Table 1 On-Call Core Supervisory Tasks, Practices and Evidence from Literature Synthesis

1. Overseeing Ongoing Patient Care.

 Supervisors improve patient safety [32,33,34,35,36] by: identifying missed diagnoses, providing support during clinical uncertainty and ensuring trainees are involved in changes in the management plan [14].

Supervisory Practices

 1. Complete full patient evaluation (SMR takes complete history and performs physical exam)

 2. Conduct focused patient evaluation (SMR takes a brief history and may or may not examine patient)^a

 3. Review prior clinical notes and investigations

 4. Read around patient’s presentations as needed

 5. Assign patient to a junior based on competency level

 6. Support juniors with monitoring and managing their patients in the ER^a

 7. Follow up results of investigations^a

 8. Request support from peers during clinical uncertainty^a

Identified Detrimental Practices

 9. No patient evaluation completed (SMR only ensures that the patient is stable)

 10. Independently monitor and manage admitted patients in the ER

2. Briefing

 Supervisors brief to set expectations for patient assessments [37] and to build collaborative plans [38].

Supervisory Practices

 1. Guide juniors on key areas to focus assessment

 2. Direct juniors on what to read before patient assessment

 3. Guide juniors on information to obtain from prior clinic notes

 4. Set expectations for the junior to complete their assessment & plan prior to case review

Identified Detrimental Practices

 5. No briefing, assign patient only

3. Case Review

 Supervisor’s feedback on the organisation and content of a presentation supports accurate problem lists [39] and appropriate management plans [40, 41].

Supervisory Practices

 1. Review case presentation in the conference room or by the bed-side^a

 2. Provide feedback on organisation of case presentation & required contextual adjustments ^a

 3. Demonstrate pertinent exam findings^a

 4. Probe the junior around knowledge gaps around their assessment & plan^a

 5. Coach and support the junior in developing their own problem list & plan^a

Identified Detrimental Practices

 6. Direct the junior on content of the problem list & plan (no coaching or probing of knowledge gaps)

4. Documentation

 Supervisors enhance the team’s ability to provide comprehensive patient care by ensuring that documentation is complete and consistent [42, 43].

Supervisory Practices

 Admission Note

  1. Explicitly direct the junior on where and what to amend in the admission note^a

  2. Observe junior amending the admission note

 Identified Detrimental Practices

  3.Not asking the junior to amend the admission note

 SMR Note

  1. SMR note contains the full problem list and plan^a

  2. SMR does not write a note but ensures that the admission note contains the full problem list & plan^a

 Identified Detrimental Practices

  3. SMR note contains part of the problem list and plan

  4. SMR does not write a note and does not ensure that amendments are made to the admission note

 Patient Care Orders

  1.Reconcile patient care orders with the full problem list and plan^a

 Identified Detrimental Practices

  2.Orders are not reconciled with the full problem list and plan

5. Preparing for Handover

 Supervisors can ensure a safe handover by: prioritising issues for handover [10,11,12], flagging pending investigations [44], and acknowledging problems that could not be fully explored during on-call [10].

Supervisory Practices

 1. Prioritise issues on problem list with junior^a

 2. Highlight patient care issues that could not be addressed and need further follow-up by the team^a

 3. Flag for junior which investigations are still pending^a

 4. Inform the junior about the attending physician’s preferred case presentation style

Identified Detrimental Practices

 5. No handover preparation