Judgement, capabilities and practice: how surgical supervisors make judgements about trainee readiness to practise

Introduction In the UK, acting as clinical supervisors, consultant surgeons make judgements about trainee performance every day. Their professional judgements provide the primary mechanism for trainee progression through and completion of surgical training, and have a consequent impact on patient safety. The exact manner in which surgical supervisors make judgements, however, has long been unclear. Correspondingly, the aim of this study was to determine whether there were particular patterns of judgement used and how far these judgements were influenced by factors in the training environment. Methods This was a qualitative study, using in-depth, semi-structured interviews with six consultant clinical supervisors from different specialties, regions and backgrounds. The interviews were audio-recorded, transcribed, coded and thematically analysed, allowing theoretical concepts and ideas to emerge. Results From the analysis, a universal picture of judgement began to form. It became apparent that all the participants used a similar approach to making decisions about the amount of trust that could be granted to trainees carrying out clinical work. Their approach focused on four categories of trainee capability: competence, decision making, administration and relationships. Conclusions The identification of a latent pattern of supervisor judgement lends support to the notion that professional judgement in workplace assessment is based on the supervisor’s global sense of trainee capability and that it is a result of the trainee–trainer relationship. This study has resulted in the creation of an explicit framework that reflects this pattern of judgement, which could serve as a useful reflective tool for both supervisors and trainees.