The Three Cs Framework

When something feels off, ask: Is this a Competence issue (can't do it), a Capacity issue (could do it but something's in the way), or a Character/Volition issue (won't do it)? Your intervention changes significantly depending on the answer.

Universal Red Flags — Across All Domains

• The "disappearing resident" — hard to find, avoids supervision, low visibility
• The "double standard" — performs well with one supervisor but not others (or vice versa)
• The "good news only" reporter — selectively shares information with supervisors
• Emotional dysregulation that impacts care or team functioning
• Physical signs of burnout, distress, or impairment
• Repeated near-miss events or patient safety concerns
• Resistance to supervision or feedback — any feedback, not just negative
• A gut feeling from multiple preceptors that "something is off"

Trust the Instinct

If you find yourself rehearsing what you'll say to a patient if the resident makes an error, or if you're checking their work more than you check others' — trust that signal. That's clinical intuition about risk, and it deserves to be acted on.

Before You Conclude There's a Problem

• Have you observed them directly, or are you relying entirely on secondhand reports?
• Is the concern consistent across supervisors and settings, or context-specific?
• Have you ruled out systemic contributors — toxic team dynamics, unsafe learning environment?
• Has the learner been made explicitly aware of the concern and given a chance to respond?

The Assessment Conversation

• "I want to check in with you about how things are going. What's feeling hard right now?"
• "Is there anything going on outside of training that's affecting your capacity?"
• "When you think about the feedback you've received, what resonates? What doesn't?"
• "What do you think you need most right now?"

The Five Elements of Any Good Plan

• Specific Concern: What exactly was observed? Behaviours, not labels.
• Goal: What does success look like? Observable and measurable.
• Strategies: What will the learner AND supervisor do? Both have responsibilities.
• Timeline & Check-ins: When will you review progress? How often?
• Consequences: What happens if goals are met — or are not? State this clearly and compassionately.

Know Your Levels

Principles of Defensible Documentation

• Behaviours, not labels: "Did not document the encounter" not "lazy"
• Specific and dated: "On [date], during [encounter], I observed..."
• Pattern vs. isolated incident: Note whether this is a pattern or a single event
• What was done: Document that feedback was given and what was said
• Timely: Same day or within 24 hours while memory is fresh
• Shared with the learner: They should not be surprised by what's in their file

Before You Walk In

• Know your goal: is this informational, developmental, or consequential?
• Have your documentation ready — specific dates, events, and observations
• Choose a private, neutral setting with adequate time (no pagers, no interruptions)
• Consider whether to have a third person present (PD, program admin)

Structure of the Conversation

• Open: "I want to talk about something important. Is now okay, or do you need a moment?"
• State: Share what you observed — specifically and behaviourally, not as a label
• Invite: "Help me understand your perspective."
• Clarify: What needs to change and by when
• Close: Document the conversation — same day, in your own words

Why Learners Resist Feedback

• Protective: Feedback feels threatening to identity or self-worth
• Discordant: Feedback doesn't match their internal experience of the event
• Trust deficit: They don't believe the supervisor has observed them fairly
• Inconsistent messages: They've received conflicting feedback from multiple supervisors
• Wellness: Capacity to receive and process is reduced by stress, fatigue, or distress

What You Can Do

• Name the pattern, not just the incident: "I've noticed that when we discuss [X], the conversation tends to [Y]."
• Separate the observation from the interpretation — stay grounded in what you saw
• Invite their perspective genuinely before adding yours
• Ask: "What would it take for this feedback to feel fair to you?"
• Document the resistance itself — it becomes part of the clinical picture

Common Biases in Assessment

• Affinity bias: Rating learners higher when they remind us of ourselves
• Halo/horn effect: One strong or weak impression colours all subsequent ratings
• Attribution bias: Attributing struggles to character in some learners, to circumstance in others
• Communication style bias: Penalizing assertiveness or directness differently based on gender or culture
• Accent or fluency bias: Conflating language fluency with clinical competence

Questions to Ask Yourself

• "Would I describe this behaviour the same way if it came from a different learner?"
• "Am I responding to what I observed, or to my expectations of this learner?"
• "Have I given this learner the same opportunities to demonstrate competence as others?"
• "Is there a pattern of concerns from multiple supervisors — or is this isolated to certain contexts?"

Core Principles

• Safety: Physical and psychological safety in the learning environment
• Trustworthiness: Consistent, transparent, and boundaried relationships
• Choice: Offering options where possible — not control
• Collaboration: Working with the learner, not on them
• Empowerment: Identifying and building on strengths throughout the process

Cultural Humility vs. Cultural Competence

Cultural competence implies mastery — a checklist of facts about groups. Cultural humility is an ongoing orientation: remaining curious, acknowledging power dynamics, and recognizing that you will never fully understand another person's cultural experience. In supervision, this means asking rather than assuming.

In Practice

• Examine your own cultural assumptions before drawing conclusions about a learner's behaviour
• Ask open questions about the learner's experience rather than filling in the gaps yourself
• Seek diverse supervisory perspectives before formalizing any concern
• Acknowledge the power differential explicitly — and work to minimize it