Educational supervision- so much more than just forms

Spotting burnout early

As a junior trainee, my educational supervisor was my role model- kind, empathic, an excellent teacher, full of passion and enthusiasm. One of the nurses once commented that I was morphing into him- at work early, walking down the corridor at great haste, leaving late… I was so proud. It turns out, that person was burning out. I didn’t notice and I’m not sure whether others did either. It’s only several years later that I realise that these behaviours were an early sign that I was at risk of burnout. Had someone stepped in then, perhaps things would have been different.

I remember several 360 degree appraisals in my first couple of years of doctoring, comments about low self belief, can get stressed at times, commits herself 100%, covering all the extra shifts… However, without any specific goals or tips to help me develop, they were just words. And so it continued for 5 years. I poured myself into medicine completing every project under the sun, a masters alongside MRCPCH, teaching, presenting, getting married, moving house and throughout it all I was commended and felt validated for my dedication. I wonder if somewhere along the way someone had sat me down and discussed the risk of burnout, suggested I lift the pedal and explained that it wouldn’t have made me any less of a doctor, perhaps things might have turned out differently. Maybe, maybe not!

Supervisors are in a key position to spot the signs and act accordingly. For me, the passion and empathy I’d had in abundance were replaced with bitterness and cynicism. I was physically and mentally exhausted, struggling to prioritise and concentrate. My mind raced, worrying about everything and anything. 

Look beyond the forms and you’ll see the person.

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Managing disclosures

Whilst on maternity leave I developed postnatal depression. When I returned to work I was open and honest about my experience knowing I was still wobbly and needed support. I explained that doing my allocated on-call shift in a children’s hospital I’d never worked in before on my second day back was not a good idea. I told the consultant in charge that I needed a more gradual introduction. Despite plenty of notice, the day came and, in front of about 20 people, I was handed the bleep. “You don’t need to look like a rabbit in headlights. We don’t bite” I was told. Clinically I was fine- a competent doctor, but inside I was wildly panicking, anxiety spirally, mind becoming foggy, hiding in a cupboard and crying. How supervisors deal with disclosures shapes what happens next. In my case, I felt like a failure. There was clearly an expectation that I should just crack on. Everyone else was pulling their weight, helping to cover the gaps. I was ashamed of myself. 

As my mental health continued to deteriorate, I found work more and more overwhelming. Resentment, cynicism, exhaustion, anxiety, low mood… I remember a conversation with my supervisor. He suggested escalating things to the school of paediatrics in order to get more support. He explained that this meant using the phrase “trainee in difficulty”- a big red button that, when pressed, cascaded a series of actions, as though somehow I was failing. Overcome with shame, my career had been reduced to three words. From winning prizes and awards, publications and presentations to this- I felt judged. Lumped in the same category as those struggling to pass exams, going through disciplinary hearings- a phrase that in no way acknowledged the effects that the job was having on my mental health. My supervisor was kind. He explained that the words would get people to listen but in my mind it sounds like I presented a risk. On paper, I was safe. In fact on paper I was excellent. 

How we refer to the body of doctors who are burnt out or mentally unwell is important. We need to reflect on the stigma that phrases like “trainee in difficulty” continue to perpetuate because these individuals aren’t ‘failing’- they are unwell. They are a group in their own right “trainees at risk of burnout” “trainees suffering from burnout” or simply “I have a trainee for whom I want to arrange additional support”. We need to remove the shame associated with being unwell.

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Secondly, how supervisors communicate with trainees is key. By this I mean the importance of creating a relationship that promotes disclosures. In the same way that we do that with our patients, we need to do this with our staff. Get to know them. For me, it wasn’t medicine per se that I was finding hard, instead it was juggling everything that was happening outside of work with the pressures and commitments of the job. By chatting over coffee, by sharing your own stories, you are valuing your trainee, seeing them as more than just a service provider or training number. Meeting specifically for a catch up without the pressure of filling in any forms was also beneficial to me: “I just wanted to  check in and find out how you were getting on and if there’s anything I can do to make things easier for you”. Forms can be filled in separately.

Advocating

Whilst I was unwell, I struggled to work out what I needed. I found that repeatedly telling my story was exhausting and exposing. At one point my supervisor asked if I wanted him to send an email explaining the situation on my behalf. It was such a relief. He took on the role of advocate- he liaised with my TPD, with the head of school, copying me into emails so I still felt part of the process. I found this hugely valuable at a time when my head simply couldn’t manage any more. 

Another supervisor I had after I returned from sick leave was fantastic at this. She took charge and was able to make suggestions on my behalf. She knew the system and what was on offer well enough to signpost and support me but was not afraid to admit when she needed to go and look something up.

Supporting a trainee off sick

After I was signed off sick, my supervisor gave me some space for a a couple of weeks. He then dropped me a text, not to ask me when I’d be back, but instead checking in. It meant a lot. I didn’t feel under pressure to return. Instead I felt seen. I was off work for eleven months in total. During that time we met face to face a couple of times, mainly towards the end as I was beginning to think about returning. It can be useful to set out some rules- to ask people whether they want to be contacted whilst off sick. That said, I’d have been incapable of telling youwhat I wanted. 

Navigating the system when you’re unwell is not easy. When your brain is foggy and simply getting out of bed is exhausting, the more other people can lighten the mental load the better: finding out who to send sick notes to, how to formalise leave, any additional deanery or charity based services available etc. I would have really benefited from sitting down with someone and retrieving the information together, writing it down and taking the information away. This kind of thing makes it so much more likely that someone will actually access that help. 

Supervisor or friend

Often we work with our supervisors. Banter, laughter, friendship… However when trainees become unwell, it’s important they have someone there for THEM. At that point, your personal issues need to be put aside and meetings need to be about them. This is not the time to share the struggles that you are going through- it reverses the dynamic- the trainee becomes an empathic listener at a time when they have no energy for that. Nothing left to give.

Other people

As well as supervisors, I had an incredible mentor. She was external to my specialty with no vested interest and had a huge amount of experience supporting trainees. Having someone independent was brilliant. She was my sounding board, listening and guiding rather than fixing. She advocated for me when I couldn’t and throughout it all, she believed in me. 

I’m no expert in all this and have had no training in clinical or educational supervision. These are my thoughts alone, ones that come from personal experience and that I hope can be of some help.