A systematic review of the factors that influence the quality and effectiveness of telesupervision for health professionals

Utilization of Telemedicine to Supervise Medical Students in the Post-Acute/Long-Term Care Setting

OBJECTIVES

Telemedicine has become a widely accepted alternative to face-to-face patient encounters. Although there have been several peer-reviewed journal articles on incorporating telemedicine into the medical school curriculum, particularly during the COVID-19 pandemic, assessments of the effectiveness of remote supervision of medical students have not been reported. This prospective cohort study of student subjects using observational survey data evaluated the efficacy of telemedicine as an educational resource by comparing learning outcomes between osteopathic medical students receiving direct (physically present) supervision with a group who received remote (telemedicine) supervision by clinical faculty within a post-acute/long-term care (PA/LTC) setting. Learning outcomes in the domains of patient rapport, attitudes, knowledge, and behavior were measured using standardized survey instruments.

DESIGN

Prospective cohort study of student subjects using observational survey data.

SETTING AND PARTICIPANTS

A total of 167 fourth-year osteopathic medical students at a teaching nursing home (TNH).

METHODS

A total of 167 fourth-year osteopathic medical students (OMS-4s) were randomly assigned face-to-face PA/LTC patient encounters at the TNH. The encounters were follow-up visits to residents of the TNH that were supervised by faculty geriatricians. Half were accompanied by the physician and the other half were supervised by the physician through telemedicine. Evaluation using validated survey instruments measured patient rapport, verbal communication, and physical examination skills as well as attitudes, knowledge, and behaviors of the student/subjects.

RESULTS

A nonparametric statistical analysis of 4 dependent variables measuring patient rapport, attitudes, knowledge and behavior showed no significant difference between the 2 teaching modalities.

CONCLUSIONS AND IMPLICATIONS

The results of this prospective cohort study indicate that telemedicine supervision is comparable (noninferior) to direct supervision of medical student trainees in a PA/LTC setting.

Empowerment of Lay Mental Health Workers and Junior Psychologists Online in a Task-Shared, Rural Setting in Kerala, India

BACKGROUND

Patients with severe mental health issues who live in isolated rural areas are difficult to reach and treat. Providing effective treatment is difficult because mental health problems are complex and require specialized knowledge from a range of professionals. Task-sharing with lay mental health workers (LMHWs) has potential but requires proper training and supervision to be effective. This article reports on the challenges and facilitators experienced in empowering LMHWs in their role, with the help of a technology supported supervision group. The study sought to understand the functioning of the Empowering Supervisory Group (ESG) in the context of junior psychologists and LMHWs in rural India, and investigate how they experienced it by exploring challenges, lessons and empowerment.

METHODS

Qualitative analysis of interviews with the 22 ESG participants and their supervisors.

RESULTS

A total of three discrete phases of supervision were identified where supervisors responded to the changing needs of the group. This began with building trust at a baseline level, tackling issues with competence and autonomy and finally experiencing meaning and impact through self-determination. The experience of empowerment even in an online setting was very beneficial given the challenges of working in rural areas.

CONCLUSION

Empowerment based supervision of LMHWs and junior psychologists online enables a level of engagement that positions them to engage in community mental health practices with greater independence and confidence.

Australian rural service learning student placements: a national survey

This preliminary national study is the first of its kind to investigate how service learning placements are implemented in real world settings in rural Australia and what factors enable or hinder their implementation. An anonymous survey was distributed to 17 University Departments of Rural Health (UDRH) in Australia. Numerical data were analysed descriptively. Textual data were analysed using a hybrid content analysis approach. Thirty seven respondents provided data representing 12 UDRHs. Responding UDRHs reported facilitating service learning programs, with experience in this context ranging from 3 months to 21 years. Service learning placements predominantly occurred in schools and aged care facilities. Occupational therapy, physiotherapy, and speech pathology were the most frequently involved professions in service learning. Enablers and barriers identified were categorised into: People, Partnerships, and Place and Space. This national-scale study provides a springboard for more in-depth investigation and implementation research focused on development of a conceptual model to support service learning across rural and remote Australia.

