The transition from trainee to specialist is a process of evolution from dependence to independence in clinical practice. All patients are entitled to receive care under the overall supervision of a specialist, but the requirements of training means that some of that care must be delivered by trainees. It is the responsibility of the specialist to determine the level of supervision required by a trainee in relation to the needs of the patients. Every doctor must therefore be prepared and able to oversee the work of less experienced colleagues. This means that trainees must themselves become competent at supervising and delegating safely. It is the responsibility of specialists and managers to ensure that patients are cared for in a safe environment. Trainees should therefore seek advice and assistance as early as possible whenever they are concerned about patient management, and at all stages of training a supervisor must attend whenever a trainee requests them to do so.

Supervision may be direct or indirect¹:

Direct: the supervisor is working directly with the trainee, or can be present within seconds of being called.

• Indirect: the supervisor is either: Local: on the same geographical site, is immediately available for advice, and is able to be with the trainee within 10 minutes of being called.
• Remote: rapidly available for advice but is off the hospital site and/or separated from the trainee by more than 10 minutes. The maximum time or distance separation permitted will depend upon the combination of the trainee's grade, the nature of the clinical work, local geography and traffic conditions. Local guidelines should be followed.

From a training perspective, the term 'supervisor' should be taken to refer to the person with the most appropriate skills for that task and environment; it does not imply ownership by a particular speciality. In general terms however, we expect that supervision will be provided by an intensive care specialist with due attention to multidisciplinary practice.

Assessment & level of expertise:

There are three levels of expertise at which competencies may be acquired. Unless other wise indicated, competencies should be performed at the level of independent practice, which may include the capacity to supervise others or direct a team where appropriate. This level implies indirect supervision of the trainee. Where we refer to a competence being performed 'under supervision', this implies direct supervision. The CoBaTrICE competencies indicate the minimum standard required by the end of specialist training; in many instances a lower level of supervision (i.e. higher levels of independence) are evidently possible, and appropriate.


During work-place based observational assessments, trainees should be observed delivering patient care with the relevant level of supervision either provided by the assessor or by another suitable professional. During an assessment the trainee should be allowed to proceed as far as possible without interference, but patient safety must be maintained at all times.

Assessment of a trainee delegating to and supervising a junior colleague provides a dual opportunity for assessment; it provides insights into the interaction between the junior trainee and supervising trainee, as well as assessment of the patient care delegated / delivered by each trainee.

The CoBaTrICE competencies indicate the minimum standard required by the end of specialist training; in many instances a lower level of supervision (i.e. higher levels of independence) are evidently possible, and appropriate.

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¹ The CCST in Anaesthesia I: General principles Section 5.2. Royal College of Anaesthetists. Edition 2: April 2003.