What are Supervisor Perceptions of Clinical Placement Sign-off Forms for Medical Students?

Background: Medical students typically must pass an end-of-placement supervisor evaluation for each clinical rotation to progress to the next level of the course. However, evidence suggests these evaluations show weak correlation with other reliable educational assessments. This study aims to determine supervisor perceptions of the sign-off process to inform possible improvements. Methods: Clinical supervisors were recruited to provide feedback on their perceptions of the end-of-placement sign-off process. Responses were received from 59 of the 161 (36.6%) Year 3 clinical placement supervisors in hospitals and General Practitioner (GP) practices affiliated with Imperial College School of Medicine. A mixed methods approach was used, combining statistical and thematic analyses. Results: Perceived positives of the single supervisor sign-off model included accountability, feasibility and continuity of supervision. Reported negatives were inflexibility, limited contact time, psychometric concerns and altered student learning behaviours with different staff. GP supervisors reported significantly more contact time with students than hospital-based supervisors (p<0.001), and were more likely to feel they had adequate supervision time to make informed ratings of student knowledge (p<0.001) and skills (p<0.001). Significantly more supervisors in Medicine (62%) and Surgery (64%) desired a change in the single supervisor sign-off model than GP supervisors (27%) (p=0.04). Conclusion: This study provides novel and rich qualitative data on supervisor perceptions of the clinical sign-off process which have implications for undergraduate medical education curriculum reform. Hospital-based supervisors were less positive towards the sign-off process, likely due to modern working practices of shared patient loads, shorter rotations, and reduced contact time with students. Different sign-off requirements should be considered for GP supervisors versus those in hospital settings; possible alterations include multi-source feedback, embedded in-placement assessment, optimisation of the sign-off form, and additional formalised supervision time in supervisors' work schedules.