Telesupervision in genetic counseling education during COVID-19 and beyond

The COVID-19 pandemic led healthcare organizations to pivot to telemedicine, precipitating the shift to telesupervision, defined as supervision over video-conferencing platforms and telephone, for genetic counseling students. This study aimed to (1) characterize the impact of the COVID-19 pandemic on genetic counseling supervision, (2) ascertain genetic counseling supervisor experiences with telesupervision, and (3) examine the association between years of genetic counseling experience and preferences related to supervision modality. Certified genetic counselors were recruited through the National Society of Genetic Counselors (NSGC), Pennsylvania Association of Genetic Counselors (PAGC), and Association of Genetic Counseling Program Directors (AGCPD) listservs and by purposive sampling via emails to Genetic Counseling Program Directors in program-rich regions. An investigator-created survey was administered online to elicit descriptions of supervision during the pandemic, including modifications to rotations, changes to the number of students supervised, and mode of supervision preference. The survey was completed by 122 genetic counselors. The 54-question survey included multiple-choice, ranking, and open-ended questions. The majority (95.9%) of the participants were female, with an average age of 32 years. Most (86%) of participants reported changes in their supervision practices due to COVID-19, including sole use of telesupervision (54.4%), decreases in rotation lengths (25.4%), and delays in rotation start dates (24.6%). Interestingly, 19.3% (22/114) supervised more students than before the pandemic, and 18.4% (21/114) of participants supervised fewer students. Approximately two thirds (67.5%) of supervisors preferred supervising students in-person, while 2.6% preferred telesupervision, and 29.8% had no preference. Those who preferred to supervise in-person had fewer years of experience than those who had no preference (median = 4 years vs. median = 7 years respectively, Wilcoxonp-value  = 0.0418, effect size rpb  = 0.19, small). Given the persistence of telemedicine beyond the pandemic, telesupervision may be necessary to train genetic counseling students. However, additional research is needed to determine the effectiveness of telesupervision in facilitating student skill development and attainment of the Accreditation Council for Genetic Counseling (ACGC) Practice-Based Competencies (PBCs).

Characteristics of perceived effective telesupervision practices: A case study of supervisees and supervisors

INTRODUCTION

Many healthcare workers have switched from face-to-face clinical supervision to telesupervision since the onset of the COVID-19 pandemic. Given the rise in prevalence of telesupervision and continuing remote working arrangements, telesupervision is no longer only limited to rural areas. As this remains an under-investigated area, this study aimed to explore supervisor and supervisee first hand experiences of effective telesupervision.

METHODS

A case study approach combining in-depth interviews of supervisors and supervisees, and document analysis of supervision documentation was used. De-identified interview data were analysed through a reflective thematic analysis approach.

RESULTS

Three supervisor-supervisee pairs from occupational therapy and physiotherapy provided data. Data analysis resulted in the development of four themes: Benefits vs limitations and risks, not often a solo endeavour, importance of face-to-face contact, and characteristics of effective telesupervision.

DISCUSSION

Findings of this study have confirmed that telesupervision is suited to supervisees and supervisors with specific characteristics, who can navigate the risks and limitations of this mode of clinical supervision. Healthcare organisations can ensure availability of evidence-informed training on effective telesupervision practices, as well as investigate the role of blended supervision models to mitigate some risks of telesupervision. Further studies could investigate the effectiveness of utilising additional professional support strategies that complement telesupervision, including in nursing and medicine, and ineffective telesupervision practices.

Cultivating support during COVID-19 through clinical supervision: A discussion article

AIM

This article aims to discuss how clinical supervision is an important approach in supporting frontline nurses and students during and post COVID-19 through the lens of the nursing metaparadigms.

DESIGN

Discussion article.

METHODS

Discourse of the literature considering the importance of working collaboratively with healthcare and educational organisations in operationalising clinical supervision.

RESULTS

The evidence base supporting clinical supervision as an effective support strategy for nurses exists, however, its implementation and practice has become sporadic. A resurgence is required to support student's and nurse's during this pandemic. It is timely for nurse educators to creatively engage with clinical partners in supporting clinical supervision to enhance both nurses and students pandemic practice experiences. Clinical supervision is proposed as one strategy to support and guide both nurses and students to develop, strengthen and challenge the effectiveness of their care during COVID-19.

