Mastering RCEM SLO 9 "Support, supervise and educate": A Practical Guide

Executive Summary

Specialist Learning Outcome (SLO) 9, "Support, supervise and educate," is a fundamental component of the 2021 Royal College of Emergency Medicine (RCEM) curriculum, marking the trainee's transition from a pure clinician to an integrated leader and educator [1]. Achieving competence in SLO 9 requires demonstrating the ability to safely delegate tasks, provide constructive feedback, facilitate learning within the clinical environment, and support the wellbeing of the multidisciplinary team. Excellence in this domain involves progressing to educational leadership, evidenced by activities such as evaluating teaching, championing multi-professional education, leading debriefs, and creating educational resources.

The core of SLO 9 is structured around three pillars: Support (pastoral care and team wellbeing), Supervise (maintaining patient safety through effective clinical oversight and delegation), and Educate (formal and informal teaching). Evidence for these competencies should be collected proactively and integrated into daily clinical shifts rather than waiting for formal teaching opportunities. Key strategies include using ACATs to assess leadership, conducting brief "sniper" teaching observations on the shop floor, and reflecting on the delivery of feedback. Trainees must meet specific, escalating expectations as they progress from ACCS to Higher Specialty Training (HST), with a focus shifting from basic teaching skills to leading the department and formal educational leadership.

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1. Understanding the Three Pillars of SLO 9

SLO 9 is a core professional role for any doctor, encompassing the education of patients, future doctors, and allied health professionals. It is built upon three distinct but interconnected pillars that define the responsibilities of a senior clinician.

A. Support (Pastoral & Wellbeing)

Core Task: Ensuring the physical and psychological safety of the team. This involves creating an environment of psychological safety where learners feel empowered to ask questions and share uncertainties, which is crucial for patient safety and deep learning.
Key Actions:

Recognising signs of burnout or struggle in colleagues.
Providing mentorship to junior doctors or medical students.
Leading "Hot Debriefs" following critical incidents using structured protocols like STOP5 [2], TALK [3] or TAKE STOCK.

B. Supervise (Clinical Oversight)

Core Task: Maintaining patient safety while enabling junior colleagues to develop their clinical skills and resilience. This includes allowing trainees exposure to sick patients in an assisting capacity to build experience in stressful situations.
Key Actions:

Effective Delegation: Matching clinical tasks to the junior's specific capabilities.
Departmental Management: "Running the board" to manage patient flow while remaining accessible for advice and support.
Remote Review: Diligently checking investigations like ECGs and X-rays that have been provisionally signed off by junior staff.

C. Educate (Teaching & Training)

Core Task: Facilitating learning in both formal and informal clinical settings. Every interaction with a learner presents a brief opportunity for a teaching encounter.
Key Actions:

Shop-Floor Teaching: Capitalising on the "teachable moment" during clinical work.
Formal Teaching: Delivering didactic lectures, leading simulation sessions, or contributing to departmental teaching rotas.
Assessment: For HST trainees, completing Workplace-Based Assessments (WPBAs) for junior colleagues.

2. Requirements and Progression Through Training

Competency in SLO 9 is developed progressively. Trainees must plan to develop their style and competencies across a range of scenarios to meet the specific entrustment decisions required at the end of each training stage.

Formative Assessment and Evidence

Evidence to inform decisions at each stage of training is gathered through a variety of assessments and reports:

Multi-Consultant Report (MCR)
Multi-Source Feedback (MSF)
Teaching Observation (TO)
Supervised Teaching and Training (STAT)
Acute Care Assessment Tool (ACAT)
Extended Supervised Learning Event (ESLE)
Relevant training courses
Educational Supervisor’s Report (ESR)
Reflection on challenging encounters and feedback received

ACCS (Core and Intermediate Training)

Focus: Developing foundational teaching skills and supervising junior learners like medical students and Emergency Nurse Practitioners (ENPs).
End of Core Training Capabilities:

Understand and identify key non-technical skills in their own practice and that of peers.
Deliver effective feedback to junior colleagues or students during the supervision of simple clinical skills (e.g., phlebotomy).

End of Intermediate Training Capabilities:

Demonstrate a comprehensive understanding of the impact of non-technical skills and human factors on patient safety.
Understand the role of debriefing and have experience facilitating a debrief in simulation.
Be ready to supervise junior doctors, identifying gaps in their knowledge, performance, and competence.
Provide evidence of delivering teaching sessions on clinical topics to peers, supported by feedback and reflection.

Suggested Evidence: TO2 (Teaching Observation), reflections on feedback delivery.

HST (Higher Specialty Training)

Focus: Leading the clinical department, formally supervising junior doctors, and demonstrating educational leadership.
End of HST Capabilities:

Lead the clinical team and manage the departmental workload effectively.
Supervise a range of practitioners, including F2s, ACCS trainees, and ACPs.
Conduct WPBAs for junior trainees.
Develop confidence in delivering constructive feedback in formal settings like ALS/ATLS/APLS courses.
Provide detailed, specific, and constructive feedback to juniors on leadership and non-technical skills (e.g., within an ESLE).
Deliver teaching sessions on complex topics such as management or leadership.

Suggested Evidence: ACAT (with a focus on leadership), multiple TO2s, ESLE, evidence of contributions to departmental teaching rotas.

