratory study (Mann et al., 2023).

Assessments are an essential part of the learning process within a clinical learning environment, allowing the trainee to receive direct feedback about progress through understanding certain knowledge, or developing expected skills or behaviours. The supervisor’s feedback will indicate the trainee’s progress made, strengths noted, and areas of improvement required to meet the learning outcomes set. Assessments can be classed into formative and summative, and each assessment method will vary in terms of validity, fairness, and reliability.

The table below shows similarities and differences between formative and summative assessments. As a supervisor advanced practice trainees will require support with the completion of practice assessment documents and workplace-based assessments. Some examples of workplace-based assessments have been linked with videos to be watched. These videos are directed towards pharmacists however, the content is relevant for multi-professional use.

Description: This session explores ways in which the clinical performance of healthcare professionals can be assessed in the workplace. It outlines the principles underpinning the design of workplace/practice-based assessment systems and tools, considering how they influence subsequent use. Examples of tools typically used to assess practice of students and trainees are provided. This session concludes with suggestions on how to best use these types of assessment tools to support the development of students and trainees.

 Learning objectives:

This module can be found at: https://portal.e-lfh.org.uk/LearningContent/Launch/726002Or on https://www.e-lfh.org.uk/: Educator Training Resources (ETR) > 03 – Assessment and Progression > Workplace and Practice Based Assessment > Workplace and Practice Based Assessment

Description: Clinical teachers are often involved in assessments of clinical competence in the workplace, in universities and for postgraduate or post qualifying examinations. This session outlines the theoretical principles underlying the development of modern structured assessments of clinical competence and describes some practical aspects of designing and implementing the most used assessment: the objective structured clinical examination (OSCE).

Learning objectives:
Recognise the background to current methods of assessing clinical competence.Identify the structure, strengths, and limitations of an OSCE.

This module can be found at: https://portal.e-lfh.org.uk/Component/Details/725665Or on https://www.e-lfh.org.uk/: Educator Training Resources (ETR) > 03 – Assessment and Progression > Structured Assessments of Clinical Competence > Structured Assessments of Clinical Competence

Take 10 minutes to note what workplace-based assessments you have completed in practice for your own learning in the table below. Then record how these tools can be used to assess and support an advanced practice trainee through training.

“Registered professionals recognise their responsibility for continued engagement in lifelong learning as new theories and methods evolve. Just as clinical capabilities need renewal and refreshing, so too with supervisor capabilities” (NHS England, 2023).

Professional development activities which support the maintenance and augmentation of supervisor capabilities include: 

As an advanced practice supervisor, there is no formal assessment of supervisor capabilities; however, it is the supervisor’s responsibility to maintain the expected knowledge, skills, and behaviours in relation to the supervisor capabilities to support current and future trainees through advanced practice training and development. There is a worksheet located in Appendix C to document any further training or updates related to supervisor training.

As a current advanced practitioner, there is an expectation to maintain a portfolio of evidence for scope of practice across the four pillars of advanced level practice, and should contain a range of evidence linked to the 38 capabilities as set out in the Multi-professional framework for advanced clinical practice in England (HEE, 2017). Each piece of evidence should state how it demonstrates capability; some pieces of evidence may demonstrate multiple capabilities. It is about quality of evidence rather than quantity.
As scope expands to include responsibilities as an advanced practice supervisor following this training, there will be an expectation to include portfolio evidence of supervisor capability. The portfolio of evidence may also be used to meet professional regulatory (HCPC/GPhC/NMC) and employment requirements, such as appraisal and revalidation purposes (Skills for Health, 2024).
 
Existing and new advanced practice trainees are expected to develop personal portfolios of evidence during advanced practice training. As an advanced practice supervisor there will be times that the trainee may require support to enable opportunities to complete certain capabilities. The trainee will be expected to show initiative in collating most evidence they require to meet programme learning outcomes and specific organisational/practice requirements.

Workbook completion:

Once the Advanced Practice Supervisor Training workbook has been completed, please have your line manager and organisational Advanced Practice Lead sign below to ensure they are aware of completion and to confirm readiness and eligibility to attend the in-person or virtual teaching session.

Advanced Practitioner signature/date____________________________________________

Line Manager signature/date___________________________________________________

Organisational Advanced Practice lead signature/date_______________________________

Attendance at in-person or virtual supervisor training teaching session:

Yes, I have attended the facilitated supervisor training teaching session:

Date attended______________________________________________________________

Facilitator signature _________________________________________________________

General principles

Trainees requiring support with education provider

There is an expectation for all advanced practice trainees to be proactive in managing their learning journey. This includes acting to manage and resolve problems that may occur during their training programme, with the support of their manager, supervisor, organisational/training hub advanced practice lead, MSc programme lead, and the NHS England – East of England Faculty for Advancing Practice.

The trainee must report to their line manager and organisation or training hub advanced practice lead immediately if they:

• intend to the leave the programme
• defer on assignments or need to resubmit assignments. These may be education provider assignments or practice placement assignments, portfolios, skills, etc.
• have difficulties in attending required study days, and or are unable to attend
• are considering requesting a deferment, to intermit or pause on their programme

The line manager and advanced practice lead must report any of the above to the NHS England – East of England Faculty for Advancing Practice via england.eoeapfaculty@nhs.net within 7 days of being informed.

Trainees in receipt of NHS England funding who are planning a complete or temporary withdrawal from programme must report this immediately to NHS England via a notification of change form.

Trainees requiring support in placement areas

There is an expectation for all advanced practice trainees to be proactive in managing their learning journey. This includes acting to manage and resolve problems that may occur during training, with the support of their line manager, supervisor, organisational advanced practice lead, MSc programme lead, and the NHS England – East of England Faculty for Advancing Practice.