Comparing Presence and Absence of Initial In-Person Contact and Written Feedback in RE&CBT E-Supervision

This pilot study aims to analyze the effects of the presence and absence of initial in-person contact and written feedback in RE&CBT e-supervision, comparing it on the Supervisory Working Alliance Inventory, the Supervisor Satisfaction Questionnaire, and the Trainee Disclosure Scale. During a period of six months, five supervisees performed ten e-supervision divided into two groups, a control group that did only the initial meetings in-person and an experimental group in which two supervisees completed whole process online. Additionally, in the first five e-supervision, the supervisor reviewed an entire session with written feedback with an additional meeting for each group. In the last five e-supervision, the supervisor only partially reviewed client sessions during supervision. After ten e-supervision, an individual post-interview was conducted with each participant. This study's primary statistical method for calculating and combining effect sizes was Tarlow Baseline Corrected Tau and Open Meta Analyst software. Both groups scored above average on the first two scales, but the disclosure scale had highly irregular and inconsistent patterns. The combined qualitative and quantitative results suggest that novice therapists generally prefer to have their entire sessions reviewed with written feedback and that a single in-person contact is unlikely to influence e-supervision satisfaction and working alliance. Given that there are no adequately validated e-supervision models, this pilot study used a pilot model named Supported Model of Electronic Supervision (SMeS). This model showed potential, but it needs further testing on a larger sample with more clearly operationalized steps. This study experimentally supports the effectiveness of RE&CBT supervision for the first time.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10942-023-00505-2.

Online clinical supervision in couple and family therapy: A scoping review

Online clinical supervision, or telesupervision, is a growing practice in couple and family therapy. This scoping review aims to identify and synthesize the existing body of knowledge regarding the utilization, experiences, and perceptions of telesupervision among the couple and family therapists and to highlight gaps in the literature. The review followed the five-step approach proposed by Arksey et al. (2005). Fifteen articles were included and their analysis yielded four themes: 1. telesupervision competence; 2. setting and boundary management; 3. advantages of telesupervision; and 4. challenges of telesupervision. Our review clearly demonstrates the dearth of available conceptual and empirical work. The rapidly growing use of online therapy and telesupervision in couple and family therapy has created a critical need to expand this body of knowledge by collecting evidence that can later be translated into practice. Moreover, we identified several gaps in the existing body of knowledge, including a lack of reports on the efficacy of telesupervision and on the experiences, processes, and ascribed meanings of the supervisors and supervisees. We also noted a lack of practice and ethical guidelines for telesupervision. We conclude our analysis by suggesting areas and directions for further investigation.

A rapid review of the impact of COVID-19 on clinical supervision practices of healthcare workers and students in healthcare settings

AIMS

To synthesize available data on the impact of the COVID-19 pandemic on clinical supervision practices of healthcare workers and students in healthcare settings.

DESIGN

A quantitative rapid review of the literature.

DATA SOURCES

A search of MEDLINE, Embase, PsycINFO, the Cochrane Library and Scopus for English language papers published between December 2019 (initial onset of the pandemic) to March 2021.

REVIEW METHODS

Using the World Health Organization and Cochrane guidelines for rapid reviews, following an identification of relevant papers and data extraction, a narrative synthesis approach was used to develop themes.

RESULTS

Eight studies met the inclusion criteria. Four themes identified from data synthesis were nature and extent of disruptions to clinical supervision, unmet need for psychological support, supervisors also need support and unpacking telesupervision. Findings highlight the extent and nature of disruption to clinical supervision at the point of care. Further information on factors that facilitate high-quality telesupervision have come to light.

CONCLUSION

The COVID-19 pandemic has placed tremendous burden on healthcare workers compromising their own health and well-being. It is essential to restore effective clinical supervision practices at the point of care, so as to enhance patient, healthcare worker and organizational outcomes into the post-COVID-19 pandemic period.

IMPACT

This review has provided initial evidence on the adverse impacts of the COVID-19 pandemic on clinical supervision of healthcare workers and students at the point of care. Available evidence indicates the urgent need to restore effective and high-quality clinical supervision practices in health settings. The review has highlighted a paucity of studies in this area, calling for further high-quality studies.

Experience of a telehealth and education program with maternal and perinatal outcomes in a low-resource region in Colombia

INTRODUCTION

Maternal morbidity and mortality rates associated with perinatal care remain a significant public health concern. Rural populations from low and middle-income countries have multiple barriers to access that contribute to a lack of adherence to prenatal care, and high rates of maternal mortality and morbidity. An intervention model based on telehealth and education was implemented between a tertiary high complex care hospital and a second-level hospital from a limited source region.

