Sue Kilminster

Effective supervision in clinical practice settings: a literature review

Clinical supervision has a vital role in postgraduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large‐scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective.

AMEE guide no. 27: effective educational and clinical supervision.

Background: This guide reviews what is known about educational and clinical supervision practice through a literature review and a questionnaire survey. It identifies the need for a definition and for explicit guidelines on supervision. There is strong evidence that, whilst supervision is considered to be both important and effective, practice is highly variable. In some cases, there is inadequate coverage and frequency of supervision activities. There is particular concern about lack of supervision for emergency and ‘out of hours work’, failure to formally address under-performance, lack of commitment to supervision and finding sufficient time for supervision. There is a need for an effective system to address both poor performance and inadequate supervision. Supervision is defined, in this guide as: ‘The provision of guidance and feedback on matters of personal, professional and educational development in the context of a trainees experience of providing safe and appropriate patient care.’ A framework for effective supervision is provided: (1) Effective supervision should be offered in context; supervisors must be aware of local postgraduate training bodies’ and institutions’ requirements; (2) Direct supervision with trainee and supervisor working together and observing each other positively affects patient outcome and trainee development; (3) Constructive feedback is essential and should be frequent; (4) Supervision should be structured and there should be regular timetabled meetings. The content of supervision meetings should be agreed and learning objectives determined at the beginning of the supervisory relationship. Supervision contracts can be useful tools and should include detail regarding frequency, duration and content of supervision; appraisal and assessment; learning objectives and any specific requirements; (5) Supervision should include clinical management; teaching and research; management and administration; pastoral care; interpersonal skills; personal development; reflection; (6) The quality of the supervisory relationship strongly affects the effectiveness of supervision. Specific aspects include continuity over time in the supervisory relationship, that the supervisees control the product of supervision (there is some suggestion that supervision is only effective when this is the case) and that there is some reflection by both participants. The relationship is partly influenced by the supervisors commitment to teaching as well as both the attitudes and commitment of supervisor and trainee; (7) Training for supervisors needs to include some of the following: understanding teaching; assessment; counselling skills; appraisal; feedback; careers advice; interpersonal skills. Supervisors (and trainees) need to understand that: (1) helpful supervisory behaviours include giving direct guidance on clinical work, linking theory and practice, engaging in joint problem-solving and offering feedback, reassurance and providing role models; (2) ineffective supervisory behaviours include rigidity; low empathy; failure to offer support; failure to follow supervisees’ concerns; not teaching; being indirect and intolerant and emphasizing evaluation and negative aspects; (3) in addition to supervisory skills, effective supervisors need to have good interpersonal skills, good teaching skills and be clinically competent and knowledgeable.

Strategic Planning in Medical Education: Enhancing the Learning Environment for Students in Clinical Settings

The 1999 Cambridge Conference was held in Northern Queensland, Australia, on the theme of clinical teaching and learning. It provided an opportunity for groups of academic medical educators to consider some of the challenges posed by recent changes to health care delivery and medical education across a number of countries.

Women in medicine − is there a problem? A literature review of the changing gender composition, structures and occupational cultures in medicine

Background  Internationally, there are increasing numbers of women entering medicine. Although all countries have different health care systems and social contexts, all still show horizontal (women concentrated in certain areas of work) and vertical (women under represented at higher levels of the professions) segregation. There is much discussion and competing explanations about the implications of the increasing numbers of women in the medical profession.

Preparedness is not enough: understanding transitions as critically intensive learning periods

Medical Education 2011: 45: 1006–1015

What is effective supervision and how does it happen? A critical incident study

Objectives  To identify the key features of supervision from the perspectives of educational supervisors and specialist registrars.

Learning for real life: patient-focused interprofessional workshops offer added value

Objectives  This paper reports relevant findings of a pilot interprofessional education (IPE) project in the Schools of Medicine and Healthcare Studies at the University of Leeds. The purpose of the paper is to make a contribution towards answering 2 questions of fundamental importance to the development of IPE. Is there a demonstrable value to learning together? What types of IPE, under what circumstances, produce what type of outcomes?

Clinical supervision of SpRs: where does it happen, when does it happen and is it effective?

Objectives  To establish what supervisory methods are used in postgraduate medical education and to determine how effective, particularly in relation to patient care, these methods are perceived to be.

A Framework for Effective Training for Supervisors.

The purpose of this paper is to identify the key theoretical and empirical considerations that should underpin effective training for supervisors. Decisions about the content of training courses are complex because there is no appropriate model of supervision in medicine. This paper argues that, in the absence of an explanatory model, effective training for supervisors should be based on existing relevant understandings about learning processes and models of supervision, together with relevant empirical data. It explores some useful models of supervision, considers helpful aspects of theories about learning from experience and identifies some relevant empirical findings to identify some key theoretical and empirical considerations that should underpin effective training for supervisors. This paper offers a framework, derived from both empirical and theoretical work, to guide the content of effective supervision training courses. It does not prescribe structure or organization of training but suggests a basis for devising specific courses for response to local needs.

Teaching in the new NHS: the specialised ward based teacher

To evaluate the effects of introducing specialised ward based teachers (WBTs) who had a broad remit to improve third year medical undergraduates’ clinical experience.