Table 1

 Examples of effective and ineffective supervision

ExampleHigher traineesSupervising consultants
IPPV, intermittent positive pressure ventilation;CPAP, continuous positive airway pressure; DTs, delirium tremens. The examples shown are typical illustrations of the responses received.
Effective supervision
    Key practical skillSupervised paediatric intubationNeedle cricothyrotomy
Insertion of bilateral chest drainsCardiac pacing
    Key diagnosisWeil’s diseaseMeningococcal septicaemia
Guillain-Barré syndromeAddisonian crisis
    Key management stepInitial therapy for febrile neutropeniaInitiation of core rewarming
Establishment of IPPVPreparing for emergency delivery
    Complex referral supportPolytrauma: burns and facial fracturesRhabdomyolysis: patient wishing to self discharge
Elderly care: burns and domestic abusePaediatric wrist fracture: domestic abuse
Ineffective supervision
    Key practical skillTrauma intubationReduction of dislocated upper limb joint
    Key diagnosisPaediatric rashSignificance of an arrhythmia
    Key management stepInitiation of CPAPInitiation of external pacing
    Complex referral supportSocial issues: alcoholic mother with DTs and with children in attendanceArguing with medical registrar in resuscitation room (despite counselling) about a referral