OBJECTIVES

We sought to identify an association in maternal and perinatal care quality indicators after implementing a model based on telehealth and education for patients with obstetric emergencies between two hospitals in a southwestern region of Colombia.

METHODS

We conducted an ecological study between 2017 and 2019 to compare before and after obstetric emergency care through telemedicine from a secondary care center (Hospital Francisco de Paula Santander-HFPS) to the referral center (Fundación Valle del Lili-FVL). The intervention included verification visits to determine the installed capacity of care, a concerted improvement plan, and on-site educational training modules in obstetric and perinatal care.

RESULTS

There were 102 and 148 patients treated before and after telemedicine implementation respectively. Clinical indicators after model implementation showed a reduction in perinatal mortality of 29%. In addition, a reduction in the need for transfusion of blood products due to postpartum hemorrhage was observed as well as the rate of eclampsia.

CONCLUSIONS

Implementing a model based on telehealth and education between secondary and tertiary care centers allowed the strengthening of the security of care in obstetric emergencies and had a positive effect on perinatal mortality.

Title-blended supervision models for post-graduate rural generalist medical training in Australia: an interview study

BACKGROUND

Expanding rural training is a priority for growing the rural medical workforce, but this relies on building supervision capacity in small towns where workforce shortages are common. This study explored factors which support the use of blended supervision models (consisting of on- and offsite components) for postgraduate rural generalist medical training (broad scope of work) in small rural communities.

METHODS

Data were collected between June and August 2021 through semi-structured, in-depth interviews with medical training stakeholders experienced in blended supervision models for rural generalist training. Interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic analysis process.

RESULTS

Fifteen participant interviews provided almost 13 h of audio-recorded data. Four themes were developed: governance, setting, the right supervisor and the right supervisee. Blended supervision models may be effective if selectively applied including where the model is well-planned, the setting has local team supports and supervisor and supervisee characteristics are appropriate.

CONCLUSIONS

Understanding factors involved in the application of blended supervision models can help with expanding rural generalist training places in distributed communities. Blended supervision models can be effective for rural generalist training if the model is planned, and the context is suitable.

Impact of the COVID-19 pandemic on medical student placements in rural Queensland: A survey study

Objective

The COVID‐19 pandemic has adversely impacted medical students' learning experiences. Students in one Australian Rural Clinical School were surveyed to investigate the impact of disruptions to clinical placements and satisfaction with educational changes implemented as a result of the pandemic.

Design

Cross‐sectional survey.

Setting

The University of Queensland Rural Clinical School.

Methods

Students undertaking one or two years of study at the participating Rural Clinical School in November 2020.

Main outcome measure

A 20‐item anonymised survey with questions on personal health and safety, quality of clinical training experience, response to changes in learning and student environment, and progression to completion of the medical degree.

Results

The survey was completed by 124 students (76% response rate). Students were satisfied with the changes made to their learning to accommodate the disruptions to health service delivery and placements. Final year students were more satisfied with their learning experiences compared to their third‐year counterparts.

Conclusions

The Rural Clinical School implemented a range of academic and psychological support strategies which appear to have helped with mitigating mental health concerns experienced by students completing rural placements, who are already prone to experiencing social isolation. Strengthening communication between the academic and health service sectors can improve the quality of learning for medical students on placements.

Effectiveness of allied health clinical supervision following the implementation of an organisational framework

Background

Clinical supervision makes an important contribution to high quality patient care and professional wellbeing for the allied health workforce. However, there is limited research examining the longitudinal implementation of clinical supervision for allied health. The aim of this study was to determine the effectiveness of clinical supervision for allied health at a regional health service and clinicians’ perceptions of the implementation of an organisational clinical supervision framework.

Methods

A cross-sectional study was conducted as a phase of an overarching participatory action research study. The Manchester Clinical Supervision Scale (MCSS-26) tool was used to measure clinical supervision effectiveness with additional open-ended questions included to explore the implementation of the clinical supervision framework. MCSS-26 findings were compared with an initial administration of the MCSS-26 5 years earlier. MCSS-26 data (total scores, summed domain and sub-scale scores) were analysed descriptively and reported as mean and standard deviation values. Differences between groups were analysed with independent-samples t-test (t) and one-way between groups ANOVA.

