Clinical supervision among family physicians: prevalence, needs, and attitudes

The Teacher, the Assessor, and the Patient Protector: A Conceptual Model Describing How Context Interfaces With the Supervisory Roles of Academic Emergency Physicians

OBJECTIVES

Emergency medicine is a fast-paced specialty that demands emergency physicians to respond to rapidly evolving patient presentations, while engaging in clinical supervision. Most research on supervisory roles has focused on the behaviors of attending physicians, including their individual preferences of supervision and level of entrustment of clinical tasks to trainees. However, less research has investigated how the clinical context (patient case complexity, workflow) influences clinical supervision. In this study, we examined how the context of the emergency department (ED) shapes the ways in which emergency physicians reconcile their competing roles in patient care and clinical supervision to optimize learning and ensure patient safety.

METHODS

Emergency physicians who regularly participated in clinical supervision in several academic teaching hospitals were individually interviewed using a semi-structured format. The interviews were transcribed and analyzed using a constructivist grounded theory approach.

RESULTS

Sixteen emergency physicians were asked to reflect on their clinical supervisory roles in the ED. We conceptualized a model that describes three prominent roles: teacher, assessor, and patient protector. Contextual features such as trainee competence, pace of the ED, patient complexity, and the culture of academic medicine influenced the extent to which certain roles were considered salient at any given time.

CONCLUSIONS

This conceptual model can inform researchers and medical educators about the role of context in accentuating or minimizing various roles of emergency physicians. Identifying how context interfaces with these roles may help design faculty development initiatives aimed to navigate the tension between urgent patient care and medical education for emergency physicians.

Witnesses in the consultation room - Experiences of peer group supervision

BACKGROUND

In Denmark group supervision for general practitioners is an established part of continuing professional development. Several different approaches are used, including Balint Groups and Bendix Groups. The aim of this paper is to describe the benefits and challenges of a peer group supervision model with the role of supervisor taken by group members in turn. The setting was a group of general practitioners using a patient-centred consultation model and video-recordings of consultations.

METHODS AND MATERIAL

As part of a larger study the first author studied this long-established group by observing three group sessions over a period of six months. She conducted two individual, semi-structured interviews with each general practitioner who presented consultations at the observed sessions, and held a group interview with the entire group at the end of the observation period. The interviews were recorded digitally and transcribed verbatim. The data were analysed using systematic text condensation.

RESULTS AND CONCLUSION

Participation seemed to improve communication skills and the ability to take a more patient-centred approach. It increased job satisfaction and prevented burnout. A non-judgemental environment, respect and acknowledgement of all participants were important for developing confidence and for supporting personal and professional development.

Family physician experiences with and needs for clinical supervision: Associations between work experiences, professional issues and social support at work

OBJECTIVE

To explore how work experiences, professional issues and social support at work are associated with a need for clinical supervision (CS) among family physicians (FP).

METHODS

Web-based survey to FPs in Finland 2011 (response rate 68%; n=165).

RESULTS

Among FPs, 36% needed CS, 35% had experience with CS, and 29% did not need CS. Feeling emotionally drained from work was associated with both needing and experience with CS. FPs needing CS felt callous and had committed a medical error in the recent past more often than those with CS experience. FPs expressing a need for CS felt greater uncertainty regarding their professional knowledge and more alone at work than FPs not needing CS. Rewarding work experiences were common.

CONCLUSIONS

A large proportion of FPs expressed a need for CS. Need for CS is associated with feeling alone at work, experiences of callousness and uncertainty regarding medical knowledge. Experience of emotional drainage was associated with experience of and need for CS.

PRACTICE IMPLICATIONS

Emotional drainage may signal a need for CS among FPs. CS might enhance FPs' emotional well-being at work. It should be more widely available to FPs and could be integrated into continuing professional development.