Summary Checklist for ARCP

Requirement	ACCS	HST
Teaching Observation (TO2)	Min 1 (Rec 2)	Min 2
Feedback Methodology	Reflected upon	Demonstrated
Supervision Evidence	Medical Students	Juniors / Team
Debriefing	Participant	Leader
Faculty Statement	Supported	Independent

3. Practical Strategies for Evidencing Competence

Evidence collection for SLO 9 should be integrated into daily shifts to ensure a rich and varied portfolio.

The "Shop Floor" ACAT: Use the ACAT not just for clinical cases, but to demonstrate leadership. Ask a consultant to observe a period of running a clinical area, focusing on delegation strategies, supervision of junior colleagues, and clinical oversight (e.g., identifying a missed diagnosis). This can be tagged with "Assessment of learning needs" and "Supervision."
The "Sniper" TO2: A Teaching Observation does not require a one-hour lecture. A 10-minute, high-impact teaching interaction on the shop floor—such as demonstrating a wrist reduction or interpreting a complex blood gas—can be observed by a senior colleague and recorded as a TO2. This is often valued more highly than formal classroom teaching.
The "Feedback" Reflection: A powerful piece of evidence is a written reflection on delivering difficult feedback. Document the context (e.g., a junior colleague's persistent lateness or a missed diagnosis), the method used (e.g., Pendleton's rules or Agenda-Led Outcome-Based Analysis), and the outcome of the conversation.
Leverage RCEMLearning: Utilise RCEM Learning content relevant to SLO 9. Completing modules, SBAs, or SAQs automatically provides a certificate of completion in the CPD Diary. All activities should be documented with a reflection, which is highly valued for both training and revalidation.

4. Moving from Competent to Excellent

To achieve the highest scores at the Faculty Educational Governance (FEG) statement, trainees must demonstrate educational leadership.

Close the Loop on Teaching: Do not just deliver a teaching session. Actively collect feedback from participants, summarise the findings, and write a reflection detailing how the feedback will inform future teaching style. Upload this entire bundle as a single, powerful piece of evidence.
Champion Multi-Professional Education: Emergency medicine is a team-based specialty. Organise and lead inter-professional simulation sessions involving nurses, paramedics, and other team members. Evidence the ability to facilitate a debrief that successfully flattens hierarchical gradients.
Become a "Hot Debrief" Leader: Proactively initiate and lead debriefs after major clinical events like cardiac arrests or traumas. Use a structured tool like the TAKE STOCK or TALK framework [3] and evidence this through a reflection or a Case-Based Discussion (CBD) focused on team management rather than pure clinical medicine.
Create Enduring Educational Resources: Move from being a consumer of guidelines to a creator. Develop a "One Page Guide," cognitive aid, or departmental guide (e.g., "How to set up the NIV machine"). This demonstrates a sophisticated understanding of systems-based learning and contributes lasting value to the department.

5. Key Frameworks and Common Pitfalls

The SLO 9 Toolkit: Useful Frameworks

For Feedback:

Pendleton’s Rules [4]: A simple structure asking "What went well?" followed by "What could be done differently?"
SET-GO [6]: A more detailed model: What was Seen, what was Elicited, what are your Thoughts, what is the Goal, and what do you Offer.

For Procedural Teaching:

Peyton’s 4-Step Approach [7]: Ideal for skills training: 1. Demonstration, 2. Deconstruction, 3. Comprehension, 4. Execution.
The OASIS framework mandates simulation preparation at critical transitional stages (see achieving SLO 6 briefing).

For Supervision:

Kennedy’s Framework [8]: Differentiates between "Clinical Oversight" and "Clinical Supervision."

For Debriefing:

TAKE STOCK: A model for hot debrief and identifying QI themes (see post on CRM)
STOP5 [2]: A model for hot debriefs after resuscitation cases.
TALK [3]: A simple, structured tool for clinical debriefing.

Common Pitfalls to Avoid

The "Imposter" Supervisor: Feeling insufficiently senior to intervene when a junior colleague is struggling.

Solution: Reflect on and practice "Graded Assertiveness" to ensure patient safety is maintained.

The "Dump" Delegate: Assigning tasks to juniors without explaining the rationale or identifying the learning objective.

Solution: Use the "What if?" questioning technique to check understanding and frame the task as a learning opportunity.

Ignoring the Environment: Attempting to teach complex topics when the department is unsafe or overcrowded.

Solution: Demonstrate maturity by evidencing the ability to correctly prioritise immediate service provision over teaching when the clinical situation demands it.

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References

Royal College of Emergency Medicine. RCEM Curriculum 2021: Specialty Learning Outcomes. London: RCEM; 2021.
Walker CA, et al. STOP5: a hot debrief model for resuscitation cases in the emergency department. Clin Exp Emerg Med. 2020;7(4):259-266.
Diaz-Navarro C, Leon-Castelao E, Hadfield A, Pierce S, Sorkin A. TALK: a simple tool for clinical debriefing. Journal of the Association of Anaesthetists of Great Britain and Ireland. 2014.
Pendleton D, Schofield T, Tate P, Havelock P. The Consultation: An Approach to Learning and Teaching. Oxford: Oxford University Press; 1984.
Kurtz S, Silverman J, Draper J. Teaching and Learning Communication Skills in Medicine. 2nd ed. Oxford: Radcliffe Publishing; 2005.
Chowdhury R, Kalu G. Learning to give feedback in medical education. The Obstetrician & Gynaecologist. 2004;6(4):243-247.
Peyton JWR. Teaching and Learning in Medical Practice. Rickmansworth: Manticore Europe Limited; 1998.
Kennedy I. Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995. London: The Stationery Office; 2001.