Results

There were 125 responses to the survey (response rate 50%). The total MCSS-26 score was 78.5 (S.D. 14.5). The total MCSS-26 score was unchanged compared with the initial administration. There was a statistically significant difference in clinical supervision effectiveness between speech pathology and physiotherapy (F = 2.9, p = 0.03) and higher MCSS-26 scores for participants whose clinical supervisor was a senior clinician and those who chose their clinical supervisor. Seventy percent of participants perceived that the organisation’s clinical supervision framework was useful and provided structure and consistent expectations for clinical supervision.

Conclusions

Clinical supervision was effective for allied health in this regional setting and clinical supervision effectiveness was maintained over a 5 year period. The implementation of an organisational clinical supervision framework may have a positive effect on clinical supervision for some professions.

Effect of a model based on education and teleassistance for the management of obstetric emergencies in 10 rural populations from Colombia

Introduction

Pregnant women and health providers in rural areas of low-income and middle-income countries face multiple problems concerning high-quality obstetric care. This study was performed to identify changes in maternal and perinatal indicators after implementing a model based on education and telecare between a high-complexity hospital in 10 low-complexity hospitals in a southwestern region of Colombia.

Methods

A quasiexperimental study with a historic control group and without a pretest was conducted between 2017 and 2019 to make comparisons before and after obstetric emergency care through the use of teleassistance from 10 primary care centers to the referral center (Fundación Valle del Lili, FVL).

Results

A total of 470 patients were treated before teleassistance implementation and 154 patients were treated after teleassistance implementation. After program implementation, the maternal clinical indicators showed a 65% reduction in the number of obstetric patients who were referred with obstetric emergencies. The severity of maternal disease that was measured at the time of admission to level IV through the Modified Early Obstetric Warning System score was observed to decrease.

Conclusion

The implementation of a model based on education and teleassistance between low-complexity hospitals and tertiary care centers generated changes in indicators that reflect greater access to rural areas, lower morbidity at the time of admission, and a decrease in the total number of emergency events.

Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond

The COVID-19 pandemic drove rapid and widespread uptake of telepractice across all aspects of healthcare. The delivery of dysphagia care was no exception, with telepractice recognized as a service modality that could support social distancing/infection control, overcome service delivery challenges created by lockdowns/service closures, and address consumer concerns about attending in-person appointments. Now, almost two years since most services first rapidly deployed telepractice, it is time to reflect on the big picture, and consider how telepractice will continue as a service option that is sustained and integrated into mainstream dysphagia care. It is also timely to consider the research agenda needed to support this goal. To this end, in this paper we present 4 discussion topics, which raise key considerations for the current and future use of telepractice within adult and pediatric dysphagia services. These are (1) Dysphagia services must meet consumer and service needs; (2) Aspects of dysphagia services can be safely and reliably provided via telepractice; (3) Telepractice can be used in flexible ways to support the delivery of dysphagia services; and (4) Providing quality dysphagia services via telepractice requires planned implementation and evaluation. Then directions for future research are discussed. These considerations are presented to help shift perspectives away from viewing telepractice as simply a COVID-19 "interim-care solution". Rather, we encourage clinicians, services, and researchers to embrace a future of "integrated care", where traditional dysphagia services are combined with telepractice models, to enhance the quality of care provided to our clients.

Hospital nurses' experiences of assessing health status changes in stem-cell transplanted patients in home care: A qualitative study

AIMS AND OBJECTIVES

To explore hospital nurses' experience assessing changes in the health status of stem-cell transplanted patients in home care (HC).

BACKGROUND

Stem-cell transplanted patients in HC are treated at home instead of in hospital wards. Hospital nurses visit patients daily and play a key role in assessing the patients' health status. Previous studies on HC for stem-cell transplanted patients focus mainly on safety in HC versus hospital care. No studies regarding nurses' experience assessing patients' health status at home when patients undergo stem-cell transplantation were found.

DESIGN

Qualitative study with an explorative design.

METHODS

Data were collected via 14 individual semi-structured interviews with hospital nurses working with stem-cell transplanted patients in HC. Data were analysed using systematic text condensation. The reporting of the study was guided by the COREQ checklist.

RESULTS

Three categories emerged from the data analysis: 1) Effective communication and clinical intuition enhances the assessment of patients' general health condition; 2) It is challenging to rely on one's own judgment in remote assessment; and 3) There are key facilitators in performing remote clinical assessments.

CONCLUSIONS

Effective communication and clinical intuition enhanced the assessment of patients' general health conditions. The lack of physical presence during remote assessments made using clinical intuition in the assessment process difficult. Experience with hematopoietic stem-cell transplantation was seen as important to facilitate accurate remote clinical assessments.

RELEVANCE TO CLINICAL PRACTICE

Nurses with responsibility for hospital at-home telephone care should receive training in remote communication and should shadow hospital at-home nurses during in home visits to gain experience assessing patients' health status. Telehealth aspects such as videoconferencing and remote patient monitoring should be considered for more accurate remote assessment. This could potentially result in more effective assessments and reduced readmissions and could promote nurses' confidence in their assessments.

Evaluating the Use of Telepractice for Bottle-Feeding Assessments

There is currently limited evidence supporting the use of telepractice to conduct bottle-feeding assessments. This study aimed to investigate the inter-rater reliability of bottle-feeding assessments conducted via synchronous telepractice (real-time videoconferencing). Secondary aims were to investigate parent and clinician satisfaction. Bottle-feeding skills of 30 children (aged 1 month-2 years) were simultaneously assessed by a telepractice SP (T-SP) at a remote location and an in-person SP (IP-SP) at the family home. A purpose-designed assessment form was used to evaluate: (1) developmental level (screen only), (2) state, color, and respiration, (3) oral motor skills, (4), infant oral reflexes, (5) tongue tie (screen only), (6) non-nutritive suck, (7) bottle-feeding, (8) overall feeding skills and (9) recommendations. Results of the T-SP and IP-SP assessments were compared using agreement statistics. Parents reported perceptions of telepractice pre and post session, and also rated post-session satisfaction. The telepractice SP completed a satisfaction questionnaire post-appointment. The majority of assessment components (45/53, 85%) met the agreement criteria (≥80% exact agreement). Difficulties were noted for the assessment of palate integrity, gagging during non-nutritive suck assessment, and 6 components of the tongue tie screen. Parent and clinician satisfaction was high; SPs reported that they would offer telepractice services to 93% of families again in the future. Overall, the results demonstrated that most components of a bottle-feeding assessment could be reliably completed via synchronous telepractice in family homes. However, further research is required to improve the reliability of some intra-oral assessment components.

Supporting the Mental Health Workforce During and After COVID-19

The COVID-19 pandemic has catalyzed structural changes in the public mental health sector, including a shift to telehealth and telesupervision, financial strain for community mental health organizations and clinicians, and risk of burnout among clinicians and staff. This Open Forum considers how technical assistance organizations have supported community mental health providers in adapting to these changes. Moving forward, knowledge gained through this work can help to build the body of practice-based evidence to inform future technical assistance activities in a postpandemic world.

Speech pathology service enhancement for people with head and neck cancer living in rural areas: Using a concept mapping approach to inform service change

BACKGROUND

Speech pathology (SP) services provide swallowing and communication intervention to people with head and neck cancer (HNC) across the continuum of care. However, difficulties exist with access and delivery of services in rural areas. The study aim was to identify actionable goals for SP change, utilizing a concept mapping approach.

METHODS

Eleven SP staff from two regional/remote services completed the concept mapping process. Multivariate analysis and multidimensional scaling were used to develop a final set of prioritized goals for change.

RESULTS

Between the two participating health services, 30 actionable goals were identified within the "green-zone" on the go-zone graph of importance and changeability. Among the most highly rated areas for change was the need to deliver and receive more support for training, mentoring, and supervision to consolidate skills.

CONCLUSIONS

This methodology enabled identification of prioritized, actionable changes to improve SP services for people with HNC living in regional/remote areas.

Group clinical supervision for allied health professionals

OBJECTIVE

To evaluate a group clinical supervision program for allied health professionals in a regional health service.

DESIGN

This study used a mixed-methods design including a cross-sectional, quantitative survey of group clinical supervision participants and a focus group of facilitators.

SETTING

A large regional health service in Victoria, providing hospital, community and mental health services.

PARTICIPANTS

Allied health professionals and managers employed at the health service.

INTERVENTIONS

Group clinical supervision, based on a critical reflection model, was implemented in 3 settings.

MAIN OUTCOME MEASURE

The Clinical Supervision Evaluation Questionnaire was administered to group clinical supervision participants, with additional open-ended questions included. The Clinical Supervision Evaluation Questionnaire tool consists of 3 subscales relating to the purpose, process and impact of group clinical supervision. A focus group was used to capture the perspectives of group clinical supervision facilitators.

RESULTS

Fifteen survey responses were received. The overall Clinical Supervision Evaluation Questionnaire score was 56.53 (standard deviation 7.66). Scores for the Process Subscale were higher than the Purpose and Impact subscales. Themes from the open-ended survey questions included the following: value of multiple perspectives, opportunities for reflection, peer support and group process and structure. Themes from group facilitators' focus group included the following: need for group clinical supervision, value of facilitator training and support, and sustainability.

CONCLUSION

Group clinical supervision was perceived to be effective, enhancing reflection, learning and peer support. Organisational support, facilitator training, group structure and planning for sustainability were identified as critical factors for success. Interprofessional and cross-organisational models of group clinical supervision are strategies that could help address issues relating to access to quality clinical supervision for rural allied health professionals.

'Steep learning curves' to 'Smooth Sailing': A reappraisal of telegenetics amidst the COVID-19 pandemic

The COVID-19 pandemic has pushed medical providers to trial telemedicine on a scale that lacks precedent. In genetic medicine, nearly overnight genetics providers were asked to transition to telemedicine platforms, irrespective of their previous experience with these modalities. This push to telegenetics prompted a reappraisal of the practice, as genetics providers learned firsthand about the feasibility, benefits, and drawbacks of telegenetics and telesupervision, all of which raise questions about the potential incorporation of these platforms beyond the pandemic. Adding to nascent literature on the transition to telegenetics amidst the COVID-19 pandemic, we aimed to evaluate provider experiences and preferences with respect to telegenetics through qualitative semi-structured interviews with genetics providers. Nineteen providers from seven institutions participated in a semi-structured interview focused on the rapid shift to telegenetics, the benefits and drawbacks of the practice, experiences supervising students on virtual platforms, and providers' preferences. We employed a qualitative methodology so that providers working across diverse subspecialties could expand upon previously reported benefits and drawbacks. Qualitative data revealed the nuanced benefits of telegenetics which included overcoming geographic, spatial, and temporal barriers to care as well as greater involvement of patients' family members in sessions. In addition, the data indicated drawbacks related to additional tasks such as completing paperwork electronically and facilitating the collection of specimens from patients' homes. Interviews with providers from different subspecialties revealed how telegenetics may be uniquely useful for particular subspecialties, patient populations, or clinics for whom the aforementioned barriers are more significant. Providers reported that telesupervision made the provision of feedback to students more cumbersome and identified a number of methods for enriching the telesupervision experience. In keeping with previous research, most genetics providers appraised telegenetics as a valuable addition to patient care (68%, N = 13) and hoped to offer it as an option beyond the pandemic (63%, N = 12).

Models of remote professional supervision for psychologists in rural and remote locations: A systematic review

Introduction

Psychology workforce shortages in geographically rural or remote contexts have highlighted the need to understand the supervisory experiences of psychologists practising in these locations, and the models of supervision employed to support their practice and improve client safety.

Objective

To review the models of remote professional supervision and the supervisory experiences of psychologists practising in rural and remote locations.

Design

Using the Joanna Briggs Institute methodology for mixed‐methods systematic review, 8 health and education databases were searched using keyword and subject heading searches.

Findings

The initial search identified 413 studies. A full‐text review identified 4 papers that met the inclusion criteria and were subjected to a methodological appraisal by 2 reviewers. Three studies included qualitative data, with 2 using transcribed interviews. Two studies reported quantitative data, with only one study including a statistical analysis of the outcomes.

Discussion

The results for the efficacy of the current models of remote supervision being used within the allied health and psychology professions are limited, with methodological limitations cautioning generalisability of results. The experiences of psychologists engaged in remote supervision do not appear to have changed over the past decade despite technological advances.

Conclusions

Quality professional supervision is critical for the sustainability of the psychology workforce in rural and remote locations, reducing professional isolation, and for improved patient outcomes. This review identified a need for improved evidence for remote supervision models for psychologists working in geographically rural and remote locations. Lessons can be learned from other health professions’ models of remote supervision.

Distant supervision of trainee emergency physicians undertaking a remote placement: A preliminary evaluation

OBJECTIVE

Clinical supervision is an essential part of post-graduate medical training. The current study investigated emergency medicine trainees' experiences and preferences regarding distant supervision via information and communication technology (ICT).

METHODS

Four emergency medicine trainees completed a 6-month placement, one at a time, at a rural urgent care centre. Trainees were remotely supervised by emergency physicians located at another ED using ICT. Trainees recorded the frequency and content of their distant supervision experiences. Trainees also completed semi-structured interviews before and after the placement to describe their experiences and preferences regarding distant supervision. Quantitative data were analysed descriptively using counts and proportions. Qualitative data were analysed using the principles of thematic analysis.

RESULTS

Trainees provided care to 1458 patients and communicated with a supervisor for 126 (8.6%) patients. Phone or audio-visual ICT was used for 111 (88.1%) and 12 (9.5%) patients, respectively. Trainees described the placement as a unique learning experience that demanded independent practice, enhanced their communication and leadership skills and increased their confidence. The trainees also described disadvantages to the placement such as reduced quality and quantity of communication with supervisors, ICT failure and the supervisor's inability to provide hands-on assistance. Trainees provided their perspectives on the essential requirements of a successful remote placement that involved distant supervision.

CONCLUSIONS

According to trainees, distant supervision had positive and negative effects on their supervision experiences, professional development and on patient management. Trainees used ICT infrequently. The trainee's perspectives on the ideal components of a remote placement programme are presented.

Terapia On-line com Casais e Famílias: Prática e Formação na Pandemia de Covid-19

Resumo A pandemia de Covid-19 potencializou o já emergente processo de intensificação das conexões virtuais. Para terapeutas de casal e família, essa grave crise de saúde pública acarretou mudanças na forma de atender clientes e interagir com colegas, exigindo a rápida transição da modalidade presencial para a modalidade remota, em muitos casos. O presente estudo sistematizou conhecimentos sobre terapia on-line com casais e famílias, trazendo considerações para a prática e a formação profissional diante da pandemia. Por meio de revisão narrativa da literatura, foram sumarizados resultados de estudos empíricos, bem como recomendações sobre aspectos técnicos, éticos e formativos. Destacaram-se, em particular, potencialidades e desafios para a utilização de tecnologias da informação e da comunicação na prática clínica com casais e famílias, incluindo indicações e contraindicações, recursos mais apropriados e seguros, relação terapêutica on-line, capacitação e supervisão. Entende-se que a Covid-19 representa uma oportunidade para revisão e reflexão da prática clínica e da formação profissional de terapeutas de casal e família no Brasil, país em que as intervenções on-line permaneciam relativamente pouco exploradas até a pandemia.

Debriefing about the challenges of working in a remote area: A qualitative study of Australian allied health professionals' perspectives on clinical supervision

Background

The benefits of clinical supervision are more pronounced for health professionals in rural and remote areas. Most clinical supervision studies to date have occurred in metropolitan centres and have used the survey methodology to capture participant experiences. There is a lack of qualitative research that captures participants’ lived experiences with clinical supervision at the frontline.

Methods

Participants were recruited from rural and remote sites of two Australian states using a purposive maximum variation sampling strategy. Data were collected through individual, semi-structured interviews with participants. Data were analysed using content analysis and themes were developed. Sixteen participants from six professions completed the interviews.

Results

Eight themes were developed including the content of supervision, context of supervision, value of supervision, increased need for professional support and unique characteristics of rural and remote clinical supervision.

Conclusions

This study has highlighted the value of clinical supervision for the rural and remote health professional workforce. Furthermore, it has shed light on the unique characteristics of clinical supervision in this population. This information can be used by organisations and health professionals to ensure clinical supervision partnerships are effective thereby enhancing rural and remote workforce recruitment and retention.

Factors that contribute to high-quality clinical supervision of the rural allied health workforce: lessons from the coalface

Objective The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results Supervisee’s work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic? There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add? This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners? Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice.